Clinical Integration Exam 2
A 27 year old female presents to the emergency room with chills, fever, and vaginal bleeding 48 hours after a spontaneous abortion. Upon analysis the patient was determined to have a septic abortion from an infection that was introduced into the uterus, as well as underlying HIV. A blood analysis was performed and high levels of S protein were detected. Which strain(s) of Campylobacter species is this patient most likely suffering septicemia from? -C. jejuni -C. coli -C. upsaliensis/ C. jejuni -C. fetus -C. jejuni /C.coli
C. fetus
A patient has been diagnosed with gastroenteritis. The organism that she is infected by is a gram-negative, comma shaped rod. This species causes vascular infections like bacteremia, arthritis, septic abortion and its common hosts are cattle and sheep. It is resistant to complement-and antibody-mediated serum killing. What is the specific campylobacter species being described above? -C. jejuni -C. coli -C. upsaliensis -C. fetus -S. protein
C. fetus
Which of the following is consumed by humans but not hydrolyzed by the enzymes of the human digestive tract? A. Sucrose B. Starch C. Cellulose D. Lactose E. Maltose
Cellulose
Sodium plays an important role in helping to absorb carbohydrates and amino acids within the small intestine. Which ion utilizes the positive electrical gradient created by sodium to passively exit the intestinal epithelium through the basolateral membrane for absorption? A. Hydrogen B. Chloride C. Bicarbonate D. Potassium E. Iron
Chloride
A 72-year-old heart transplant patient has been in the hospital for several weeks and is currently taking clindamycin along with several immunosuppressants. During rounds, his nurse reports that the patient now has a fever, elevated WBC count, and frequent watery bowel movements. The doctor discontinues the clindamycin and orders a stool sample be sent to the lab for enzyme immunoassay, nucleic acid amplification test, and glutamate dehydrogenase test. What is the likely causative bacterial agent? -Vibrio cholerae -Rotavirus -Clostridium difficile -Norovirus -Giardia lamblia
Clostridium difficile
A 77 year old patient presents to the emergency department with worsening diarrhea and abdominal discomfort for the past few days. The patients describes the diarrhea as watery with little to no blood. A physical examination reveals the patient has a fever of 102 degrees. The patient states that they are currently on antibiotics for a respiratory infection. A stool sample is taken, and a test confirms the presence of a toxin that can cause pseudomembranous colitis. What organism is most likely causing this patients diarrhea and abdominal discomfort? -Clostridium difficile -Vibrio cholerae -Salmonella -E. coli
Clostridium difficile
A 30-year-old female patient with a medical history of occult colon cancer and diabetes presents to the emergency room with a severe case of myonecrosis that began 2 days ago with no known recent trauma. Patient is admitted into the hospital and expires later that night. Which of the following bacterial species are most likely the result of her symptoms. Clostridium septicum Clostridium botulinum Clostridium tetani Clostridium difficile Clostridium tertium
Clostridium septicum
A 38-year-old male with a medical history of type II diabetes presents to the emergency department with high grade fever and abdominal pain. He states that he fell while gardening four days ago. Physical examination reveals the presence of a painful blister on his right foot. A sample was taken from the blister, stained and cultured on blood agar. Gram-positive rods were observed as well as anaerobic sporulated Gram-positive bacillus. Which of the following is the most likely cause of infection? -Necrotizing Fasciitis -Clostridium tertium -Localized tetanus -Clostridium sordellii -Clostridium perfringens
Clostridium tertium
A 26 year old patient presents to the emergency room with extreme gastrointestinal discomfort. After several exams, it is determined that the patient is suffering from gastric atrophy and the pH of their stomach after maximum stimulation remains above 6.5 due to a complete lack of HCl secretion in the stomach. What condition would be included in the patient's diagnosis? A. Lactose Intolerance B. Achlorhydria C. Sickle Cell Anemia D. Peptic Ulcer caused by H. pylori infection E. Megaesophagus
Achlorhydria
A 68- year old woman presents to the emergency department with complaints of bloody diarrhea with severe pain in the abdomen and stomach area. Her medical history was not unusual and she has not undergone regular health checkups. She reports that she enjoys seafood and typically has sushi at least once a week. When asked about recent travel, she reports going canoeing on Lake Erie a few days prior. Microscopic findings show gram negative straight bacilli. Further tests were conducted and it was discovered that the bacteria does not grow on TCBS (thiosulfate- citrate-bile salts-sucrose) agar. What genus does this bacteria belong to? -Vibrio -Clostridium -Listeria -Aeromonas -Lactobacillus
