Case #2 student questions

A patient presents to the emergency department after having water, noninflammatory diarrhea that now has bright red blood in it. Patient stated that he attended a family picnic 3 days ago with home cooked meals and developed symptoms and developed symptoms yesterday. The patient recalls that he did not see one of their family members wash their hands before serving food. The physician determines that the patient is suffering from acute shigellosis caused by shigella. How does this organism cause bloody stool? A. Destruction of the stomach lining B. Hemolysis of intravascular blood C. Invasion of colonic tissue D. Formation of hemorrhoids E. The patient's bloody diarrhea is unrelated to shigella.

C. Invasion of colonic tissue

A 23-year-old male visits an urgent care after complaints of nausea, vomiting, and diarrhea. Upon physical examination, the physician notes that the patient was scratching their foot, which revealed an irritated rash as well as a non-productive cough. Originally, the patient attributed his rash to ground-bees as they are common for him in his backyard. The physician orders a CBC and OVP. Lab results find that the patient has minor blood loss and non-bile stained segmented eggs are found in his stool. What drug or treatment would be the most beneficial to treat this patient? A. Ivermectin B. Antihistamines C. Mebendazole D. DEC E. Symptomatic

C. Mebendazole

A 32 year old male with AIDS presents to the clinic complaining of loose, foul-smelling stools, fatigue, and malaise. Careful examination of a concentrated stool sediment and special acid-fast staining reveal the parasite, Cystoisospora belli. What is the diagnostic stage of this parasite that is present in fecal specimens? A. Cysts and large trophozoites containing cilia and macronucleus B. Trophozoites only C. Oocysts D. Cysts and trophozoites E. Small trophozoites with 1 to 2 nuclei and central karyosome consisting of granules

C. Oocysts

A 30-year-old patient went to the hospital because he was not feeling well. The patient had recently traveled to Africa, and was experiencing daily chills, fevers, severe nausea, vomiting, and diarrhea. The doctor ordered thick and thin blood films suspecting a malaria infection. The results showed a high-grade parasitemia consisting of ring forms. Infected RBCs were not enlarged or distorted. Three or even four small rings were seen, as well as appliqué or accolé forms within the individual erythrocytes. What species of Plasmodium was responsible for this patient's symptoms? A. Plasmodium knowlesi B. Plasmodium vivax C. Plasmodium falciparum D. Plasmodium ovale E. Plasmodium malariae

C. Plasmodium falciparum

A 25-year-old male presents to the emergency room with complaints of abdominal pain, cramping, and colitis with diarrhea. The patient indicates that he has recently returned from a mission trip in Africa. He states that he had been diligent about drinking water from only sanitized and packaged water bottles. However, he does recall getting an iced drink from a local vendor toward the end of his trip. Lab testing and stool samples indicate that the patient has been infected with an organism that leads to flask-shaped ulcerations of the intestinal mucosa and extensive local necrosis in the large intestine. The basis for the extensive local necrosis and tissue destruction is attributed to which of the following? A. Invasion of trophozoites into the mucosal lining B. Trophozoite attachment to intestinal villi C. Production of a cytotoxin D. Sexual and asexual reproduction of organism in the intestinal epithelium E. Trophozoite multiplication by binary fission

C. Production of a cytotoxin

A recent immigrant and dairy farmer from northern Europe, visits the outpatient clinic for the first time. She's experiencing both nausea and vomiting, but decided to come in due to pharyngitis and arthralgia. Further questioning reveals she has experienced no fever or diarrhea. Physical examination also reveals erythema nodosum on the front of her legs below the knee. The physician orders a stool sample, and the pathogen responsible grows on Yersinia-selective agar. What complication is possible following infection? A. Guillain-Barre B. Hemolytic-uremic syndrome C. Reactive arthritis D. Toxic megacolon E. Bloody diarrhea

C. Reactive arthritis

A 55-year-old male patient initially presented to the clinic with fever, anorexia, nausea, and vomiting. Upon further assessment, small erythematous maculopapular lesions were noticed (Rose spots) on the chest. The patient has a recent travel history to the Philippines, where his friends had him try raw eggs. What is the causative agent responsible for the patient's signs and symptoms? A. Salmonella enteritidis B. Yersinia pestis C. Salmonella Typhi D. Clostridium difficile E. Enterohemorrhagic Escherichia coli (EHEC)

C. Salmonella Typhi

A 40-year-old female presents to the hospital for a lung transplant. During her evaluation in pre-op, routine blood tests, as well as serological screenings for blood protozoa were conducted. Among the patient's results, elevated IgG antibodies and low IgM antibodies were seen. During the doctor's evaluation, the patient mentioned that she had 2 indoor/outdoor cats at home and thought that she washed her hands every time that she cleaned their boxes but wasn't 100% sure. If the doctor was to biopsy the patient's original lung tissue after surgery, what would he see that would confirm his diagnosis based on the information mentioned above? A. Leishmania amastigote B. Trypomastigote with an undulating membrane C. Toxoplasma gondii tachyzoites and cysts with bradyzoites D. Multiple ring forms in erythrocytes E.Naegleria trophozoites

C. Toxoplasma gondii tachyzoites and cysts with bradyzoites

A 6-year-old male arrived at the emergency room accompanied by his parents who stated that he has abdominal pain and distention. Due to irritation and straining during defecation his rectum had prolapsed. This family lives in a remote area with no running water or sanitary sewer. It was stated that they receive food from neighboring unregulated farms. Which is most likely the cause of his condition? A. Dracunculus medinensis B. Enterobius vermicularis C. Trichuris trichiura D. Dirofilaria immitis E. Trinella spiralis

C. Trichuris trichiura

An 18-month-old girl is brought to her PCP. She was recently adopted from South America and brought home with her new parents in the US. Her parents initially brought her in because they noticed she was experiencing chills, fever, and has been severely fatigued, even upon just waking up. Physical exam notes a rash and edema around her eyes. Given her recent history you diagnose this rash as Romaña's Sign and begin to determine your course of treatment. What organism is responsible for this disorder? A. Plasmodium falciparum B. Leishmania donovani C. Trypanosoma cruzi D. Trypanosoma brucei E.Naegleria fowleri

C. Trypanosoma cruzi

A 25-year-old male patient presents to the emergency room with symptoms of fever, headache, and day-time sleepiness. A swelling of the lymph nodes (Winterbottom's sign) is also observed. A review of the patient's history indicates that he recently immigrated to the US from Ghana, West Africa, seventeen days ago. When asked if he remembers anything peculiar that happened before he immigrated, he states that he noticed a bug bite on his arm the day before travelling. He is diagnosed with West African sleeping sickness. Which of the following is most likely the vector through which he got the disease? A. Reduviid bug B. Trypanosoma brucei gambiense C. Tsetse fly D.Trypanosoma brucei rhodiense E. Trypanosoma cruzi

