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23 Cards in this Set
- Front
- Back
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A 30 yr old female presents to your office with sudden onset of double vision, dry mouth and weakness. Through careful history-taking you find that his family does home-canning and they had a large meal which mostly consisted of those foods last night. Which of the following is an important characteristic of this microbe?
a. Inhibits inhibitory neurotransmitter release b. Enters the body as a pre-formed toxin c. Replicates in the body d. Consists of 2 subunits |
b. enters the body as pre-formed toxin Clostridium botulinum
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How does the pathogenesis of the microbe in question #1 differ when it presents in a baby (c.botulism)?
a. Infection is preventable with vaccines b. It causes muscle spasms instead of muscle paralysis c. The bacteria produce toxin in the intestine (not pre-formed) d. Only Cranial Nerves are affected |
bacteria produce toxinin in the intestine (not pre-formed)
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For which area of the body does C. botulinum have a preference?
a. PNS b. CNS c. Sympathetic Nervous System d. Parasympathetic Nervous System |
PNS
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What is the mechanism of action of C. botulinum?
a. Prevents Ach release from pre-synaptic nerve b. Inhibits inhibitory neurotransmitter release c. Causes demyelination of axons d. Blocks attachment of Ach on post-synaptic nerve |
prevents ACh release from pre-synaptic nerve
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A 12-yr old girl presents to the Emergency Room because of sudden fever with chills, severe headache, stiff neck and lethargy. Physical exam shows nuchal rigidity, a positive Kernig’s Sign, altered sensorium, and petechial/macular rash all over the body. She had been otherwise healthy until coming to the Emergency Room. What is the most likely etiology?
a. Streptococcus agalactiae (GBS) b. H. flu c. Streptococcus pneumonia d. Neisseria meningitidis |
Neisseria meningitis:
you really only need to know the age group; the additional symptoms of macular rash further clue you into meningococcemia |
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What do you expect to see on Gram Stain it its N.Meningitis?
a. Extracellular Gram + cocci in ‘strips’ b. Extracellular Gram – rods c. Intracellular Gram + diplococci d. Intracellular Gram – diplococci |
intracellular G - diplococci
N. Meningitis |
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What is responsible for the pathogenesis of disease in this young girl (Nieseria Meningitis)?
a. Pre-formed exotoxin ingestion b. Endotoxin released by ‘blebbing’ from membrane c. Replication of exotoxin in body d. IL-1 production |
endotoxin released by 'blebbing' from membrane remember G- = endotoxin
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What is the appropriate treatment for this young girl?
a. Steroids + Anti-pyretics b. Steroids + Anti-virals c. Steroids + Antibiotics d. Steroids + Anti-fungals |
steroids + antibiotics
steroids --> decrease inflammation while abx kill the bug |
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What do you expect to see in the CSF after lumbar puncture of this young girl (bacterial meningitis)?
Pressure Lymphs Neutros Glucose Protein: a. increased Pressure, Lymphs, and protien; decrease glucose (neutro normal) b. increase Pressure, Neutros, and Protein, decrease in Glucose, and Lymphs normal c. increase in Lymphs only |
a. fungal
b. correct (bacterial) c. viral |
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A 5-day old boy is brought to the emergency room with lethargy, fever and stiff neck. What is the first etiology that comes to mind?
a. Streptococcus agalactiae (GBS) b. Streptococcus pneumoniae c. Neisseria meningitidis d. Listeria monocytogenes |
streptococcus agalactiae (GBS)
know the etiology of each one |
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A 12-yr old boy presents to your clinic with stiffness of the jaw and inability to swallow. Through his HPI you learn that he has not received any immunizations in the last 10 years. On physical examination you find a small puncture wound in the bottom of his foot that is red, hard and swollen with pus. He states that he stepped on a rusty nail about 2 weeks ago. What is the mechanism of action of the microbe causing his jaw stiffness and inability to swallow?
a. Prevents Ach release from pre-synaptic nerve b. Inhibits inhibitory neurotransmitter release c. Causes demyelination of axons d. Blocks attachment of Ach on post-synaptic nerve |
inhibits inhibitory nt release (Clostridium tetani)
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For which area of the body does this microbe have a preference?
a. PNS b. CNS c. Sympathetic Nervous System d. Parasympathetic Nervous System |
CNS
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What type of Tetanus would this be characterized as (initial injury in the foot)?
