Micro 1-Liners Digestive System & Hepatitis

Front 1

1. Causative agent of nausea, vomiting (onset < 6 hr) after eating cold cuts, or potato salad, or mayonnaise, or custards?

Back 1

Staphylococcus aureus

Front 2

2. Rapid-onset food poisoning is mediated by what component of staphylococcus?

Back 2

Enterotoxin

Front 3

3. Tx of staphylococcal food poisoning?

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Rehydration

Front 4

4. Microbial cause of nausea and vomiting, +/- diarrhea (onset < 6 hr) after eating reheated rice?

Back 4

Bacillus cereus

Front 5

5. Bacterial spores are resistant to heat due to what component?

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dipicolinic acid core

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6. Microbial cause of nausea, vomiting, watery diarrhea w/ rapid (onset >6 hr) after eating reheated meat or gravy?

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Clostridium perfringens

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7. Most likely cause of persistent dyspepsia in a pt not receiving NSAIDs is

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Helicobacter pylori

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8. Increased risk of gastric adenocarcinoma and MALT lymphoma

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H. pylori colonization

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9. Indications to treat H. pylori-associated PUD

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Presence of organism

Front 10

10. Standard first-line abx for PUD due to H. pylori is

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PPI + clarith + amox

Front 11

11. Cause of acute onset of diarrhea with rice-water stools, vomiting, dehydration during travel to South America

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Vibrio cholerae

Front 12

12. Pathophysiology of cholera is due to what mechanism?

Back 12

A-B toxin causes ↑ cAMP

Front 13

13. Cholera pathogen is isolated from stool by culture on selective medium called

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thiosulfate-citrate-buffered sucrose (TCBS) agar

Front 14

14. The comma-shaped cholera organisms are microscopically similar to

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Campylobacter

Front 15

15. Tx of cholera involves

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Rehydration (tet in severity)

Front 16

16. Secretory diarrhea, fever and vomiting during travel are caused by

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Enterotoxic E. coli

Front 17

17. Secretory diarrhea w/ fatty, foul-smelling stools in campers, hikers; also day-care outbreaks is caused by

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Giardia lamblia

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18. Following ingestion of 15-25 cysts, excysted trophozoites adhere at brush border of enterocytes and contribute to malabsorption. TOW?

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Giardiasis

Front 19

19. Dx of giardiasis is confirmed by

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Stool antigen (+)

Front 20

20. Giardiasis is specifically treated with

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Metronidazole

Front 21

21. Protracted, secretory diarrhea w/ large fluid loss in AIDS is caused by (clue: acid-fast organisms)

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Cryptosporidium >> Cyclospora > Isospora

Front 22

22. Frank bloody diarrhea, after eating undercooked meats or drinking fruits drinks, is caused by prepared foods or water, contaminated w/

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E. coli O157:H7

Front 23

23. Pathogenesis of hemorrhagic enterocolitis caused by E. coli involves

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Shiga toxin (a cytotoxin)

Front 24

24. Complication of hemorrhagic enterocolitis in children

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hemolytic uremic syndrome

Front 25

25. Profuse diarrhea, fever, vomiting, and dehydration in infants is caused by

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Rotavirus

Front 26

26. Mechanism of rotaviral diarrhea involves

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Villus destruction

Front 27

27. Infantile watery diarrhea and fever are caused by

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Adenovirus 40,41

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28. Outbreak of nausea, vomiting, fever in adults is caused by

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Norovirus

Front 29

29. Cause of nausea/vomiting, abdominal cramps, diarrhea +/- bloody 12-48h after eating eggs or poultry or peanut butter?

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Non-typhoidal Salmonella

Front 30

30. Abx treatment in acute gastroenteritis due to Salmonella spp. is not warranted to avoid

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carrier (in bile ducts) state

Front 31

31. Abx used only to treat septic phase of salmonella gastroenteritis is

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ciprofloxacin

Front 32

32. Cause of fevers (>103°), headaches; macular rash on torso (“rose spots”) abdominal pain and little diarrhea later; PE: bradycardia; hepatosplenomegaly (+/-) in a pt with hx of travel (to tropics)?

Back 32

Salmonella typhi

Front 33

33. Cause of diarrhea w/ occult blood, abdominal cramping and fever, 2d after ingestion of poultry-contaminated salad

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Campylobacter jejuni

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34. Abx to treat campylobacter enteritis with high fevers in pregnancy, and HIV is

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Erythromycin

Front 35

35. Cause of dysentery-like illness with fever + abdominal cramps, tenesmus + blood & mucus in children?

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Shigella sonnei

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36. Dysentery due to invasive Shigella spp. in elderly is treated with

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Ciprofloxacin

Front 37

37. Cause of dysentery-like illness (+/- pseudoappendicitis or pseudo-crohn syndrome) in the northern region after eating cheese

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Yersinia enterocolitica

Front 38

38. Cause of dysentery-like illness in a patient w/ hx of broad-spectrum abx use

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Clostridium difficile

Front 39

39. Clostridium difficile-associated diarrhea (CDAD) is mediated by toxins

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A (enterotoxin) + B (cytotoxin).