Aeromonas
The final products of carbohydrate digestion are all water soluble monosaccharides that are absorbed immediately into the portal blood. Which pairing of intestinal epithelial enzyme/end product is INCORRECT? A. Lactase → galactose B. Sucrase → fructose C. Maltase → glucose D. 𝞪-dextrinase → glucose E. All of these answer choices are correct
All of these answer choices are correct
A 27-year-old male, day care worker presents to his PCP with chief complaint of diarrhea, fever, and abdominal pain that started about 4 days ago, but decided to come in once he saw blood in the diarrhea. After taking stool sample cultures, the PCP diagnoses him with a gram negative, hydrogen sulfide negative, facultative anaerobe. What treatment plan is most likely prescribed for this patient to shorten the clinical course? Ibuprofen IV fluid only Antibiotic treatment Antidiarrheal medication Pepto Bismol
Antibiotic treatment
A 36-year-old male has been seen by his GI physician for a routine appointment. He often has bloody diarrhea, fever, and stomach cramps. He is diagnosed with gastroenteritis as a result of contracting Campylobacter jejuni infection by consuming undercooked seafood at a summer family reunion party. He is treated with fluid and electrolyte replacement therapy, but his body doesn't seem to respond well. The Gastroenterologist must advise the patient to immediately start taking which of the following for his rising gastroenteritis severity? -Omeprazole -Ciprofloxacin -Levofloxacin -Azithromycin -Metronidazole
Azithromycin
In celebration of a successful rocket launch, Elon ate his favorite fried rice dish (with lots of vegetables and bean sprouts) that has been left out, unrefrigerated, overnight. 5 hours after eating, he experienced vomiting and diarrhea, but did not have a fever. If it was determined that these symptoms were caused by ingestion of a preformed toxin, which bacterial strain is most likely the culprit? -Giardia lamblia -Campylobacter jejuni -Bacillus cereus -Vibrio cholerae -Cryptosporidium parvum
Bacillus cereus
The hormone released by S cells in the mucosa of the duodenum and jejunum stimulates copious secretion of what substance? -Pancreatic enzymes -Bile -Glucagon -Bicarbonate ions -Insulin
Bicarbonate ions
A 24 year old female has an excessively extended duodenum that triggers her to vomit. What action will not occur during the preparation of the vomiting act? A. Raising of the hyoid bone B. Descending of the soft palate to open posterior nares C. A deep breath D. Downward contraction of the diaphragm E. Closure of the glottis
Descending of the soft palate to open posterior nares
What are the two most important functions of bile? -Digestion and absorption of fat; excretion of bilirubin out of blood -Digestion of proteins; excretion of amino acid out of blood -Absorption of amino acids; excretion of bilirubin out of blood -Digestion of carbohydrates; Absorption of glucose -Digestion of proteins; excretion of heme out of blood
Digestion and absorption of fat; excretion of bilirubin out of blood
A patient, 25-year-old male, comes into see the physician complaining of abdominal pain, diarrhea, nausea, and fatigue. The physician takes a history and finds out that the patient had been on a fishing trip along a lake with a friend a few days ago. The patient discloses that for the duration of the trip he and his friend ate the fish they caught and cooked them over the fire. The friend that travelled with the patient is not experiencing any symptoms. The doctor has a CBC done and finds that the patient has an MCV of 98 fL (normal = 80-95 fL) and reticulocyte count of 0.3% (normal = 0.5-2%). What organism is most likely responsible and what would be expected to be observed in the stool sample? -Diphyllobothrium latum, proglottids/eggs in stool -Ascaris lumbriocoides, eggs in stool -Giardia intestinalis, cysts in stool -Enterobius vermicularis, eggs from the Scotch tape test -Necator duodenale, eggs in fecal smear
Diphyllobothrium latum, proglottids/eggs in stool
Chaise comes into the clinic complaining of an abrupt onset of watery diarrhea that resembles rice water, vomiting, and abdominal pain. He recently went to Haiti after their earthquake, to help those affected by the disaster. A gram stain is done, and it is found that the causative agent is a gram negative, comma shaped bacteria. Which of the following is the primary way to transmit this disease? -Sexual Intercourse -Drinking contaminated water -Sharing a towel -Puncture wound
Drinking contaminated water
Tom, a 22-year-old male presents to the clinic with explosive watery diarrhea and abdominal cramps for 2 days. He states that he came back from a trip to Mexico 4 days ago and remembers eating questionable food from a buffet. He was diagnosed with Traveler's Diarrhea. What's the most common cause of Traveler's Diarrhea? -ETEC -EPEC -EHEC -C. difficile -STEC
ETEC
