GRAM NEGATIVE RODS - GIT AND GUT

Question 1

lactose fermenter

GREEN sheen

Answer 1

Escherichia coli

Question 2

lactose fermenter
UREASE (+)
ESBL

Answer 2

Klebsiella pneumoniae

Question 3

comma-shaped
motile
OXIDASE (+)

Answer 3

Vibrio cholerae

Question 4

comma-shaped
microaerophilic
SKIRROW’S AGAR

Answer 4

Campylobacter jejuni

Question 5

comma-shaped

UREASE (+)

Answer 5

Helicobacter pylori

Question 6

LACTOSE FERMENTERS

Answer 6

KEEC

Klebsiella
Escherichia coli
Enterobacter
Citrobacter

Question 7

WATERY DIARRHEA

MONTEZUMA’s REVENGE

TRAVELLER’s DIARRHEA

Answer 7

EnteroToxigenic E. coli ( ETEC)

heat labile - inc cAMP
heat stable - inc cGMP

Question 8

bloody diarrhea, mucus, fever

INVASIVE - hemorrhagic diarrhea but WITHOUT HUS

Answer 8

EnteroInvasive E. colo (EIEC)

rare

enterotoxin

Question 9

hemorrhagic colitis
hemolytic uremic syndrome (HUS)
*microangiopathic hemolysis
*uremia
*thrombocytopenia

children, elderly

Answer 9

EnteroHemorrhagic E. coli (EHEC)/Shiga like toxin (STEC)

O157.H7

shiga like toxin/verotoxins
*(-) mammalian protein synthesis via 60s ribosomal subunit

transmitted via UNDERCOOKED MEAT (burgers etc.)

Question 10

watery diarrhea of long duration

INFANTS

DEVELOPING COUNTRIES

Answer 10

EnteroPathogenic E. coli (EPEC)

pediatric, poverty, Pinas

Question 11

persistent watery diarrhea in children and patients infected w/ HIV

Answer 11

EnteroAdherent E. coli (EAEC)

AIDS

Question 12

MCC of community acquired UTI

2nd MCC of neonatal meningitis

Answer 12

Escherichia coli

Question 13

For attachment, colonization factor, associated w/ UTI

Answer 13

E. coli

PILI OR FIMBRIAE

Question 14

Associated w/ PNEUMONIA and NEONATAL meningitis

Answer 14

capsule (K)

Question 15

27/M develops severe abdominal cramping and bloody diarrhea. Patient reports consuming rare hamburger days prior to the onset of the symptoms.
This best describes the toxin-mediated mechanism of this disease process

Answer 15

(-) of 60s ribosomal subunit – decreased protein synthesis in GI mucosal cells

Question 16

2nd MCC of gram (-) sepsis

PINK MUCOID COLONIES

Friedlander’s pneumonia

• fever, cough (productive), dyspnea
• thick and bloody sputum - CURRANT JELLY SPUTUM

Answer 16

Klebsiella pneumoniae

ALCOHOLICS

BULGING FISSURE SIGN

Question 17

Vibrio cholera is cultured on

Answer 17

Thiosulfate Citrate Bile Salts (TCBS) agar

SHOOTING STAR MOTILITY

Question 18

Vibrio cholerae

water,food

Answer 18

GASTROENTERITIS

Question 19

Vibrio parahaemolyticus

shellfish, seawater

Answer 19

gastroenteritis, wound infection, bacteremia

Question 20

V. vulnificus

shellfish, seawater

Answer 20

bacteremia, wound infection, cellulitis

Question 21

Pathogenesis (Cholera)

Answer 21

ENTEROTOXIN (CHOLERAGEN)

• increased ADP ribosylation
• increased adenylate cyclase activity
• increased cAMP
• loss of water and electrolytes

Question 22

MC presentation of cholera

Answer 22

ASYMPTOMATIC

Question 23

Watery diarrhea in large volumes (RICE WATER STOOLS)

sunken eyes, dry mouth, cold clammy skin, decreased skin turgor or wrinkled hands and feet (washerwoman hands)

Answer 23

Cholera

COMPLICATIONS

• cardiac and renal failure
• non gap acidosis
• hypokalemia

Question 24

Associated w/ H. pylori

Answer 24

gastritis
GASTRIC CANCER
gastric/duodenal ulcers

Question 25

Pathogenesis of H. pylori

Answer 25

damages GOBLET CELLS of the gastric mucosa

production of large amt of AMMONIA from urea by organisms urease

Question 26

Management of H. pylori

Answer 26

Amoxicillin
Clarithromycin
Metronidazole
Tetracycline
Bismuth compounds

Question 27

MCC of duodenal ulcers and chronic gastritis

2nd leading cause of gastric ulcer

Answer 27

Helicobacter pylori

ASSOCIATIONS:
gastric carcinoma
MALT lymphoma

Question 28

Types of PUD

Answer 28

TYPE I - body or antrum

TYPE 2 - antrum and duodenum

TYPE 3 - prepyloric

TYPE 4 - cardia

TYPE 5 - associated w/ NSAIDS; anywhere

Question 29

MCC of bacterial gastroenteritis

Causes REACTIVE ARTHRITIS - can’t pee, cant’see, can’t climb a tree

Causes ASCENDING PARALYSIS and GUILLAIN BARRE

Answer 29

Campylobacter jejuni

undercooked chicken and meat

Question 30

Antigenic cross-reactivity b/w oligosaccharides in bacterial capsule and glycosphingolipids on surface of neural tissues

Answer 30

Guillain Barre syndrome

Question 31

5 As pf Klebsiella

Answer 31

Aspiration pneumonia
Abscess in lungs and liver
Alcoholics
DiAbetics
CurrAnt jelly sputum

Question 32

20 y/o college student
(+) dysuria, frequency and urgency
sexually active

urinalysis: polymorphonuclear cells

Answer 32

E. coli

Question 33

55 y/o homeless man
(+) alcoholism
severe multilobar pneumonia

Gram stain : numerous PMN leukocytes
and gram (-) w/ capsule

lactose fermenter
very mucoid

non motile
lysine decarboxylase (+)

Answer 33

Klebsiella pneumoniae

Question 34

HIV positive man
developed acute watery diarrhea and abdominal pain w/o fever

3 days later – persistent of symptoms
(+) weight loss

A. enteroinvasive E. coli
B. Salmonella typhi
C. enteropathogenic E. coli
D. Shigella flexneri
E. Enteroaggregative E. coli

Answer 34

E. Enteroaggregative E. coli

Question 35

Heat Labile toxin of ETEC acts by

Answer 35

activation of adenyl cyclase