Ipapburke Inf Dz Test 2- Diarrheas

Front 1

Chronic diarrhea is defined as…

Back 1

diarrhea >3 weeks

Front 2

Diarrhea is characterized by 3 criteria… what are they?

Back 2

Stool weight, stool liquidity, stool frequency

Front 3

Stool weight requirement for diarrhea…

Back 3

> 250gm per day

Front 4

Stool frequency requirement for diarrhea

Back 4

3/day - 2/week (this is how it's presented in the book)

Front 5

Stool liquidity requirement for diarrhea

Back 5

>80% water

Front 6

Non infectious types of diarrhea include

Back 6

Malabsorption (cystic fibrosis, celiac dz), Milk protein/lactose intolerance, IBS, Inflammatory Bowel Dz, Laxative abuse

Front 7

Infectious types of diarrhea include

Back 7

Viruses, Bacteria, Fungi, and parasitic

Front 8

What is a general description of the type of diarrhea that tends to be afebrile with abdominal cramping with watery diarrhea?

Back 8

Noninvasive toxin mediated diarrhea

Front 9

"What do you suspect has happened in the case of a bacterial induced diarrhea when the pt is febrile with ""bloody"" stool (contains both RBC's and WBC's)?"

Back 9

The bacteria has invaded the mucosa

Front 10

With Acute Gastroenteritis (AGE), how long does the diarrhea normally last?

Back 10

"Pt will have 1-5 days of ""watery"" diarrhea"

Front 11

"With ""AGE"", what normally accompanies the diarrhea? … Fever Or Nausea and Vomiting?"

Back 11

"Nausea and Vomiting normally accompanies AGE (no fever… remember ""watery"" normally does not have fever)"

Front 12

"What causes ""AGE""?"

Back 12

Any number of infections, drugs, toxins, and systemic Dzs

Front 13

Dz caused by a toxin present in food…

Back 13

Food poisoning

Front 14

Food poisoning from chemical causes (ie. Mushrooms) normally has an incubation time of…

Back 14

1-2 hrs (ultrashort)-- think chemical rxns… they happen fast

Front 15

Food poisoning from preformed toxin in the food (ie: rice) normally has an incubation time of…

Back 15

1-6 hrs (short)

Front 16

Food poisoning caused by organisms present in food (ie: clostridium) normally has an incubation time of …

Back 16

8-16 hours (this is the longest time due to the fact that the bacteria produces the toxin after the food is consumed)

Front 17

How many infants develop Acute Gastroenteritis anually?

Back 17

3.5 million

Front 18

How many adult doctor appointments does AGE account for?

Back 18

8 million

Front 19

How many hospitalizations?

Back 19

250,000 doctor appts. Annually

Front 20

Do these cases normally occur in onezies or twozies?

Back 20

No, they usually occur in outbreaks

Front 21

Traveler's Diarrhea normally affects_________ of traveler's to developing countries

Back 21

20-50%

Front 22

In the US, how many food poisoning related deaths are there, annually?

Back 22

5,000 deaths

Front 23

How many food poisoning related illnesses?

Back 23

76 million illnesses

Front 24

How many food poisoning related hospitalizations?

Back 24

325,000 hospitializations

Front 25

This organism accounts for 1 Billion in medical costs and losts work time

Back 25

Salmonella

Front 26

Causes diarrhea associated Poultry

Back 26

Campylobacter species

Front 27

Causes diarrhea associated with Oysters

Back 27

Calicivirus, Plesiomonas, and Vibrio species

Front 28

Causes diarrhea associated with Eggs

Back 28

Salmonella

Front 29

Causes diarrhea associated with Ground Beef

Back 29

Enterohemmorhagic E. Coli (EHEC)

Front 30

Causes diarrhea associated with Meats

Back 30

C. perfringens, Aeromonas, Campylobacter, and Salmonellas species

Front 31

Causes diarrhea associated with Dairy

Back 31

Campylobacter and Salmonella

Front 32

Causes diarrhea associated with Vegetables

Back 32

Aeromonas species, C. perfringens

Front 33

Countries known for Yersinia species

Back 33

Australia, Canada, Europe, and Mexico

Front 34

Countries known for Entamoeba

Back 34

Mexico, India, South and Central America, and Africa

Front 35

Countries known for Vibrio Cholera

Back 35

Africa, South and Central America, India, and Asia

Front 36

Where does C. perfringens dominate?