A 27-year-old male infected with HIV presents to the Emergency Department with diarrhea. He is diagnosed with a type of E. coli. This type of E. coli contains adherence of brick-like rods to the epithelium surface and a mucus biofilm that inhibits the absorption of fluids. What type of E. coli was the patient diagnosed with? -Enterotoxigenic (ETEC) -Enteroinvasive (EIEC) -Enteroaggregative (EAEC) -Enterohemorrhagic (EHEC) -Enteropathogenic (EPEC)
Enteroaggregative (EAEC)
Which of the following pathogenic Escherichia coli produce Shiga-like toxins and cause clinical symptoms similar to those resulting from S. dysenteriae infection? Enteropathogenic E. coli Enterohemorrhagic E. coli Enterotoxigenic E. coli Enteroaggregative E. coli Enteroinvasive E. coli
Enterohemorrhagic E. coli
A 65-year-old patient presents to his primary care physician with a chief complaint of severe diarrhea and abdominal cramping that started 2 days ago and is not resolving. Patient's PCP learns that the patient was prescribed Clindamycin 7 days ago after visiting the ER for a bacterial infection. Colonoscopy reveals the patient has pseudomembranous colitis. Which of the following toxins is responsible for the patient's severe diarrhea? -Beta Toxin -Epsilon Toxin -Enterotoxin (Toxin A) -Cholera Toxin -Tetanospasmin
Enterotoxin (Toxin A)
A four-year-old child comes home from daycare on Friday feeling unwell, with symptoms of watery diarrhea. By Sunday, stool contents now contain blood and leukocytes, and the parents report that there is also significant straining during defecation. The child is diagnosed with shigellosis caused by S. sonnei, and the parents later find out that there was an outbreak at the daycare. What is the most likely route of transmission of shigellosis? -Zoonosis -Respiratory transmission -Flea vector -Traumatic inoculation -Fecal-oral
Fecal-oral
A 4-month-old infant ingested some honey while her unemployed mother neglected her to shoot a TikTok video. The infant began suffering some strange symptoms the next few days and was rushed to the emergency room. Which symptom does the infant most likely present with? -Flaccid Paralysis -Necrotizing Fasciitis -Anemia -Gout -Depression
Flaccid Paralysis
When high-protein food is consumed and reaches the antral end of the stomach, which cells are stimulated, and what do they release? -Parietal cells are stimulated to release intrinsic factor into the stomach -Enterochromaffin-like cells (ECL cells) are stimulated to release gastrin into the blood -G cells are stimulated to directly release hydrochloric acid into the stomach -Parietal cells are stimulated to release pepsinogen into the stomach -G cells are stimulated to release gastrin into the blood
G cells are stimulated to release gastrin into the blood
A 31 year old male presents to his urologist with infertility. His urologist determines that the patient is lacking expression of the transporter responsible for supplying his spermatozoa with fructose. He explains to the patient that this transporter is also found on the apical membrane of his intestinal epithelial cells where it is responsible for facilitating the absorption of fructose. Which of the following transporters does this describe? A. SGLT1 B. GLUT5 C. SGLT2 D. GLUT1 E. GLUT2
GLUT5
A 68 year old male presents to the emergency department with persistent nausea, vomiting, and the feeling of fullness. He describes that he has had similar episodes of symptoms in years past, but that they are becoming worse and more frequent. Lab diagnostics reveal that his infection is caused by a urease producing bacteria that is transmitted via the fecal-oral route. Which disease complication is the physician most worried about in this patient? -Scarlet fever -Gastric adenocarcinoma -Guillain-Barre syndrome -Reactive arthritis -Pseudomembranous colitis
Gastric adenocarcinoma
A 26-year-old male is taken to the emergency department because he has been experiencing profuse sweating, drooling and facial spasms. Upon examination, the patient informs the physician that he was recently in a bicycle accident that left him with a wound on his arm, which he never sought treatment for. There was no evidence of other wounds on the patient. Which of the following is the patient most likely suffering from? -Localized tetanus -Generalized tetanus -Cephalic tetanus -Neonatal tetanus -Wound botulism
Generalized tetanus
A 32-year-old male patient arrives to his PCP and explains that he is experiencing acute diarrhea and some unexplained weight loss. Upon further questioning the physician learns that the patient went camping with his friends for his bachelor party last month. The physician orders a stool sample and diagnoses the patient with the most common parasitic pathogen in humans. What pathogen was this patient infected with? -Trichuris trichiura -Enterobius vermiculari -Taenia solium -Plasmodium falciparum -Giardia lamblia
Giardia lamblia
What is the most common parasitic pathogen in humans worldwide?