C. Tsetse fly

In central Africa, a 24 year old male visits the office with complaints of fever and pain coming from an ulcer on his leg. The patient looks abnormally hyperactive and has a large bump on the right posterior side of his neck. What is the vector that could've caused these symptoms? A. Sandfly B. Epimastigote C. Tsetse fly D. Trypomastigote E. Promastigote

C. Tsetse fly

A 4-year-old male presents to the clinic with symptoms of abdominal pain, cough, seizures, and pruritic skin lesions. Upon physical exam, the child is observed to have hepatosplenomegaly. The patient and his family recently moved to the area and he was enrolled in preschool, and his parents state that the patient has especially loved the petting zoo they have at the school, consisting of dogs, chickens, and cats that live on the property. Following diagnostic blood tests, the patient is found to have elevated eosinophil levels. How might the patient have contracted this nematode? A) Playing with infected animals at school B) Contaminated clothing/toys at the school C) Inhaling the infected egg-laden dust in the family's new home D) Playing outside with bare feet E) Eating a piece of infected bacon

A) Playing with infected animals at school

A 28-year-old female presents to the ED complaining of profuse watery diarrhea (rice water stools), fatigue, and increased thirst. The patient reveals she went on a trip to Bangladesh to visit her grandmother and returned back to the United States, 2 days ago. The ER physician runs a series of lab tests and the results revealed the patient's symptoms are consistent with Vibrio Cholerae. The patient's symptoms are caused by the cholera toxin. What is the mode of action of the cholera toxin? A. Activation of adenylate cyclase, increasing intracellular cAMP B. Activation of guanylate cyclase, increasing cGMP C. Protein synthesis inhibition D. Ribosylation of small GTPases (Rho) E. M cell invasion

A. Activation of adenylate cyclase, increasing intracellular cAMP

A 17-year-old teenager presents to the clinic with complaints of watery diarrhea, vomiting and stomach pain. He reports being at a party about 6 hours earlier that day where food was served. The meal included fried rice, meat and vegetables that seemed rather raw. After 32 hours the patient's health seemed to be back to normal. Given the signs and symptoms displayed by the patient, which of the following organisms most likely caused his illness? A. Bacillus cereus B. E. coli C. Salmonella typhi D. Vibrio parahaemolyticus E. Norovirus

A. Bacillus cereus

An 84-year-old man presents to the ED with cramps, a fever, and watery diarrhea with a foul smell. The patient mentions that he was recently prescribed antibiotics for a skin infection and is almost finished with the course. Lab findings revealed leukocytes and occult blood in his stool, indicative of pseudomembranous colitis. What is the bacteria that is responsible for causing this patient's pseudomembranous colitis? A. C. difficile B. Y. pestis C. EIEC D. Shigella Salmonella

A. C. difficile

A 70-year-old woman presents to her clinic with watery diarrhea and abdominal cramps for the past week. She was hospitalized few weeks ago for pneumonia and treated with penicillin. Physical examination reveals lower abdominal tenderness. The initial laboratory evaluation of the stool reveals the presence of leukocytes. What is the most likely causative agent and the virulence factor(s) responsible for the symptoms? A. Clostridium Difficile -toxin A (enterotoxin) and toxin B (cytotoxin) B. Shigella - Shiga toxins (Stx1 and Stx2) C. Clostridium Difficile - Heat labile toxin (LT-I or LT-II) D. EHEC - Heat labile toxin (LT-I or LT-II) Y. enterocolitica- M cell invasion

A. Clostridium Difficile -toxin A (enterotoxin) and toxin B (cytotoxin)

A patient returns from a tropical vacation still experiencing Diarrhea, bloody stool, fever and abdominal pain. The cause of this particular infection is determined to be a protozoan. What is the method of transmission of the protozoan infection? A. Consuming fecally contaminated water B. Bite from sand fly C. Contact with the saliva of an infected animal D. Swimming in contaminated water E. Bite from the reduviid bug

A. Consuming fecally contaminated water

A patient who just recently gave birth to her baby complains that her newborn has failed to have a bowel movement within 48 hours after birth. Assessing the newborn's belly, distension of the baby's abdomen to a diameter of 3-4 inches was noticed. It was determined that the accumulation of a tremendous quantity of fecal matter in the colon led to this distension. Which of the following would be the most likely cause of this disease? A. Deficiency of ganglion cells of the colon B. Helicobacter pylori C. Gluten D. Allergic or immune destructive effect E. Excessive stimulation of the parasympathetic nervous system

A. Deficiency of ganglion cells of the colon

A mother brings her 3 year old child to the pediatrician with a chief complaint of pruritus and loss of sleep. She informs the pediatrician that she recently enrolled her child in day care and that many of the other children share the same symptoms. The pediatrician diagnosed the child with Enterobius vermicularis and treated them accordingly. However, the child comes back 2 days later but now with complaints of abdominal pain, flatulence and intermittent diarrhea. This time the pediatrician treats the child with doxycycline and alleviates his symptoms. What is the responsible organism for the second set of symptoms? A. Dientamoeba fragilis B. Giardia duodenalis C. Entamoeba histolytica D. Clostridium difficile E. Necator Americanus

A. Dientamoeba fragilis

A 6 year old child is sent home from daycare due to a fever and watery diarrhea. After two days the child's mother noticed the watery diarrhea had progressed to bloody diarrhea and decided to take the child to the doctor. The doctor performed tests to differentiate Shigella from Enteroinvasive E. coli, prior to diagnosing the child with Shigellosis. What is one characteristic that is different between Shigella and Enteroinvasive E. coli? A. Enteroinvase E. coli does not produce toxins B. Shigella does not produce toxins C. Enteroinvasive E. coli is only spread through person to person contact D. Enteroinvasive E. coli does not progress into bloody diarrhea E. Shigella is highly resistant to gastric acid

A. Enteroinvase E. coli does not produce toxins

A pig farmer enters the clinic with complaints of abdominal pain and tenderness, watery stools with blood and pus for the past few days. He claims it most likely isn't food related since his wife and kids have been eating the same thing and had no issues that week. Upon further examination and one stool sample later, it has been revealed that his feces contain large trophozoites with cilia and a large macronucleus. What might the route of transmission of the suspected species found in his feces be? A. Fecal-oral B. Respiratory C. STD D. Direct skin penetration E. Arthropod bite

A. Fecal-oral

A healthy 25 year old male ate a big hamburger for dinner and his body is in the process of digesting the fats he has eaten. What enzyme is responsible for the majority of triglyceride digestion from this meal? A. Pancreatic Lipase B. Lecithin C. Bile Salts D. Pepsin E. Maltase

A. Pancreatic Lipase

A patient presents to an Urgent Care Clinic with extreme diarrhea. The physician there is aware that whenever significant amounts of intestinal secretions are lost to the exterior the sodium reserves of the body can sometimes be depleted to lethal levels within hours. Normally, however, less than 0.5% of the intestinal sodium is lost in the feces each day. Most likely, why is this? A. Rapid absorption of sodium through the intestinal mucosa B. Reabsorption of sodium in the renal system C. Excessive intake of sodium on a daily basis D. Sodium cotransporter between the ECF and ICF E. Isosmotic absorption of water