Back 36

Underdeveloped Tropics

Front 37

Organisms found in Mexico

Back 37

Aeromonas, Entamoeba, Plesiomonas, and Yesinia species

Front 38

Organism found in New Guinea

Back 38

Clostridium

Front 39

People who are at risk for diarrhea due to C. difficile

Back 39

the hospitalized, and people who are undergoing abx administration

Front 40

This medical condition will predispose individuals to diarrhea caused by the Plesiomonas species

Back 40

liver dz or malignancy

Front 41

These medical conditions will predispose one to diarrhea caused by the Salmonella species

Back 41

Intestinal dysmotility, malnutrition, achlorhydria, hemolytic anemia, sickle cell dz, immunosuppression, malaria

Front 42

Hospitilization in and of itself predisposes one to this virus

Back 42

Rotavirus

Front 43

Agammaglobinemia, chronic pancreatitis, achlorhydria, and cystic fibrosis predisposes one to this species

Back 43

Giardia species

Front 44

What should be the focus of the PE for diarrhea?

Back 44

Determining the severity of the diarrhea

Front 45

Tools to assess the severity of diarrhea

Back 45

Lethargy, Depressed consciousness, dry mucous membranes, sunken eyes, skin turgor, delayed cap refill, fall in BP

Front 46

When would you have a fever associated with your diarrhea?

Back 46

When there is an invasive organism involved.

Front 47

When would you have reduced muscle and fat mass

Back 47

Chronic Disease

Front 48

What are other nonspecific signs and symptoms of diarrhea?

Back 48

Nonfocal abdominal pain, cramping, borborygmi (bowel sounds), perianal erythema, fever, and reduced muscle /fat mass

Front 49

What are nonspecific tx for diarrhea?

Back 49

Oral rehydration if tolerated, IV, BRAT diet, antimotility agents (depending on the circumstance), and abx tx (not with EHEC)

Front 50

When should you suspect viral causes of diarrhea?

Back 50

normally <72hrs, vomiting is prominent, 14hr + incubation, no bacterial warning signs, no epidemiologic clues (more than one person eating at the same place, for instance)

Front 51

"Viral cause for ""multiple viral illnesses"" (the cold), and is more prolonged than Rotavirus"

Back 51

Adenovirus

Front 52

Common cause of pediatric diarrhea, and possibly associated with intusseption

Back 52

Calicivirus (also associated with Oysters)

Front 53

virus associated with cruise ships

Back 53

Norovirus (or Norwalk virus)

Front 54

Most common cause of acute gastroenteritis (AGE), vaccine not widely used, causes URI's

Back 54

Rotavirus

Front 55

Virus associated with Immunocompromised patients, possible dysentry, and benefits from anitvirals such as Ganciclor

Back 55

Cytomegalovirus

Front 56

Commonly misdiagnosed as appendicitis, associated with polyarticular arthritis, and a cause of severe cramping

Back 56

Yersinia enterolitica

Front 57

"Infection caused by toxin in the food, and causes that ""I want to die"" gastroenteritis"

Back 57

Staphylococcus aureus

Front 58

From contaminated fried rice; causes systematic movement through the GI tract

Back 58

Bacillus cereus

Front 59

Known for causing gas gangrene; mild gastrointestinal sxs

Back 59

Clostridium perfringens

Front 61

Organism that wil cause an Ill appearing pt with a diffusely tender abdomen

Back 61

Campylocbacter jejuni (associated with chickens)

Front 62

What are the major signs and symptoms of a patient infected with campylobacter jejuni?

Back 62

Psuedoappendicitis (rlq pain, the pain can be in the llq , as well), Abdominal pain (which is a differentiator from salomonella), High fever as high as 104, HA, Myalgias. 10+ water, bloody bms per day.

Front 63

The campylobacter jejuni organism is an antecedent for which neurological condition resulting in respiratory arrest?

Back 63

Guillian Barre

Front 64

Campylobacter jejuni is the most common cause of this type of enteritis

Back 64

Community-acquired inflammatory enteritis

Front 65

How is this organism transmitted?

Back 65

Food borne- Fecal/oral

Front 66

What is the most common food associated with Campylobacter, and about how many infections is it responsible for?

Back 66

Chickens account for 50-70% of infections

Front 67

What is another cause of outbreaks of campylocbacter jejuni?

Back 67

Sick pets (especially puppies)

Front 68

What is the diagnostic procedure for campylobacter?

Back 68

Stool examination (microscopic and culture in slow growing medium)

Front 69

What is the treatment for campylobacter jejuni

Back 69

"Azithromycin (most documentation states ""use a macrolide"", and Ciprofloxacin"

Front 70

How many Salmonella serovars are there?

Back 70

2,300 serovars (all grouped into a single species)

Front 71

What was the vehicle of transmission of Salmonella typhimurium as of January 25th, 2009?

Back 71

Peanuts

Front 72

As of December 2009, what was the vehicle of transmission?

