intraabdominal infections

Question 1

Where in the body are you gonna find each of the bacteria below?

1. S. aureus, candida, CoNS, streptococci
2. anaerobe
3. candida, strep, anaerobes
4. H. pylori, streptococci
5. enterobacterales, enterococcus, streptococcus (EES)
6. strep pneumoniae, haemophilus, morexella, neisseria (SHMN)
7. enterobacterales, enterococcus, streptococcus, enteric anaerobes, candida (EESEC)

Answer 1

1. S. aureus, candida, CoNS, streptococci - skin
2. anaerobe - GIT
3. candida, strep, PO anaerobes - mouth
4. H. pylori, streptococci - stomach
5. enterobacterales, enterococcus, streptococcus (EES) - small intestine / biliary tree
6. strep pneumoniae, haemophilus, morexella, neisseria (SHMN) - sinus tract / upper resp tract / lower resp tract
7. enterobacterales, enterococcus, streptococcus, enteric anaerobes, candida (EESEC) - large intestine / colon

Question 2

Which of the following statements is false?
A. clostridia is a GI anaerobe
B. streptococcus appears as gram negative chains
C. candida is commonly found in the large intestine
D. lactobacillus appears as gram positive rods
E. PO anaerobes are typically treated by clindamycin
F. all of the above

Answer 2

correct: E

A. true
B. true - also, enterococcus
C. true - also, enterococcus, enterobacterales, streptococci, enteric anaerobes
D. true - also, Corynebacteria
E. false - penicillin, amoxicillin, amoxi-clav

Question 3

Which of the following are potential etiologies of intraabdominal infections?
A. opportunistic pathogens
B. translation / perforation
C. obstruction
D. exogenous pathogens
E. all of the above

Answer 3

correct: E

A.
B.
C. cholecystisis - OBSTRUCTION (usually due to gall stones) of cystic duct that traps organisms in gall bladder

Question 4

Your pt has been in the hospital for 7 days. Culture susceptibility results are pending, but you do receive a +ve result back for drug-resistant gram negative bacteria. What should you do?
A. wait until you receive culture results back before initiating tx b/c you don’t want to trigger more bacterial resistance
B. initiate empiric tx
C. initiate empiric tx as if pathogen is drug-resistant until culture results are available
D. A or C
E. none of the above

Answer 4

correct: C

Question 5

Your pt has a community-acquired intraabdominal infection. They are presenting to the ER for the first time for this event, and have not received any abx for it either. What should you do?
A. wait for culture susceptibility results return b4 initiating tx to avoid triggering bacterial resistance
B. initiate empiric tx
C. assume local susceptibility rates + initiate corresponding empiric tx
D. none of the above

Answer 5

correct: C

Question 6

Which of the following is/are not sx of cholecystitis?
A. left upper quadrant pain
B. temp > 37.5C
C. hard, abdominal lump
D. lack of jaundice
E. B and C
F. B and D
G. all are sx of cholecystitis
H. none of the above

Answer 6

correct: F

A. left upper quadrant pain - RIGHT
B. temp > 37.5C - correct (FEVER)
C. hard, abdominal lump - ABDOMINAL TENDERNESS
D. lack of jaundice - correct

Question 7

What is false about ascending cholangitis?
A. it is an obstruction of the gallbladder
B. likely pathogens include: klebsiella pneumoniae, E. coli or strep anginosus
C. causes bile to back up into the liver
D. sx include fever, abdominal tenderness and jaundice
E. A and B
F. A and C
G. C and D

Answer 7

correct: E

A. false - obstruction of common bile duct = traps organisms in biliary tree = backs up bile into liver
B. false - those are pathogens for liver abscess
C. true
D. true - also, right upper quadrant pain

Question 8

Which of the following is not a sx of cholecystitis?
A. right upper quadrant pain
B. lack of jaundice
C. tachycardia
D. abdominal tenderness
E. fever

Answer 8

correct: C

tachycardia is a sx of pancreatitis

Question 9

Which of the following is false about viral diarrhea?
A. more common in the winter
B. may be due to contaminated food or water
C. risk factor is contact with sick people
D. more common cause of diarrhea than bacterial diarrhea
E. all of the above are true

Answer 9

correct: B

A. true
B. FALSE
C. true
D. true

Question 10

Pt presenting with bloody and mucousy stool that is watery. Started 1 day ago. Has never happened before. Likely cause?
A. bacterial diarrhea
B. diverticulosis
C. viral diarrhea
D. parasitic diarrhea

Answer 10

correct: A

A. bacterial
B. diverticulosis - uh, no
C. viral
D. parasitic - chronic, recurrent

Question 11

T/F: diverticulitis pts are often asymptomatic

Answer 11

False - diverticulosis