Giardia lamblia
Which of the following bacterial infections produces an excess secretion of acid in the stomach? A. Helicobacter pylori B. Campylobacter jejuni C. Clostridium perfringens D. Clostridium difficile E. Vibrio cholerae
Helicobacter pylori
A 4 year-old patient presents to the emergency department with bloody diarrhea and rectal bleeding. Upon further examination, his temperature was 102.4° F , and the patient also complained of abdominal cramping and flank pain. The mother of the patient is worried that her son is not urinating enough, and states that there blood is present in his urine. The physician collects a stool sample as he is concerned that this may be a bacterial infection due to the patient's recent history of possible exposure to contaminated food or water. The sample was found to be positive for S. dysenteriae type 1 shigellosis. What major complication is this child presenting with? -Kidney Stones -Toxic Shock Syndrome -Hemolytic-Uremic Syndrome -Listeriosis -Reactive Arthritis
Hemolytic Uremic Syndrome
A 50 year old patient was treated for H. pylori 7 months ago. When screening the patient's serum what antibodies are most likely still present? A) IgA and IgG B) IgG and IgM C) IgM and IgA D) IgD and IgM E) IgA and IgD
IgA IgG
Feeling hungry and not wanting to make a trip to Walgreens in the snow, Michael decided to reheat 5 day salmon he had sitting in the fridge. In the time it was sitting in the fridge, a colony of Enterotoxigenic E. Coli (ETEC) began growing, and the microwave destroyed the heat-labile toxin produced by this bacteria. By what mechanism does the heat-stable toxin from ETEC cause diarrhea? -Increase in cGMP -Increase in cAMP -Invasion of intestinal cells -Neutralization of gastric acid -Inactivation of eukaryotic ribosome
Increase in cGMP
A researcher creates a targeted loss-of-function mutation in the Vibrio cholerae zot (zonula occludens toxin) gene. Due to this mutation, what will the bacteria no longer be able to do? -Adhere to the intestinal mucosal cells -Increase intestinal permeability -Induce hypersecretion of electrolytes and water -Bind to bacteriophage -Avoid phagocytosis
Increase intestinal permeability
A 27 year old female presents to the ER after cutting herself and being unable to stop the bleeding. Upon questioning, she also reports complaints of fatigue, weight loss, generalized weakness, lethargy, and pale and foul-smelling stools for the past two weeks, and that she had returned from visiting family in the Caribbean three weeks ago. What is the most likely cause of her symptoms? A. Consuming wheat and rye flour B. Excess secretion of acid and pepsin by the gastric mucosa C. Infectious agents D. Damage to cerebral nerves E. Sigmoid colon spasms
Infectious agents
A 20-year-old male comes to the traveler's clinic complaining of profound weakness, dehydration, no fever, and severe diarrhea of about two days duration. He has just returned from Nepal where he worked for one month in a refugee camp. While traveling on the plane he developed abdominal bloating, vomiting, intestinal gurgling followed by two loose bowel movements, and abrupt onset of watery diarrhea occurring hourly. What is the mechanism of transmission of this curved, gram-negative rod bacterium? -Ingestion of contaminated food and water -Ingestion of shellfish and seawater -Ingestion of milk -Ingestion of uncooked chicken -Ingestion of uncooked hamburgers
Ingestion of contaminated food and water
A 24-year-old female patient complains of intermittent diarrhea that started approximately one month ago; she states that the diarrhea has been happening ever since she went on a Caribbean cruise and has persisted since. The patient has also undergone a kidney transplant a few years ago due to an autoimmune condition and has been on an immunosuppressant ever since. Which of the following is true with regards to the most likely causative agent? -It contains a thick peptidoglycan wall -It has a very high infective dose at around 105 particles -It has a single-stranded RNA genome -It contains NSP4 proteins that destroy mature enterocytes -It is readily destroyed at freezing temperature