A. Rapid absorption of sodium through the intestinal mucosa

A 25 year old male patient presents to a clinic in Nepal one rainy day with complaints of diarrhea and abdominal cramping having lasted a week. The patient shares that he has been unable to eat recently, but usually enjoys fresh salads he buys weekly from his local farmers market. Having seen these symptoms in several other patients this week, you suspect Cyclospora cayetanensis due to a local contaminated crop of spinach. A wet mount is necessary for diagnosis. Presence of which microscopic results would confirm the diagnosis of Cyclospora cayetanensis? A. Spherical oocysts 8-10 μm in diameter B. A large trophozoite with a pseudopod C. Flask shaped oocysts D. Elliptical oocysts 15-25 μm in diameter E. Oocysts containing five sporocysts

A. Spherical oocysts 8-10 μm in diameter

A researcher is studying the digestion of proteins in the stomach. The researcher decides to focus the study on the activity of pepsin, an enzyme in the stomach which initiates digestion, at different levels of pH. During one observation of the stomach acid, it is noted that pepsin is inactive. Which of the following is the explanation for the inactivation of pepsin? A. The stomach acid was too basic B. The stomach acid was too acidic C. The stomach acid was between 2.0 and 3.0 D. All of the above E. None of the above

A. The stomach acid was too basic

21M presents to his PCP with complaints of constipation. He also reports not urinating very much, and when he does it is dark yellow. He is extremely active and plays club soccer, football, and basketball every week. He admits that he often forgets to drink water while playing. He is otherwise healthy. Which characteristic of the large intestine is most responsible for allowing more complete absorption of electrolytes and water than the small intestine? A. Tighter tight junctions B. Presence of gut flora C. It is longer, which allows more time for absorption D. More villi E. Secretion of bicarbonate ion

A. Tighter tight junctions

A 25 year old female comes to the clinic complaining of vaginal itching, discharge, and discomfort with urination. She tells the physician that she is sexually active and has been experiencing these symptoms for the past 7 days. The gynecological exam reveals a strawberry cervix and thin, frothy, and green vaginal discharge that is malodorous. The vaginal pH is 5.3. The physician prescribes her metronidazole. What parasite is most likely causing this patient's condition? A. Trichomonas vaginalis B. Toxoplasma gondii C. Trypanosoma brucei D. Entamoeba histolytica E. Giardia

A. Trichomonas vaginalis

A 23 y.o. Female presents to her PCP with scant watery vaginal discharge, itching, burning, and painful urination for the past week. She reports being sexually active with her boyfriend. Microscopic examination of the vaginal discharge will most likely reveal which of the following: A. Trophozoites with flagella and short undulating membrane B. Cysts and trophozoites C. Small trophozoites with one or two nuclei and karyosome consisting of granules D. Large trophozoites with cilia and macronucleus and cysts E. Oocysts

A. Trophozoites with flagella and short undulating membrane

A researcher is studying the effects of pepsin, which is expressed as pepsinogen by gastric chief cells, an important protein digesting enzyme in the stomach. After genetically modifying the chief cells to inhibit secretion of pepsinogen in a population of lab rats, their goal is to study the impact this inhibition has on pepsin in relation to protein digestion. Thus, which of the following macromolecules is most likely no longer hydrolytically cleaved due to the absence of pepsin? A. collagen B. keratin C. elastin D. fibronectin E. myoglobin

A. collagen

A 22-year-old female presents to her primary care physician of a fever of 100.1 degrees Fahrenheit, abdominal pain and vomiting. Upon physical examination, the patient was also found to have rose spots on her chest and abdomen. The patient mentions that two weeks prior to her appointment, the patient had returned from a vacation to India with her family. What is the initial pathology of the bacteria causing the patient's symptoms? A. invasion of the small intestinal M cells B. toxin release and activation of adenylate cyclase C. overgrowth of the bacteria in the colon D. attachment to the surface of CD4+ T-cells E. release of cytotoxins

A. invasion of the small intestinal M cells

A 28 years old female presents to the Emergency Room with complaints of pain with urination accompanied with bloody urine. She recently studied abroad in Africa and while she was there, she did develop acute dermatitis while she was there, but she has been back in the US for a month now she didn't think it was important. The physician suspects she is suffering from a parasitic Schistosoma haematobium infection. What test would the physician use to confirm the diagnosis? A. presence of eggs in a urine sample B. Presence of eggs in a blood smear C. presence of eggs in the stool D. CT scan E. tape test

A. presence of eggs in a urine sample

Postmortem findings for a recently deceased HIV-positive 23 year-old patient showed evidence of multiple brain abscesses, trophozoites and cysts present in their brain. Three days before they passed away, they presented to the emergency department and the resident on duty collected several specimens from the patient and sent them to be cultured. These cultures had proven difficult to grow on agar plates specific for two different types of amebic organisms. Finally, the microbiologist was successful in recovering the specimen in tissue culture using a mammalian cell line. What was the causative agent and form of encephalitis that the patient had? A. Acanthamoeba; chronic granulomatous encephalitis B. Balamuthia; chronic granulomatous encephalitis C. Naegleria; acute primary amebic meningoencephalitis D. Naegleria; chronic granulomatous encephalitis E. Acanthamoeba; acute primary amebic meningoencephalitis

B. Balamuthia; chronic granulomatous encephalitis

A 23 year old male presents to his physician with complaints of fever, chills, headaches and vomiting after returning from travel in West Africa. The patient admits that he did not receive any prophylactics or immunizations before his trip, as he "didn't know he was supposed to." What type of treatment should the patient receive for his illness? A. Diphenoxylate and loperamide B. Chloroquine C. Azithromycin D. Metronidazole E. No treatment needed- self limiting

B. Chloroquine

44. A person who just experienced a traumatic car accident presents to the hospital. The physician finds that the patient sustained a spinal cord injury and the upper cord involved in the voluntary portion of defecation reflex is blocked. The physician suggested administration of small enema after a meal to excite the actions of the upper cord since the basic cord for reflex is still intact in the patient. Which area of the spinal cord (crucial for defecation reflex) is still intact in this patient. A. Ventral horn B. Conus medullaris C. Dorsal horn D. White matter E. Grey matter

B. Conus medullaris

A 22 year old female begins working on a fruit farm where she decided to eat an unwashed peach. She later learned that she consumed Ascaris lumbricoides eggs on the peach that grew from contaminated soil. What would need to be detected or what diagnostic test was used in order to arrive at this definite conclusion? A. Colorless growth on Sorbitol-MacConkey Agar B. Detection of eggs in stool sample C. CBC D. Thiosulfate citrate bile salts sucrose agar E. Blood smear

B. Detection of eggs in stool sample

A few months ago, a farmer in sub-Saharan Africa switched over to an organic fertilizer that is feces-based. After a long morning, the farmer's 10-year-old daughter danced around barefoot in the fields and then went straight to soccer practice. Once she was home, she immediately took off her cleats because her feet were so itchy. A few weeks later, she complained of abdominal pain, diarrhea, loss of appetite, fatigue, and shortness of breath. What was she infected with? A. Entamoeba histolytica B. Hookworm C. Pinworm D. Trypanosoma brucei gambiense E. Onchocerca volvulus

