BLY 213 - Exam 2 (Summer 2021)

Case 1.2: Meg's mom, upon hearing the presumptive diagnosis, declares that Meg will not return to that camp, which she loves and had planned to attend next summer. The doctor suggests that Meg need only take some precautions. How can she protect herself from getting this infection again?

Avoid ticks with repellent and protective clothing.

Case 4.8: You have a friend in your hometown that is HIV-positive. When you told her about your TB scare, she said that her specialist can't use the TB skin test, even though HIV-positive people are at higher risk than the healthy population for TB. Why is the skin test not recommended for HIV-positive people?

HIV infects T cells and destroys them, so low T cell counts could result in a false negative test

Case 4.1: What types of infections are in the differential diagnosis?

Infectious mononucleosis (Mono), Common Cold

Chemical barrier of the Skin:

- sebaceous glands-oily acidic sebum - sweat (sudoriferous) glands - salty acidic sweat - antimicrobial peptide - lysozymes disrupts peptidoglycan (sweat, tears, saliva)

Case 4.1: You are a physician's assistant at a local pediatrician's office. Five-year-old Michael is brought to the office by his father. Michael is crying and complaining that his mouth hurts. His father has been at work and does not know whether the boy has had a fever during the day. Currently, his temperature is 103°F. The physician notices that Michael's breath smells rotten. Lymph nodes in his neck are swollen and visual examination of the throat reveals a white packet adhering to the left tonsil. Much of the soft palate is red. What laboratory tests are called for?

Rapid Strep Test

Case 1.4 Are there steps the teacher should take to prevent the spread of this infection in the classroom?

Yes, it is highly contagious through hands and fomites, so the teacher should disinfect the classroom objects.

Case 1.2: Would the diagnosis be any different if Meg had attended camp in Arizona. Explain.

Yes, it is more prevalent in the Northeast US and rare in Arizona

Staphylococcus aureus is responsible for all of the following EXCEPT

acne

An intravenous drug user who develops a sudden fever, a pronounced heart murmur, a cough, and abdominal pain is admitted to the hospital. During his hospital stay, he is administered high doses of intravenous antibiotic therapy after he is found to have Staphylococcus aureus in his blood. This individual is being treated for

acute bacterial endocarditis.

The mucociliary escalator

allows materials in the bronchi to be lifted to the pharynx

Case 1.4: What is the treatment for this condition?

antibiotic eyedrops

Which of the following are used in the treatment or prevention of diphtheria?

antibiotics, vaccination, antitoxin (all of the above)

Which of the following would you expect to result in an influenza pandemic?

antigenic shift within a type A influenza virus

Which affects the lower respiratory tract, but NOT the upper respiratory tract?

atypical "walking" pneumonia

Lyme disease is characterized by all EXCEPT

caused by a flea bite

Tinea pedis is a fungal infection found where?

foot

Dermal (cutaneous) warts are caused by

human papillomavirus.

Case 3.4: What are the two main places in the human body that are exploited by the causative organism in this disease?

liver, blood cells

Koplik spots are a diagnostic indicator of

measles

The white enanthem, known as Koplik's spots, shown in the mouth of this individual is followed by the maculopapular rash shown in the image of a child's back. These signs are indicative of

measles.

Case 4.1: What are the possible sequelae of untreated sore throats?

rheumatic fever, glomerulonephritis

Which correctly matches the disease caused by Varicella-Zoster virus?

shingles-cell mediated immunity drops below a critical level

Case 4.2: What is the difference about the vaccine from year to year? Who decides what form it will take every year?

surface antigens of the envelope, the CDC decides

Case 1.1: Kate suggest that she had rubella in second grade, but the disease she described doesn't sound like rubella to you. Why not?

the illness described was too lengthy to be rubella

Case 1.4: What sign leads you to believe that the infection is bacterial in origin?

thick yellow discharge from eye

Case 1.2: How did she most likely acquire her infection?

tick bite

Which is the cause of a fungal infection on the scalp?

tinea capitis

Which of the following is the cause of a fungal infection on the scalp?

tinea capitis

P. acnes can be treated with which of the following?

topical ointments

Avoiding contact with contaminated cat feces during a pregnancy is important in preventing ________.

toxoplasmosis

Infectious mononucleosis is characterized by all of the following EXCEPT

transmitted by mosquito

What condition(s) could result from an untreated strep throat illness?

two of these are correct

A 65-year old patient presents with a localized painful dermatomal rash traveling along the sensory nerve from his shoulder to his chest. What is the course of this rash?

varicella-zoster

The paroxysmal stage of whooping cough is characterized by

violent coughing

All of the following are transmitted via the respiratory route EXCEPT A. smallpox B. chickenpox C. measles D. warts

warts

Case 4.1: Your practice has recently been overrun by sore throats and now, late in the evening, there are no supplies for performing the proper test. Should the physician prescribe antibiotics or not?

yes

Case 1.4: Is the condition communicable?

yes, it is highly contagious to others

Case 4.2: Susan wants to know why your don't have to get other vaccines annually.