a. Generalized b. Localized c. Cephalic d. Neonatal |
generalized
don't think it is cephalic just b.c we are only seeing symptoms in the head right now – the injury was in the foot, not the head. |
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Will his exposure protect him from future infection?
a. Yes b. No |
no
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Which of the following is NOT a characteristic of C. tetani?
a. Consists of 2 subunits b. Replicates in the body c. Ingested as a Pre-formed toxin d. Gram + ‘drumstick’ |
ingested as pre-formed toxin
(c. Botulism) |
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A 15-day old infant is brought to the Emergency Room with marked muscle rigidity and spasm. On the slightest touch or noise, spasm worsens and he develops stridor & becomes cyanotic. What do you expect in the history of the mother and infant?
a. Mother received no prenatal care b. Delivery was conducted at home c. Infant received no immunizations d. All of the above |
d – unsterile birthing technique (i.e. cut umbilical cord with dirty knife), lack of maternal immunization and lack of infant immunization – all roads lead to Neonatal tetanus!
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A 30 yr old male presents with recent-onset Altered Mental Status and you are told by his wife that yesterday, his right hand and face were moving abnormally and not under his control (focal neuro abnormalities). On Physical exam, he is clearly confused and disoriented. CT demonstrates characteristics of encephalitis seen over the Temporal lobes. What is the most likely etiology?
a. West Nile b. Rabies c. HSV1 d. HSV2 |
HSV1
temporal lobe |
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A patient presents with altered mental status, focal neuro abnormalities and has experienced some seizures recently. Without knowing the specific etiology, what do you do for the patient?
a. Administer Acyclovir b. Administer steroids c. Administer anti-pyretics d. Administer antibiotics |
administer Acyclovir
remember that HSV1 is associated with ↓morbidity/mortality when treated with Acyclovir & since it is the only treatable cause of encephalitis – just treat until you know the exact etiology |
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A 65 yr old male presents to the ER with his wife. She states that he has been ‘distant’ and has had a very flat affect for the last day. She has also noticed that he cannot even lift his coffee cup to his mouth. She started to notice a rash all over his body and decided it was time to do something about it. It is clear from PE that he has altered mental status and focal neuro abnormalities. What do you expect to hear in the HPI?
a. He recently had gastroenteritis b. He recently had a URI c. He was camping and was bit by a raccoon d. He went hiking in the forest preserve and forgot his mosquito repellant |
he went hiking in the forest preserve and forgot his mosquito repellant
this is West Nile encephalitis; Flaccid paralysis, Rash and Parkinsonian behavior all add up to the diagnosis. |
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A 14 yr old boy is brought to the ER by his mother. She states that he has had 2 seizures since this morning and ‘just has not seemed right’ the last 2 days. On physical exam you note that he has focal neuro abnormalities and parotitis. What do you expect to find upon questioning about immunization status?
a. He is up-to-date b. He has never received a meningitis vaccine c. He missed his Diptheria/Tetanus/Pertussis booster d. He has never received an MMR vaccine |
he has never received MMR vaccine
the parotitis tips you off; this is a post-infectious encephalitis |
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A 40 yr old male laboratory researcher presents with high fever, neck rigidity and drowsiness for the last few days. His history indicates that he works with animals such as hamsters, mice and rats. On physical exam you note fever, nuchal rigidity and positive Kernig’s sign. What is the expected etiology?
a. Rabies b. Lymphocytic Choriomeningitis Virus c. Coxsackie Virus d. Echovirus |
lympocytic chriomeningitis virus
the rodents tell all!! |
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A 27 yr old female presents to the ER with drowsiness, lethargy, neck stiffness, headache and fever. Through questioning, she admits to being an IV drug user and a prostitute. This combination of meningitis-like symptoms and risky behaviors puts her at an increased risk for what?
a. HSV1 b. HSV2 c. HIV d. Chlamydia |
HIV remember HIV can present as meningitis originally
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A 25 yr old male presents to your clinic for the 3rd time with symptoms of meningitis. The past 2 episodes have resolved spontaneously. At this point, you are considering that he has Mollaret’s Meningitis. What is the most likely etiology?
a. HSV1 b. HSV2 c. LCV d. HIV |
HSV2
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