B. Hookworm

A 27 year old woman was making chocolate chip cookies for her mother. After she made them she felt sick and was experiencing watery diarrhea. She goes to the doctor after experiencing these symptoms and she tells him she consumed some of the raw cookie dough which was made with raw eggs. An H2S test revealed a positive result. What is the virulence factor of this pathogen? A. Production of 2 shiga-like toxins (Stx1 & Stx2) encoded on phage B. Invasion of M cells of the small intestine C. Production of heat-labile and heat-stable enterotoxins (LT1 and Sta) D. Production of exotoxins that disrupt the tight junctions in intestinal epithelial cells E. Binding of the toxin to the presynaptic nerve terminal preventing acetylcholine release

B. Invasion of M cells of the small intestine

A patient presents to the urgent care clinic with concern of a persistent ulcer with raised edges that is located on the patient's leg. The patient informs the physician of recent travel to Brazil and recalls being bitten by a "strange looking fly" while hiking. The physician performs a tissue biopsy for identification of the organism. Which organism is most likely to have caused this ulcer? A. Trypanosoma rhodescience B. Leishmania braziliensis C. Trypanosoma cruzi D. Giardia Lamblia E. Clonorchis sinensis

B. Leishmania braziliensis

A 40-year-old male visits his physician and presents with epigastric pain and tenderness as well as vomiting. Examination of concentrated stool samples reveals larval worms that can be distinguished from hookworms by two morphological features. Results of the stool sample confirm infection with Strongyloides stercoralis. This particular nematode burrows into the mucosa of the intestines and releases its larvae into the lumen of the bowel. Which two morphological features would distinguish an infection with S. stercoralis from that of a hookworm? A. Mouthpart location and size of head B. Length of buccal cavity and genital primordium C. Segmentation and distinct shape D. Undulating membrane and nuclei on the tail region E. Larval sheath and microfilariae

B. Length of buccal cavity and genital primordium

A researcher is studying the different digestive enzymes in the human body. He is focused on one enzyme in particular: ptyalin. To study the efficacy of this enzyme he tests how much of its substrate (starch) gets hydrolyzed in the mouth. Due to the short amount of time food is spent in the mouth, it turns out ptyalin is only able to hydrolyze about 5% of all the starches. This means it is not very efficacious and there must be other enzymes to digest starches later in the digestive system of the human body. What are the product(s) of the breakdown of starch by ptyalin? A. Glucose alone B. Maltose and 3-9 glucose polymers C. Fructose and Glucose D. Maltose alone E. Galactose and Glucose

B. Maltose and 3-9 glucose polymers

A 28-year-old man comes in for an appointment with his primary care physician with complaints of fever, urticaria, and severe pruritus. He had moved to the United States 6 months ago from the Volta river basin where he worked near the streams. After physical examination, subcutaneous nodules were found on the head and neck, and blood tests revealed eosinophilia. Which laboratory test would confirm the diagnosis for the suspected organism? A. Flooding the nodule with water to recover larval worms B. Microfilariae in skin snip preparations C. Cysts in a stool sample D. Protozoa present in a wet prep E. Trypomastigote stage in a blood smear

B. Microfilariae in skin snip preparations

A 47-year-old male reports to his PCP for the second time in two weeks after continuing to present with general malaise, headache, chills, and weakness. The man previously reported to his physician after being bit by a tick while on a service trip on Africa. The physician suspected the man had been infected by Plasmodium falciparum after seeing rings form within erythrocytes on a blood smear and prescribed him chloroquine. Since the man still seems to be having symptoms what do you suggest the man needs in terms of treatment? A. Needs a higher dose of chloroquine B. Needs to be prescribed an antiprotozoal C. Needs to be on chloroquine for a longer amount of time D. No medication is needed, and eventually the symptoms will subside E. Needs a blood transfusion

B. Needs to be prescribed an antiprotozoal

A patient presents to the emergency room with abdominal cramps, vomiting, and diarrhea. Most patients with diarrhea should be treated primarily with which of the following types of therapy? A. Intravenous Fluid Therapy B. Oral Fluid Therapy C. Antimicrobial Therapy D. Virotherapy E. All of the above

B. Oral Fluid Therapy

26-year-old female arrived at the ED with complaints of bloody diarrhea, abdominal pain, and fever which onset 2 days ago. In the patient's history, she denied recent travel and reported no changes to her diet but noted that 4 days ago, she was at a neighborhood cookout where she ate grilled chicken, hot dog, and potato salad. Lab results revealed that the patient's symptoms were caused by the bacteria Campylobacter jejuni, most likely from eating undercooked chicken. Which of the following is not a virulence factor of Campylobacter jejuni? A. Motility via flagella B. Pili C. Adherence D. Release of cytotoxin E. Mucosal invasion

B. Pili

A 5 year old male presents to the clinic with persistent abdominal pain and loss of appetite. His mother complains that he has also been feeling nausea and has difficulty swallowing. After performing blood and stool tests, a bacterial infection by Helicobacter Pylori was found. He was given antibacterial therapy to prevent further damage to the gastroduodenal mucosal barrier. Which of the following ways does Helicobacter Pylori lead to a peptic ulcer? A. Failure of the pancreas to secrete pancreatic juice into the small intestine B. Release ammonium that liquifies the barrier and stimulates secretion of hydrochloric acid C. Stomach fails to secrete hydrochloric acid D. Blocks the release of intrinsic factor by parietal cells E.By preventing bowel movements in the large intestine

B. Release ammonium that liquifies the barrier and stimulates secretion of hydrochloric acid

The parents of a 3 year old girl walk into their primary care physician's office with complaints of watery diarrhea that has worsened to finding blood in the stool. The parents are very concerned as this is their first child. While getting a history, the parents look a bit on edge as they both work full time to keep up with the finances and to allow their daughter to have an amazing future. They state that their daughter spends the day at a private daycare center on the weekdays. After obtaining a physical, it was determined that the illness may have spread via fecal oral from another child attending daycare. Based on this, what is the type of infection that is responsible for causing this patient's watery diarrhea? A. Campylobacter spp. B. Shigellosis C. Salmonellosis D. Yersinia spp. E. ETEC

B. Shigellosis

A 10 year old male presents to the ER with complaints of abdominal pain, cramping, and watery but non-bloody diarrhea. His parents mention that he was recently vacationing with them and had swam in chlorinated, but unfiltered water. What is the best method of definitive diagnosis for this parasite? A. Histological examination of bowel tissue B. Stool analysis for O & P C. Blood analysis D. Electrolyte panel E. Diagnostic treatment with oral antimicrobials