Other microbes don't change their surface antigens through mutation

Physical barrier of the Eyes:

- conjunctiva (mucous membrane over eye) - cornea (transparent outer part)

Physical barrier of the Skin:

- dead epithelial cells of epidermis - dermis - keratin - thicker skin on palms and soles - calluses-thickened areas from constant wear

Normal Microflora of the Skin:

- dense in moist area and folds - sparse in dry flat areas

Case 1.4: What are some of the eye's natural defenses that help to prevent infections?

- eyelashes/eyelids provide mechanical barrier - mucus traps organisms - lysozyme in tears - tears act as flushing mechanism

Case 1.6: What are some possible reasons for the epidemic in 1989-1991?

- improperly stored vaccine was ineffective - too many were not getting vaccinated

Know the general innate defenses for each organ system (physical and chemical barriers and if there is a normal microflora/microbiota)

...

Case 1.1: When do most children in the United States receive their rubella immunization?

12-15 months old

Case 1.2: Why does the doctor ask Meg if her joints hurt?

A common sign/ symptom is pain or swelling of joints (arthritis)

Case 3.1: You are at your son's baseball game when another boy's dad experiences dizziness and nearly faints in the stands next to you. You tell him that you are a paramedic and will walk him to your car where you have your medical equipment. He reports that he has had a headache off and on since he had a tooth extracted four days ago. This evening he is feeling very weak.His blood pressure is normal. When you listen to his heart you note that he has a pronounced murmur. He reports having had rheumatic fever 15 years ago. You examine his fingernails and find one that has tiny petechial hemorrhages under it. Which cardiovascular infection condition is this?

Bacterial endocarditis

Case 1.4: Why was amputation the best solution for the infection in this case?

Because the infection is spreading up the leg too rapidly affecting more and more of the tissue.

Case 4.8: You have just been accepted into the nursing school at a local medical center. The program requires that you have a physical, which includes tuberculosis (TB) test as well as the hepatitis B recombinant vaccine series. The nurse administering the TB skin test explains that if significant swelling occurs around the injection site, you will probably have to have a chest X-ray to determine if you are infected with Mycobacterium tuberculosis. One and a half days later you wake up and look at your arm, which appears swollen in an area about the size of a quarter around the skin test. It is red and tender to the touch. You're alarmed; could you have TB? Why does the reaction take 36-48 hours to show up?

Because the skin test relies on the principle of delayed hypersensitivity

A child with a violent paroxysmal cough has an impeded mucociliary escalator. If it were possible to look at tracheal epithelial cells in this child, you would see something similar to this image. The structures attached to the cilia are

Bordetella cells.

Whooping cough is caused by ________.

Bordetella pertussis

In which of the following ways are Epstein-Barr virus (EBV) and cytomegalovirus (CMV) similar?

Both are capable of causing latent infections.

The causative agent of trachoma, which is the greatest single cause of blindness worldwide

Chlamydia trachomatis

The main causative agent of gas gangrene is

Clostridium perfringens

Case 1.4: You are a school nurse at Willowdale Elementary. This morning Ms. Matthews, one of the first grade teachers brings a little girl named Keisha to your office. Her right eye is swollen and bloodshot. The lining of her lower lid is bright red. There is a thick yellow discharge in the corner of her eye. What is the most likely diagnosis and what is the etiology (causative agent)?

Conjunctivitis; bacterial

Epidemic typhus is caused by

Corynebacterium diphtheria

Plague is characterized by all of the following EXCEPT A. infects by flea bite B. lymph node enlargements called buboes C. etiology is Yersinia pestis D. sylvatic plague infects city rats only

D. sylvatic plague infects city rats only

The body louse (plural=lice) is the arthropod vector for

Epidemic typhus

Case 3.1: What is the treatment or preventative?

IV antibiotics, prophylactic antibiotics before invasive procedures like tooth extractions

Case 1.6: What is herd immunity in relation to this outbreak.

It is a form of indirect protection from disease when a large percentage (95% for this disease) of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not vaccinated.