Back 72

Water Frogs

Front 73

Salmonella is closely associated with what species?

Back 73

Reptiles (Salmonella from the Salamander), and birds

Front 74

How are the majority of the cases of Salmonella contracted, and what is the percentage?

Back 74

95% of cases are Food borne illnesses (eggs, cheese, poultry, and unpeeled fruit)

Front 75

Pathogenic salmonellae is also known as…

Back 75

Nontyphoidal Salmonellae

Front 76

Describe the diarrhea associated with salmonella

Back 76

loose, watery stools (no blood)

Front 77

When does diarrhea occur?

Back 77

12-36 hours after exposure

Front 78

What other sxs are associated with salmonella?

Back 78

Mild abd cramping, N+V, and rarely… choleralike with tenesmus (contracting of the anus)

Front 79

What is the dx procedure for Salmonellosis?

Back 79

Culture in MacConkey agar

Front 80

What is the treatment for Salmonellosis?

Back 80

Ciprofloxacin or Bactrim

Front 81

"Greek for ""flow of bile""

Back 81

Vibrio cholerae

Front 82

How quickly does death occur with Cholera

Back 82

Within hours of infection

Front 83

Four places where Cholera is prevalent

Back 83

Nigeria, Chad, Cameron, Pakistan

Front 84

Describe the type of diarrhea that presents with Cholera

Back 84

Painless, rice wattery, with a fish odor (followed by diarrhea)

Front 85

Is there fever associated with cholera?

Back 85

No

Front 86

Treatment for Cholera

Back 86

Supportive (fluid replacement) Abx can shorten the course: Ciprofloxacin, Doxy, Erythromycin

Front 87

Lysteria Monocytogenes is particularly dangerous for what populations?

Back 87

Pregnant, neonates, Elderly, Immunocompromised

Front 88

How is Lysteria Monocytogenes transmitted?

Back 88

Unpasteurized milk, cheese, cold cuts

Front 89

Typical adult presentation of Lysteria Monocytogenes

Back 89

non invasive diarrhea (1-3 days). Fever, myalgias, arthralgias, back pain, HA

Front 90

Typical early onset neonate presentation of Lysteria Monocytogenes

Back 90

non invasive diarrhea (1-3 days). Fever, myalgias, arthralgias, back pain, HA

Front 91

Typical late onset neonate presentation of Lysteria Monocytogenes

Back 91

Seizures, encephalitis of the brainstem, meningitis, ventriculitis, Hemiplegia, cranial deficits (CNS predilection for brain parenchyma)

Front 92

Which is more sensitive for Listeria, a blood culture or CSF Culture?

Back 92

The CSF Culture is 100%, where the blood culture is 60-75%

Front 93

What about Wet Mounts? Can they identify listeria?

Back 93

Yes. They are motile, but the CSF Culture remains DX of choice

Front 94

Is serologic testing reliable?

Back 94

no

Front 95

What about Stool cultures?

Back 95

no. They are neither sensitive or specific

Front 96

What is the treatment for listeria?

Back 96

IV Ampicillin Cat B; IV Septra Cat C

Front 97

Describe the diarrhea associated with ETEC Eschericia Coli (traveler's)

Back 97

Frequent, explosive with ocassional tenesmus

Front 98

"Where are the 4 endemic regions of ETEC where you can really get ""SLAM""med with ETEC?"

Back 98

South Asia, Latin America, Africa, Middle East (20-50% of travelers)

Front 99

How do you treat ETEC?

Back 99

"Loperamide (Immodium or any antimotility drug) plus a ""single dose"" antibiotic: Cipro or levofloxacin"

Front 100

How do you diagnose ETEC?

Back 100

Typically clinical

Front 101

How long is the incubation?

Back 101

"1 to 3 days to incubate, and 3-5 days to ""travel"" it's course"

Front 102

Is there vomiting and abdominal pain?

Back 102

Oh, but yes!

Front 103

Is there fever associated with ETEC?

Back 103

Low, but yes.

Front 104

Ecoli associated with Hamburger meat

Back 104

Enterohemmorhagic

Front 105

Name of toxin produced by EHEC

Back 105

Shiga

Front 106

Will EHEC present with vomiting?

Back 106

no, the Shiga toxin normally irritates the bowel, and downstream plumbing

Front 107

Why is EHEC so much more dangerous?

Back 107

The risk of dying from HUS

Front 108

Describe the diarrhea associated with EHEC.

Back 108

Starts off watery, ends up grossly bloody

Front 109

What serious disease is associated with EHEC?

Back 109

Hemalytic Uremic Syndrome (even though only 10% will have HUS, it is dangerous due resulting thrombocytopenia, and uremia, which may require dialysis)

Front 110

What is the definitive DX for EHEC?