B. Stool analysis for O & P

A 36-year-old patient presents to his PCP with complaints of a fever, chills, general malaise, vomiting, and headaches. Patient notes that he returned 12 days ago from a visit to sub-Saharan African and the symptoms started 3 days ago. After detecting the Plasmodium species on a Giemsa stain blood smear and confirming the patient has malaria, what chemoprophylaxis does the PCP indicate to take? A. Chloroquine phosphate B. mefloquine C. ivermectin D. metronidazole E. oseltamivir

B. mefloquine

A 32-year-old patient presents to her primary care physician with a fever, chills, and swollen lymph nodes. The patient denies any recent travel outside of the USA, but further prompting reveals she traveled to Central Africa one year prior. Which of the following is an accurate part of the causative agent's life cycle? A) The larvae will hatch in the small intestine and later migrate to the large intestine B) The larvae will grow in the alveoli C) The larvae will mature in the lymphatic system D) The larvae will migrate to cecum and penetrate mucosa E) The larvae will mature in the retroperitoneal space

C) The larvae will mature in the lymphatic system

A 2-year-old female is taken to the pediatrician by her mother as she has been experiencing diarrhea for the last three days and has been increasingly fatigued. Her mother is concerned that she may be dehydrated. Her mother informs the physician that she has been going to daycare daily for the last 6 months and there are a few other children with similar symptoms. What is the incubation period of the bacteria causing her symptoms? A. 1-5 days B. 3-4 days C. 6-72 hours D. 2-7 hours E. 3-7 days

C. 6-72 hours

A 58-year old woman presents to her PCP with concerns of food "feeling stuck" in her throat during and following a meal. Her physician is concerned that she may have somehow damaged part of her myenteric plexus. What term describes her symptoms, and if left untreated what may it lead to? A. Constipation; Megaesophagus B. Achalasia; Megacolon C. Achalasia; Megaesophagus D. Achalasia; Pernicious Anemia E. Gastritis; Peptic Ulcer

C. Achalasia; Megaesophagus

A college student comes into the ER with complaints of abdominal pain, nausea, vomiting. While taking the student's history, the physician learns that the college student has recently traveled to Cancun, Mexico. The college student explains that his bowel movements have occurred 3 times a day for the past week. What type of diarrhea is the college student experiencing and what is the mechanism responsible for his symptoms, respectively? A. Acute diarrhea, release of neurotoxins B. Persistent diarrhea, attachment to the brush border of intestinal epithelium C. Acute diarrhea, attachment to the brush border of intestinal epithelium D. Persistent diarrhea, release of cytotoxins Persistent diarrhea, release of neurotoxins E. Persistent diarrhea, release of neurotoxins

C. Acute diarrhea, attachment to the brush border of intestinal epithelium

A 7-year old girl has gone to the doctor's office with her mother complaining of stomach cramps and regular pale, foul smelling stools. It is also noted that she seems to be growing at a lower rate than her peers at school and has joint pains often. One of the solutions that her doctor gives her is to remove any sort of wheat and rye flour from her diet. Which disease is she most likely to have and where is it most affecting her? A. Celiac disease; Large intestine B. Hirschsprung's disease; Large intestine C. Celiac disease; Small intestine D. Pancreatitis; Small intestine E. Hirschsprung's disease; Small intestine

C. Celiac disease; Small intestine

A 27 year old male had a large cheeseburger for dinner with fries, a large Pepsi, and a slice of pie for dessert. With regard to fat absorption, what is responsible for transporting triglycerides into the thoracic lymph duct? A. Micelles B. Lipase C. Chylomicrons D. Microvilli E. Endoplasmic Reticulum

C. Chylomicrons

A 26 year old female enters the emergency clinic with complaints of abdominal cramps, flatulence and foul-smelling watery diarrhea. Upon further questioning it was found that the patient had been on a hiking trip where they attempted to consume untreated water from a mountain stream. Which of the following routes of transmission did the patient most likely acquire this organism? A. Respiratory transmission B. Zoonotic Transmission C. Consumption of untreated contaminated water D. Oral-anal route E. Sexual Transmission

C. Consumption of untreated contaminated water

A patient has been diagnosed with Addison's disease. Addison's disease is characterized by low levels of aldosterone and cortisol. Which of the following will result in the intestine due to decreased aldosterone levels? A. Increased sodium absorption B. Increased activity of SGLT cotransporter C. Decreased chloride absorption D. Decreased loss of sodium chloride in the feces E. Increased activity of sodium/amino acid cotransporter

C. Decreased chloride absorption

A 30 y/o male presents to ED with abdominal pain, diarrhea, nausea and vomiting. Onset began a week ago and progressively worsened. He notes daily EtOH use with a history of alcohol abuse. On exam patient in severe distress with distended abdomen, severe abdominal tenderness to palpation and jaundice. Labs showed low pancreatic amylase level and he was diagnosed with alcoholic pancreatitis. What significance does low pancreatic amylase have? A. Decreased conversion of Lactose to Galactose B. Decreased conversion of Sucrose to fructose C. Decreased conversion of Starch to Maltose D. Decreased conversion of Maltose to Glucose E. Increased conversion of Starch to Maltose

C. Decreased conversion of Starch to Maltose

A 57 year old caucasian male has been a farmer his whole life. He has noticed over the past week that he has lost weight, is having diarrhea and is experiencing arthralgia. He is seen by his primary care provider and diagnosed with Whipple disease. What morphology did the primary care provider see that led him to this diagnosis? A. Flask shaped ulcers B. Pseudomembranes C. Dense accumulation of distended, foamy macrophages D. Enlarged, sharply delineated Peyer patches E. Abundance of M cells in dome epithelium

C. Dense accumulation of distended, foamy macrophages

Bruce Wayne arrives to the ER with symptoms of a parasitic infection. Unfortunately, the lab had a power outage and tests cannot be run at this time. Because of this the doctor takes an extensive patient history to hopefully narrow down what organisms it may be. Which of the following history questions has the correct organism associated with it? A. Do you own any cats? (Plasmodium falciparum) B. Have you noticed any mosquito bites on you? (Toxoplasma gondii) C. Do you own any cats? (Toxoplasma gondii) D. Have you gone swimming in warm water recently? (Plasmodium falciparum) E. Have you noticed any mosquito bites on you recently? (Naegleria fowleri)

C. Do you own any cats? (Toxoplasma gondii)

A 32-year-old male patient presents to the clinic with complaints of abdominal cramps, nausea, vomiting, and watery diarrhea. The patient has recently traveled to Costa Rica for a business trip and started experiencing these symptoms two days after the trip. What organism is most likely responsible for these symptoms? A. Clostridium Difficile B. Yersinia Enterocolitica C. Enterotoxigenic Escherichia coli D. Shigella E. Entamoeba Histolytica

C. Enterotoxigenic Escherichia coli

A 25 year old medical student is anxiously finishing up final revisions for his GI examination in an hour. The student appears pale, sleep deprived, and slightly diaphoretic. He feels unprepared despite studying hours for the exam. Just a few minutes before the exam starts, the student suddenly has a strong urge to use the restroom and has massive diarrhea. Which of the following could be the most probable cause of the diarrhea? A. Excessive stimulation of the sympathetic nervous system B. Inflammation of the GI tract C. Excessive stimulation of the parasympathetic nervous system D. Immune response from a bacterial infection E. Hyperactivity of parietal cells