Case 1.2: In late September a women brings her 14-year-old daughter to the family physician. She shows the doctor the back of her thigh where there is pale red non-raised discoloration. the rash covers a wide area of the thigh and seems to be roughly circular. The center of the circular area appears normal. She has no other symptoms but her mother brought her in because the rash had been present for over three weeks and it seems to be growing. The doctor questions her about possible exposure. has she worn any new pants lately? Has she been in the woods? do her joints hurt? she reports that she spent the months of August at summer camp in Vermont. she's been wearing mostly shorts and bathing suits for the past two months, none of them knew. she doesn't remember any insect bits on her thigh. On the basis of Meg's oral history, what is the most likely diagnosis?

Lyme disease

Robert, a middle-aged man living in Connecticut, decides to visit his physician because he has been experiencing general malaise and arthralgia in his large joints. Although he does not remember any tick bites or developing a "bull's-eye" rash, Robert's doctor feels he is experiencing a the second stage of the systemic bacterial disease known as ________.

Lyme disease

Case 3.4: A 63-year-old international telecommunications executive visits your office with complaints of a high fever. The fever is not constant, but intermittent. When you press him for details he estimates that every three days or so he suffers these debilitating "sweats." He usually has headaches and muscle aches during the episodes. They keep him home from work. After half a day or so he feels better. He reports that he has experienced these episodes for about two months. What is the name of the condition you suspect?

Malaria

Case 1.6: In the late winter of 1988 pediatricians in big cities around the country started reported large increases in the number of patients they saw with diffuse red rashes and high fever. The rash, usually extending downwards from the hairline of the rest of the body, began after two weeks incubation period. the spots were often so close together that the entire involved area appeared red. sometimes the skin in such an area peeled after a few days. the rash lasted five to six days. many of the children also suffered from diarrhea. The age group most affected was preschoolers. this was a change in epidemiology for this infection, as previously the disease most often struck school-aged children. a vaccine had been introduced for this disease in 1963 and since then only 5,000-6,000 cases a year had been reported in the US. in 1982 18,193 cases were reported. in 1990 the epidemic peaked with almost 28,000 cases reported in the US. Since then the incidence in the country has fallen rapidly and is again in the range of 5,000-6,000 cases per year. What was this resurgent infection?

Measles (Rubeola)

Case 4.2: You and your friends are driving to the mall; it's late October. A public service announcement comes on the radio urging people to get their flu vaccinations. You are a second year nursing student and you mention that the nursing staff at your university is holding a vaccine clinic next week. Your friend Susan says " Im not getting a flu shot! The last time I did, it gave me the flu." Others in the car agreed with her. But Heather asked you if it's true that the vaccine can give you the flu. What should your answer to Heather's question be? (Is is true that the vaccine can give you the flu.)

No

Case 3.4: Can this individual transmit the infection to others and why?

No, it is transmitted by mosquitos

The etiology of the common cold is

Parainfluenza virus, Rhinovirus, Adenovirus (all of the above)

Case 4.8: You are referred for a chest X-ray, but the results are inconclusive. The clinic doctor prescribes a six-month course of isoniazid (abbreviated INH). You take the medicine according to the pharmacist's instructions. Six months later you are taking a medical microbiology course as part of your nursing curriculum. On the day you study tuberculosis you suddenly realize why you had a positive skin test. It has nothing to do with a true infection, but with the fact that you were born in the Netherlands. Your family moved to the United States when you were 4 years old. What do you suppose is going on here? Discuss as fully as you can.

People in the Netherlands receive a TB immunization, called BCG, which sensitizes the T cells to the TB antigen causing a positive skin test.

Case 3.4: What is the most likely causative organism?

Plasmodium

Case 4.6: When you left for school this morning your 3-month-old son was wheezing a bit and he had a slight fever of 99.8°F. Your mother is watching him while you come to school to take your anatomy and physiology exam. Your pager goes off halfway through the exam. The baby's fever is rising and he is having more trouble breathing. Your mother says she is taking him to the emergency room. You rush over to the hospital. When you get there, he is in an examining room and the doctor is signing papers to admit him to intensive care. She says she suspects some kind of pneumonia. She mentions the type of pneumonia but you don't recognize the name and you are too worried about your son to pin her down at this moment. You do note that she mentions that the hospital has seen a dozen pediatric cases of the same type of pneumonia in the past week and a half. The doctor swabs your son's nose but says the results won't be back for several days. In the meantime, they will give him supportive therapy, including an inhaled spray, but no antibacterial drugs. The doctor says that she feels sure that the child will recover since the infection was caught very early. Nonetheless, after she leaves, your mother is frantic and indignant. She fires off the following questions to you. What kind of pneumonia is it?

Respiratory syncyctal virus (RSV)

A vaccine is available to prevent all of the following EXCEPT

Roseola

Measles is also known as ___________

Rubeola

Case 4.6: How can the doctor be sure what's causing the pneumonia if she doesn't yet have test results?