Front 40

40. Lab confirmation of CDAD does not require stool Cx, but is based on

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EIA for stool toxins A or B

Front 41

41. Besides rehydration and cessation of inciting meds, CDAD is treated with

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Metronidazole (mild) or oral vancomycin (severe/relapse)

Front 42

42. Health-care associated (nosocomial) spread of Clostridium difficile diarrhea and protracted outbreak is due to

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Fecal-oral and/or contact w/ environmental spores

Front 43

43. Hx of abdominal pain, tenesmus, stools with mucus + blood in a patient, who recently traveled to tropics; CBC: eosinophilia. TOW?

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Amebic dysentery

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44. Stool microscopy to confirm amebic dysentery should reveal characteristic trophozoites of Entamoeba histolytica w/

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endocytosed RBCs (distinction from luminal ameba)

Front 45

45. Rx of amebic dysentery involves

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Metronidazole + iodoquinol

Front 46

46. Abscesses in liver or peritonitis in travelers w/ or w/o hx of amebic dysentery is confirmed by

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Serology for E. histolytica

Front 47

47. A boar hunter develops dysentery after eating meat at campsite; O & P test should reveal a ciliate parasite, known as

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Balantidium coli

Front 48

48. Most likely cause of chronic abdominal pain, diarrhea; intestinal obstruction; cholangitis; liver abscess, in children

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Ascaris lumbricides

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49. Ova & Parasite test using microscopy for oval eggs (with a thick coarse shell) in stool confirms

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ascariasis

Front 50

50. A child has stomach ache, distended abdomen, poor appetite. “Pearl-colored earthworm”-like organisms in the stool. Major immune response against this infection?

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IgE

Front 51

51. DOC of ascariasis is

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Mebendazole

Front 52

52. Vomiting, cramping, diarrhea, epigastric pain, weight loss in an immigrant from developing country is caused by

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Strongyloides stercoralis

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53. DOC of strongyloidosis is

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Ivermectin

Front 54

54. Pt w/ AIDS (low CD4+ counts) develops pulmonary infiltrates (+ eosinophilia) and/or gram negative sepsis. TOW?

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Invasive strongyloidosis

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55. Weakness, fatigue, lightheadedness, dyspnea, pruritis; pallor; iron-deficiency anemia; eosinophilia (hx of outdoor activity). TOW?

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Hookworm (Necator americanas) infection

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56. Fever, periorbital edema, subconjunctival hemorrhages, muscle weakness, and rash, after eating undercooked pork (Lab: eosinophilia., ↑CPK, ↑LDH &). TOW?

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Trichinellosis

Front 57

57. Abdominal pain, bloating, altered appetite after ingestion of sushi. CBC: megaloblastic anemia; leukocytosis/eosinophilia. TOW?

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Diphyllobothriasis (fish tapeworm)

Front 58

58. Dx of tape worm infection is confirmed by

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Proglottids in stool

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59. Tape worm infections are treated with broad-spectrum agent

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Praziquantel

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60. Cause of fever, lymphadenopathy, hepatosplenomegaly in an immigrant from Africa or Orient; pt recalls wading in stagnant water. RUQ ultrasound (+); CBC: eosinophilia.

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Schistosoma mansoni (Africa) S. japonicum (Far East)

Front 61

61. Microscopy of stool in chronic stage of schistosomiasis reveals

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Large eggs with lateral spine.

Front 62

62. Chronic stage of schistosomiasis is treated with

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Praziquantel

Front 63

63. Patient with acute jaundice is HAV IgM (+); household contact should receive for prophylaxis

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Inactivated HAV vaccine

Front 64

64. Patient with jaundice for < 1 week has HBsAg (+), Anti-HBc IgM (+). TOW?

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Acute HBV infection

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65. Multiple sex partners, IDU, infants born to infected mothers are risk groups for which hepatitis virus

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HBV

Front 66

66. This is an enveloped, double stranded DNA virus w/ ss-break; transmitted by infective body fluids. TOW?

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HBV

Front 67

67. This asymptomatic man has hep serology profile of HBsAg (-), Anti-HBs (+), Anti-HBc IgG (+), Anti-HBc IgM (-). TOW?

Back 67

Resolved hepatitis B

Front 68

68. This man has jaundice and is HBsAg (+) > 6 months, Anti-HBs (-), HBeAg (+), Anti-HBc IgG (+), HBV DNA > 20,000 IU/ml. TOW?

Back 68

Chronic active hepatitis B

Front 69

69. This man has jaundice and is HBsAg (+) > 6 months, HBeAg (+) and evidence of necroinflammation. He should receive

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Peg-IFNα 2a + lamivudine (or cidofovir)

Front 70

70. This man has no jaundice, but HBsAg (+) >6 months, Anti-HBs (-), Anti-HBc IgG (+), HBeAg (-), persistently normal ALT. TOW?

Back 70

Inactive HBsAg carrier

Front 71

71. This man, at the time of annual physical exam, reveals Anti-HBs (+) and other markers are (-). TOW?

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HBV immunized

Front 72

72. Virologic confirmation of chronic jaundice in a HBV-immunized pt w/ IDU or hemodialysis is based on

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HCV RNA > HCV IgG

Front 73

73. More chronicity of HCV (than HBV) is due to immune-evasive quasispecies generated during replication (in blood) of

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error-prone HCV RNA virus

Front 74

74. Fulminant hepatitis in a patient, who has multiple sexual partners and is HBsAg (+); HBcIgM (-), can be fatal due to what?

Back 74

HDV superinfection.

Front 75

75. Cause of acute onset of jaundice, nausea, right-upper quadrant pain, hepatomegaly in pregnant women in India

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HEV