C. Excessive stimulation of the parasympathetic nervous system

A 54-year-old male, who recently visited his family in Germany, presents to his PCP with abdominal pain, bloating, diarrhea, nausea, and vomiting. He tells the physician that he lost weight recently due to loss of appetite and complains of light, foul-smelling stools. He also recently underwent a Whipple procedure to remove the head of his pancreas due to malignancy. Which of the following should the physician expect to see increased in the patient's stools? A. Blood B. Entamoeba histolytica cysts C. Fat D. ETEC E. Leukocytes

C. Fat

A 68 year old male has an upcoming birthday, and is very excited. However, he has been diagnosed with metabolic syndrome which explains his significantly low HDL levels from last week's bloodwork. Even though he has been advised to watch his diet, he devours cake, ice-cream, and a delicious, greasy birthday dinner. Which of the following best explains the mechanism of fat digestion from his delicious birthday dinner? A. Fat is primarily digested by lingual lipase in the stomach, and only absorbed later in the colon B. Fat emulsification involves polar head groups of bile salts projecting inward in micelle formation, allowing absorption in the duodenum C. Fat is emulsified in the by bile acids, and then digested by pancreatic lipase in the small intestine D. Fat is made more readily fragmentable by lecithin, and absorbed as VLDLs into the enterocyte E. Fat is emulsified in the small intestine by bile acids, and then digested by pancreatic amylase

C. Fat is emulsified in the by bile acids, and then digested by pancreatic lipase in the small intestine

The small intestine is one of the primary sites of nutrient absorption in the human body. Which of the following is not responsible for increasing the mucosal surface area/assisting with absorption? A. Villi B. Microvilli C. Flagella D. Brush Border E. Folds of Kerckring

C. Flagella

Carbohydrates are primarily absorbed in the form of monosaccharides, such as glucose. Absorption of glucose occurs in the intestinal tract via a glucose-sodium cotransporter. If sodium wasn't present, what effects, if any, would this have on intestinal glucose absorption? A. Intestinal absorption of glucose will not be affected B. Intestinal absorption of glucose will slow down C. Intestinal absorption of glucose will not occur D. Intestinal absorption of glucose will speed up E. Intestinal absorption of glucose will slow down, adapt, and then return to normal

C. Intestinal absorption of glucose will not occur

A 19-year-old visits his primary care physician after experiencing problems with his eyes. He wears contacts every day and admits that he does not take them out every night as instructed. His physician takes scrapings from his eye and observes ameba with both trophozoites and cysts present in the tissue. What organism is most likely responsible for his eye infection? A. Naegleria B. Escherichia coli C. Toxoplasma gondii D. Acanthamoeba E.Plasmodium falciparum

D. Acanthamoeba

A 20-year-old female presents to urgent care with complaints of bloating, gas, and abdominal pain. The patient reports that she is lactose intolerant and forgot to take a Lactaid pill prior to consuming ice cream a few hours prior to the visit. Which of the following is the function of the deficient enzyme that is causing the patient's symptoms? A. Breaks down sucrose into glucose and galactose B. Breaks down lactose into fructose and galactose C. Breaks down maltose into two glucose molecules D. Breaks down lactose into glucose and galactose E. Breaks down sucrose into fructose and glucose

D. Breaks down lactose into glucose and galactose

A 45-year-old female visited the ER because she was suffering from a Respiratory Tract infection and the doctor prescribed her to take Ciprofloxacin 500 mg orally every 12 hours to help relieve the symptoms. After a week, the female patient was admitted to the ED with a fever of 103.5 Farheinhiet and complains of abdominal cramps and was dehydrated. The stool sample collected was watery diarrhea with leukocytes presented in the stool but no signs of any blood. The doctor ordered the patient to stop taking the ciprofloxacin and recommend her to take Metronidazole which will be an effective solution. Which of the following pathogenesis would best match the symptoms shown in the patient? A. Enteroinvasive E.coli (EIEC) B. Schistosomiasis C. Enterohemorrhagic E.coli (EHEC) D. C. difficile E. Yersinia

D. C.difficile

A couple present to the clinic after returning from a cruise in the Caribbean. They both complain of fever, chills, vomiting and diarrhea. Due to the recent travel history and adequate time spent in close quarters, the physician believes the two patients have winter vomiting disease. What is the family and genome of this virus? A. Orthomyxovirus, SS -RNA B. Paramyxovirus, SS -RNA C. Rotavirus, DS RNA D. Calicivirus, SS +RNA E. Flavivirus, SS +RNA

D. Calicivirus, SS +RNA

A 33-year-old female was visiting her family in Asia over the summer. She was used to her filtered water here in the states, but her family instructed her that it was safe to drink water from the nearest step well. She came back to the states with no symptoms and carried on with her life. About a year later, she noticed a blister started to form on the side of her foot and went to her doctor immediately. She described a burning sensation and intense pain in her foot where the blister was located. What is the infectious form of the organism described? A. Trophozoites B. Cercariae C. Trypomastigotes D. Copepods E. Promastigotes

D. Copepods

A 45-year-old Caucasian male presents to his primary care physician complaining of diarrhea, fatigue and joint pain for the past month. He also mentions that he has been steadily losing weight for the past 6 months. He denies any recent changes to his diet. A PAS stain and an acid-fast stain are performed, which confirm the physician's diagnosis. Which of the following is a characteristic of the disease described by the patient's symptoms? A. FOXP3 gene mutation B. Purulent pseudomembranes C. Attaching and effacing (A/E) lesions D. Foamy macrophages with gram-positive microbes E. NKG2D and MIC-A interaction

D. Foamy macrophages with gram-positive microbes

A researcher is studying glucose uptake through the intestinal epithelium. Using animal subjects, he removes the Na/K ATPase transporters on the basolateral side of the epithelial cell membrane. What will happen to the transport of glucose on the apical side in these animals? A. Glucose will enter the cell through an exchange with HCO3- B. Glucose will enter the cell through facilitated diffusion C. Nothing changes D. Glucose will not enter the cell due to the buildup of sodium in the cell E. Glucose will use paracellular diffusion to enter the interstitial fluid

D. Glucose will not enter the cell due to the buildup of sodium in the cell

A 24-year-old female presents to the emergency department with complaints of fever, myalgia, abdominal pain, headache followed by acute watery diarrhea. A routine stool culture showed evidence of inflammation with positive fecal leukocytes and lactoferrin. When asked if she had change anything in her diet, she noted that she recently switched from being fully vegetarian to incorporating lean proteins into her diet such as chicken breast. What is a complication related to the bacteria that she is infected with? A. Hemolytic -uremic syndrome B. Thrombotic thrombocytopenia purpura C. Reiter's Syndrome D. Guillain-Barre Syndrome E. Amebic abscess