Back 110

Stool Culture

Front 111

Another name for EHEC

Back 111

E Coli serotype O157:H7

Front 112

Besides a stool culture, what else can you order to diagnose EHEC?

Back 112

It's called a Sorbitol-MacConkey (SMAC) agar. This is a special test request

Front 113

How do you treat EHEC?

Back 113

NO drugs!! Abx's increase renal complications due to HUS. You can treat HUS with dialysis as needed

Front 114

What is the mortality rate of EHEC?

Back 114

3-5% of the patients who develop HUS will die

Front 115

How long does the EHEC bacteria take to incubate?

Back 115

"1-8, and 3-6 days to ""run"" it's course"

Front 116

Is there fever associated with EHEC?

Back 116

May or may not have fever

Front 117

Offending agents in Shigellosis

Back 117

Shigella sonnei and Shigella flexneri

Front 118

How many of the cases of Shigellosis are these two agents responsible for?

Back 118

90%

Front 119

What are the two mechanisms by which the Shigella species cause bacillary dysentry

Back 119

Invades the colonic epithelium, and produces enterotoxin (this doesn't cause colitis, but the enterotoxin enhances virulence)

Front 120

How many cases are there annually in the US?

Back 120

15,000

Front 121

Describe the diarrhea assoicated with Shigella?

Back 121

Acute bloody with tenesmus (of course this will accompany lower abdominal tenderness)

Front 122

How is Shigella spread?

Back 122

Fecal-oral (contaminated food/water)

Front 123

Besides blood, what else may accompany diarrhea?

Back 123

mucus (any time there is damage to the epithelial wall, there will be mucus)

Front 124

When does fever present?

Back 124

1-3 days after exposure

Front 125

What type of bowel sounds are present?

Back 125

Normal to increased bowel sounds

Front 126

What are the rare presentations of Shigella?

Back 126

Seizure in 10% of pts (due to very HIGH fever)

Front 127

What is the diagnostic test of choice?

Back 127

Stolol culture, of course. (both leukocytes and erythrocytes will be seen in the stool)

Front 128

Will anti-motility drugs help the Shigella patient?

Back 128

No, narcotic-related antidiarrheals should be avoided, and the dz allowed to run it's course.

Front 129

How do you treat Shigella?

Back 129

As was previously mentioned, this dz in usually self-limited. ABX identified as treatment as necessary is Cipro, Septra, and Rocephin

Front 130

In Typhoid fever, where is the offending agent isolated for a definitive diagnosis?

Back 130

In the blood or bone marrow

Front 131

What other lab findings might you find in Typhoid fever?

Back 131

anemia, elevated ESR and LFT's, decreased thrombocytes and lymphocytes

Front 132

Treatment for Typhoid

Back 132

Cipro and Zithro

Front 133

How long is the incubation period for Typhoid?

Back 133

7-14 days

Front 134

What is the organism that causes Typhoid fever?

Back 134

Salmonella Typhi (most common and severe form of Salmonella)

Front 135

amoung the 400 cases per year in the US, what is the most common predisposing factor?

Back 135

70% of these patients are travelers

Front 136

How many cases per year, worldwide?

Back 136

17 million

Front 137

How is Typhoid transmitted?

Back 137

Contaminated food/water with feces and urine

Front 138

What is the hallmark of Typhoid fever?

Back 138

Invasion/multiplication of mononuclear of phagocytic cells in the liver, lymph nodes, peyers patches of the illuem, and the spleen (resulting in splenomegaly)

Front 139

Because of the systemic effects of this organisms, what else is the patient at risk for?

Back 139

Systemic bacteremia

Front 140

Symptoms during the incubation period

Back 140

Asymptomatic with transient diarrhea and constipation

Front 141

Typhoid sxs during the 1st week

Back 141

HA, malaise, rising remittent fever (103-104)

Front 142

Typhoid sxs during the 2nd week

Back 142

"pink papules ""rose spots"" on the upper abd and lower chest that fade with pressure. Abdomen distends, pt is toxic looking. Splenomegaly, apathetic, sustained pyrexia. Relative bradycardia and a dicrotic pulse (double beat)"

Front 143

Sxs at third week

Back 143

Delirious, pea soup diarrhea, weak and thready pulse and tachypnea, considerable weight loss (week 2 sxs are more pronounced)- death may occur at this stage

Front 144

Sxs at 4th week

Back 144

if pt survives third week, the fever, malaise, and abdominal distension slowly resolve (intestinal sxs may still occur). Relapses occur. Convalescence is prolonged. Carrier state possible (Typhoid Mary)