She has seen a dozen cases in the past week and a half, so can make an educated guess based on the age of the child and the symptoms

Necrotizing fasciitis (flesh-eating disease) is caused by

Streptococcus pyogenes

Necrotizing fasciitis is caused by:

Streptococcus pyogenes

The bacteria that can cause the sequelae rheumatic fever and glomerulonephritis is ________.

Streptococcus pyogenes

Cae 3.1: What's the connection, if any, with rheumatic fever?

The bacteria can colonize the scarred heart valves easier due to rheumatic fever.

Case 4.1: In deciding whether to prescribe antibiotics, should the physician be extra careful not to prescribe an unnecessary antibiotic, or be extra careful not to let a bacterial infection go untreated? Group of answer choices

The doctor should treat this infection with antibiotics because it can lead to serious sequelae, like heart and kidney damage.

Why is it easy for upper respiratory infections to spread into the middle ear?

The middle ear is connected to the nasal cavity by the Eustachian tube.

Case 4.6: What about your other child, who is 3 years old? Has she been exposed to the infection by being around the baby? Should the baby remain isolated when he comes home? Can the 3-year-old be vaccinated?

The older child has probably already had this illness but developed more mild symptoms

Which of the following is FALSE regarding gas gangrene?

The organism is aerobic.

Case 1.1: Kate, your sister-in-law, is about to undergo fertility treatments. Her doctor insist that she receive the rubella vaccination, and then wait several weeks before beginning the actual fertility regimen. Kate calls you and wants to know why she has to do this. You ask her if she is able to produce evidence of vaccination for rubella (also known as German measles). She says no; her family had a house fire a few years ago and all those records were lost. "But I had German measles when I was in second grade!" she says. "I remember that I was really sick and missed almost a month of school."You suggest that she follow her doctor's advice and get the immunization. Why would a fertility specialist recommend the rubella vaccine?

The rubella virus is particularly dangerous for fetuses (teratogen) and causes rubella syndrome.

Case 4.2: Another friend, Dru, says that even though she had the flu shot last year she got terribly sick with the stomach flu over Thanksgiving break and missed most of her vacation. What is your explanation for this?

The stomach flu (a digestive illness) is caused by a different virus than influenza (a respiratory illness).

Case 4.2: Heather says that because she had a flu shot last year she's going to skip it this year. How would you respond?

The strains change each year, so a new vaccine is made annually.

Case 1.4: What features suggest that it is not Clostridium perfringens gangrene?

The surgical wound was superficial, not deep and the bacteria are gram-positive cocci in chains.

Case 4.6: Why aren't they giving him antibacterial drugs?

This is a viral illness, so antibacterial drugs won't be effective.

The disease known as the Black Death during the Middle Ages leads to the development of buboes in individuals bitten by infected fleas and is caused by the bacterium

Yersinia pestis.

Which term refers to only the presence of bacteria in the blood stream?

bacteremia

Case 3.1: What is the most likely route of transmission?

bacteria from mount entered bloodstream during tooth extraction

Malaria is NOT characterized by A. transmitted by mosquito vector B. bacteria that infects red blood cells C. severe form causes red blood cell agglutination causing ischemia (low oxygen) in tissues D. is caused by a eukaryotic organism

bacteria that infects red blood cells

Which infection refers to inflammation of the lining and valves of the heart?

bacterial endocarditis

A child who has not received any childhood vaccinations is taken to the emergency room with lethargy, a temperature of 40°C, and difficulty breathing. The attending physician notes a grayish membrane partially obstructing the child's trachea and a characteristic "bull neck", similar to the neck seen in this photograph. The most likely diagnosis is

diphtheria.

Case 3.4: Is this pathogen eukaryotic or prokaryotic?

eukaryotic

Rocky Mountain Spotted Fever is characterized by all of the following EXCEPT

most cases are in the northwest U.S.

Case 1.4 What condition did the patient have?

necrotizing fasciitis (flesh-eating)

A term for a rash made of pin-point hemorrhages under the skin is

petechia

Case 3.1: Why did you look at his fingernails?

petechial hemorrhages in nails are a sign often signs of this disease

A 6-month-old girl who attends daycare develops a fever, chills, and respiratory wheezing. She is diagnosed with viral pneumonia and admitted to the local hospital where she is treated with hydration, oxygen, and bronchodilators. Her parents are distraught and feel that they could have done more to prevent their daughter's illness. The physician assures them no vaccine is currently available for her illness because the exact mechanism of the immune response has not yet been delineated. The girl is infected with ________.

respiratory syncytial virus