D. Guillain-Barre Syndrome

A 32 year old male patient visits his primary care doctor for an annual physical check-up. While his doctor was ordering a lab test to check his cholesterol level, she asked him whether he has eaten anything since last evening, to which he responded yes. The patient completely forgot about the fasting instructions and ate a big breakfast this morning. All of the components of his meal, which includes macromolecules of lipid, carbohydrate and protein, are broken down into monomers inside of his body by which of the following chemical reactions: A. Neutralization reaction B. Displacement reaction C. Combustion reaction D. Hydrolysis reaction E. Condensation reaction

D. Hydrolysis reaction

A 16-month infant presents to your pediatrician office with his parents. His parents report that he has been vomiting for the past 4 days with associated cough and coryza. The infant recently started going to daycare around 3 months ago, after his mother started a new job. You suspect that the causative agent is a naked, dsRNA virus. What is the mechanism of infection for this particular virus? A. Macrophages accumulate within the small intestine lamina and mesenteric lymph nodes. B. Direct invasion of epithelial cells. C. Use of adhesins. D. Infection and destruction of mature enterocytes in the small intestine. E. Release cytotoxins that cause direct epithelial damage.

D. Infection and destruction of mature enterocytes in the small intestine.

Private Ryan, a 21-year-old male serving in the United States army pays a visit to his primary care physician during his return home for the Thanksgiving holiday. His chief complaint to his doctor is that he had a red papule on his arm during his deployment in Iraq. After about 2 weeks, the papule began to ulcerate and gradually leaked a thin, serous material. Based on this clinical description, what vector did Private Ryan come in contact with? A. Dirt fly B. Tsetse Fly C. Ixodes Scapularis D. Lutzomyia Sandfly E. Anopheles Mosquito

D. Lutzomyia Sandfly

A 49 year old male presents to his PCP with complaints of abdominal pain that radiates to his back. He claims that the pain feels worse after he eats, and he usually feels nauseous. When asked about alcohol and drug consumption, the patient claims no prior drug usage but that he has been drinking chronically for nearly 20 years. After performing an amylase test, the serum amylase activity was elevated at 351 units/L (normal range: 30-220 units/L). What is the patient's diagnosis? A. H. pylori infection B. Ulcerative colitis C. Hirschsprung's Disease D. Pancreatitis E. Megaesophagus

D. Pancreatitis

A patient is told by their physician that they are lacking an enzyme that is essential for digesting a major protein found in the connective tissue of meats. This digestion allows for other enzymes to penetrate ingested meats, and without it, meats may be poorly digested. What is the enzyme and which protein fibers does it digest? A. Trypsin; collagen fibers B. Pepsin; elastin fibers C. Chymotrypsin; collagen fibers D. Pepsin; collagen fibers E. Trypsin; elastin fibers

D. Pepsin; collagen fibers

A 65-year-old female presents to the emergency room with complaints of fatigue, nausea, heartburn and severe abdominal bloating. After obtaining the patient's medical history, it is discovered that the patient has been suffering from long-term alcohol abuse. A form of gastric atrophy is suspected, which resulting condition would you expect to find and what complications could occur as a result of that condition? A. Achalasia; The ulceration of the mucosa B. Achlorhydria; Increased production of pepsin in the gut C. Sprue; Osteomalacia D. Pernicious anemia; Decreased B12 absorption E.Megacolon; Constipation

D. Pernicious anemia; Decreased B12 absorption

A 26-year-old female patient presents to the emergency department with bloody diarrhea (dysentery). The patient is a mother of 2 young children in daycare who have similar symptoms. What is a likely organism and category of the diarrhea? A. V. cholerae- enterotoxin B. V. cholerae- cytotoxin C. Shigella dysenteriae- enterotoxin D. Shigella dysenteriae- cytotoxin E. Shiga toxin- producing strain of E. coli (STEC)- enterotoxin

D. Shigella dysenteriae- cytotoxin

Which of the following transporters absorbs sodium across the basolateral membrane in the intestinal epithelium? A. Sodium-Glucose Co-transporter B. Sodium-Hydrogen Exchanger C. Sodium-Chloride Symporter D. Sodium-Potassium ATP-ase pump E. Sodium-Amino Acid Co-transporter

D. Sodium-Potassium ATP-ase pump

A 46-year-old male has presented to his primary care physician with digestive issues and serious pain in his heart. The patient has taken it upon himself to become a master of WebMD and diagnosed himself with esophageal cancer. After multiple tests and treatment with omeprazole, it was confirmed severe heartburn. After carefully educating the patient about avoiding fats and chocolate; what part of the patient's digestive tract is the poorest absorptive area only absorbing a few highly lipid soluble substances? A. Valvulae conniventes B. Large intestine C. Pancreas D. Stomach E. Small intestine

D. Stomach

A 13-year-old patient presents to his primary care physician with his mother with concerns of his diarrhea, bloating, loss of appetite, and weight loss over the past couple weeks. The mother states that the only recent change is that they switched to a ketogenic diet. What could be the cause of the patient's symptoms? A. The patient's sodium co-transporter is not functioning properly. B. The patient's unable to absorb his monosaccharides via facilitated diffusion. C. The patient's secondary active transport system is not functioning properly. D. The patient does not have enough functioning micelles. E. The patient is unable to directly absorb short-chain fatty acids.

D. The patient does not have enough functioning micelles.

A woman presents to the emergency room with abdominal pain, diarrhea, and vomiting. After inspection of her diarrhea, the physician notes the stool is clear with small flecks of mucus and looks like rice-water. What pathogen is the most likely cause of these stools and how should the patient be treated? A. Campylobacter jejuni, erythromycin B. Campylobacter jejuni, rehydration and electrolytes C. Noncholeraic Vibrio, fluoroquinolone D. Vibrio cholerae, rehydration and electrolytes E. Enterotoxigenic Escherichia coli, fluoroquinolone

D. Vibrio cholerae, rehydration and electrolytes

A 27 year old man on a mission trip falls ill and meets the local doctor. He expresses complaints of profuse watery diarrhea with a strong odor and dehydration. Within 24 hours, the man had passed. The doctor has no way of testing the stool samples, if they did, what would they find? A. A spore forming gram negative rod B. A toxin producing gram negative bacillus C. A spore forming gram positive bacillus D. A protozoan parasite/ parasitic cysts and trophozoites E. A toxin producing gram negative curved rod

E. A toxin producing gram negative curved rod

A patient presents to the ER with flaccid paralysis. After getting a history from the patient, they admit to consuming an undercooked chicken sandwich. What virulence factor of Campylobacter jejuni is causing the patient's symptoms? A. Spore that passes the blood brain barrier B. Pathogenicity island C. Exotoxin production D. Flagella that invade the CNS E. Cross reactivity of LPS and gangliosides

E. Cross reactivity of LPS and gangliosides

An 8 year old boy is taken to their PCP regarding a fever and dysentery. During the history, the patient does state that he had been to a restaurant 3 days ago and had some poultry that was very pink and looked very unusual; but being a kid, he didn't think about it and ate his dinner. As the provider dwindled down their options, they were coming back to Salmonella. For this Enterobacteriaceae, what is the molecule that induces the mucosal damage, causing dysentery? A. Heat Stable Toxin B. Th1 T Cells C. Type III Secretion System D. Heat Labile Toxin E. Eicosanoid Hepoxilin A3

E. Eicosanoid Hepoxilin A3

A 23 year old patient comes into the ER with non bloody diarrhea. The morphology of the bacteria is a "stacked brick" appearance. What strain of Enterobacteriaceae does the patient have? A. Enterohemorrhagic E. coli B. Enterotoxigenic E. coli C. Enteropathogenic E. coli D. Enteroinvasive E. coli E. Enteroaggregative E. coli

E. Enteroaggregative E. coli

Upon being picked up from daycare, the parents of a 4 year-old male noticed the child showing exacerbated agitation around his perianal region, as displayed by excessive itching and irritation. Upon examination by his pediatrician, the child's diagnosis was confirmed with the tape test. What family of parasitic helminths does the causative organism belong to? A. Trypanasoma Cruzi B. Ancylostoma duodenale C. Trichuris Trichiura D. Onchocerca volvulus E. Enterobiasis

E. Enterobiasis

A 42-year-old female presents to the emergency department with abdominal pain, nausea, vomiting, and heartburn. She states that antacids seem to help a little, but don't completely take away the symptoms. In taking a medical history, the physician discovers that the patient has been taking a large amount of NSAIDs for months due to chronic knee pain. The physician suspects a peptic ulcer. Which of the following is not a cause for a peptic ulcer? A. Irritation B. High acid and pepsin content C. Poor blood supply D. Infection with H. pylori E. Increased pyloric gland secretions

E. Increased pyloric gland secretions

A 71 year old man presents to the ER with diarrhea and intense pain in the joints. He notes symptoms began while harvesting strawberries and herding cattle as his primary occupation is farming. He also suspects to have lost weight recently and reports an increased tendency to experience food cravings. After ordering a CBC, the doctor notes an increase in macrophages. Physical exam is not notable with exception of pain during lymph node examination. Which of the following answers is most likely associated with the patient's condition? A. Increased lymph drainage B. Upregulation of macrophage synthesis in lymph nodes C. Accumulation of granulocytes D. Increased absorption in small intestine E. Lymphatic obstruction

E. Lymphatic obstruction

A 21-year-old male by the name of Peter Parker accompanied his girlfriend to Africa to protect her as she foolhardily embarked upon a month-long journalism trip with no regard for her safety or health. His girlfriend (MJ) as usual got herself entangled with some dangerous criminals and contracted benign tertian malaria. Peter Parker, being a scientist himself, immediately diagnosed her based on her symptoms of a recurring pattern of chills, fever, and malarial rigors. What is the name for these set of symptoms? A. Hibby-Jibbies B. Febrile Periodicity C. Quotidian D. Exoerythrocytic Cycle E. Paroxysms

E. Paroxysms

Twenty-year-old Mary Jane Watson comes into the hospital with a paroxysms of fever, chills, and malarial rigors that appear generally every 48 hours or so, as best as her boyfriend can tell. She tells that she has just gotten back from Africa on a month-long journalism trip and the symptoms hit her just as she was getting home. Blood smears show the enlarged RBCs with Schüffner dots and golden-brown hemozoin pigment granules. The doctors also find that she is indeed positive for the Duffy blood group antigen on the RBC surface. What bacteria is MJ infected with? A. Babesia microti B. Leishmania columbiensis C. Leishmania peruviana D. Plasmodium falciparum E. Plasmodium vivax

E. Plasmodium vivax

A 37-year-old female presents to the clinic complaining of nausea, abdominal pain, and diarrhea. During the patient interview, she states the symptoms did not begin until after she moved back to her childhood home to help her aging parents run their cattle farm. Due to the general nature of her symptoms, a stool sample is taken for examination. Microscopy shows the presence of sporocysts in her stool. What is the method of treatment for this patient? A. Metronidazole, followed by iodoquinol B. Doxycycline C. Trimethoprim-sulfamethoxazole D. Pyrimethamine and Sulfadiazine combination E. There is no known treatment method

E. There is no known treatment method

A 27-year-old male is brought into the Urgent Care Clinic by his parents with complaints of muscle pain, fever, and rigors. His parents inform you that he has been "acting strange" and has unintentionally lost a lot of weight within the last week. Upon obtaining a travel history they explain how they returned the previous week from visiting their family in Africa. The physician suspects the patient has a parasitic infection by T. b. rhodesiense which is confirmed by blood and spinal fluid examination. Which of the following is not a characteristic of T. b. rhodesiense? A. Myocarditis B. Kidney damage C. Rapid CNS disease D. Rapidly fatal E. Winterbottom sign

E. Winterbottom sign

In order to neutralize the acids created by bacteria in the large intestine, which of the following is necessary for this function ? A. Na+/glucose co-transporter B. bile salts C. Vitamin K D. Na+/H counter-transporter E. bicarbonate/chloride counter-transporter

E. bicarbonate/chloride counter-transporter

A 21-year-old male presents to the Emergency Department complaining of fever, gastrointestinal distress, and muscle pain. A complete blood count is preformed, and the patient presents with marked eosinophilia. Upon taking the patients history the physician recalls that the patient has just moved out on his own after college and was recently experimenting with new pork dishes for dinner. What is the patient diagnosed with? What was the likely cause of infection? A. Ascaris lumbricoides; undercooked, dried, or smoked pork B.Trichinella spiralis; undercooked, dried, or smoked pork C. Enterobius vermicularis; undercooked beef D. Trichinella spiralis; seafood E. ETEC; Enterotoxigenic Escherichia coli

b) Trichinella spiralis; undercooked, dried, or smoked pork

Nancy C., female, 43-year-old, arrived to the emergency room with complaints of an extremely painful nodule on her left ankle. Upon examination, the attending physician determined the nodule to be a pruritic Calabar swelling. The last time Nancy traveled out of the country was 14 months ago, in which she was exploring the congo river basin on her honeymoon. What is the likely causative agent and the vector? A. ​L.loa and blackflies B. L.loa and monkeys C. L. loa and Chrysops, Mango fly D. Wucheria bancrofti and mosquito E. Erichinella and rabid ferrets

c) L. loa and Chrysops, Mango fly

A 45-year-old female with a history of left toe amputation, uncontrolled diabetes, and left eye blindness presents to the emergency department complaining of right upper quadrant abdominal pain. Lab work performed in the ED showed elevated ALT and AST. Gastroenterology and general surgery were consulted on the case prior to general surgery taking lead and opting for surgical intervention of suspected gallstones following a positive ultrasound. Following initial incisions of the patient's abdominal wall, "knobby coated" oval eggs were observed by operating room staff. Which of the following organs is NOT affected during the migration of this organism? a) Lung b) Liver c) Small Intestine d) Heart e) Spleen

e) Spleen