It has a single-stranded RNA genome
A 41-year-old male presents to his primary care's office complaining of lumps around his genitalia and inguinal area. The patient is an expat having just returned to the U.S after living in Vietnam for 17 years; says he developed a low grade fever the week he returned, and started noticing painless lumps and nodules two weeks after. The patient has no significant medical history and has been healthy otherwise. Upon taking sexual history the physician learns that the patient has not been sexually active for 6-8 weeks now. During the physical exam the physician notices a small, beefy penile ulcer resembling syphilitic lesions. Which organism and virulence factor is the primary cause of the patient's symptoms? -K. granulomatis, capsule. -K. ozaenae, toxin coregulated pilus. -K. oxytoca, polar flagella. -N. gonorrheae, hemolysins. -K. pneumoniae, protein capsule. -H. ducreyi, fimbriae.
K. granulomatis, capsule
A 69 year-old male patient presents to the Emergency Room with nausea, vomiting, bouts of severe abdominal pain and very frequent episodes of watery diarrhea. Patient reports that he has experienced 11 episodes of diarrhea within the past 5 hours and goes on to confirm that there was no blood in his stool. Through further history and physical examination, the ER physician is correct in deducing the diarrhea and secondary symptoms are viral in origin and starts the patient on IV fluids. Which IV fluid did the physician order for the patient? -Pure Water -D5W -Half Normal Saline -Lactated Ringer's Solution -⅔ D5W, ⅓ Normal Saline
Lactated Ringer's Solution
A 24 y.o. Patient presents to the ED with symptoms of septic shock. Samples were taken, and pathology confirms that the etiology of the suspected septic shock is due to LPS. Lipopolysaccharides (LPS) are composed of, and found in? -N-acetyl-glucosamine, N-acetyl-muramic acid: Gram negative bacteria -Lipid A, Core polysaccharide, O polysaccharide: Gram positive bacteria -Lipid A, Core polysaccharide, O polysaccharide: Gram negative bacteria -N-acetyl-glucosamine, N-acetyl-muramic acid: Gram positive bacteria -N-acetyl-glucosamine, N-acetyl-muramic acid: Acid fast staining bacteria
Lipid A, Core polysaccharide, O polysaccharide: Gram negative bacteria
A 28 year-old patient presents to her physician complaining of being unable to pass stool for the past several days and feels constipated. Her physician reveals that her patient has a deficiency of ganglion cells in the myenteric plexus in a segment of the sigmoid colon. Which of the following disorders of the large intestine is most likely evident? A. Ulcerative Colitis B. Enteritis C. Megacolon (Hirschsprung's Disease) D. Psychogenic Diarrhea E.Pancreatitis
Megacolon (Hirschsprung's Disease)
A 64-year-old male comes to the emergency room presenting with peptic ulcers. He has a history of being very excitable, and his sympathetic nervous system is likely being stimulated often. What function in the duodenum of this patient is being inhibited which would protect against these ulcers? -Water and electrolyte secretion of Brunner's glands -Mucus secretion of Brunner's glands -Mucus secretion of crypts of Lieberkühn -Mucus secretion of goblet cells -Mucus secretion of enterocytes
Mucus secretion of Brunner's glands
A 52 year-old male present to the emergency room vomiting blood, dark tarry stools, and burning stomach pains. Through culturing, it is determined that the patient has peptic ulcers caused by H. pylori. Of the potential virulence factors listed below, which is the most crucial for initial colonization in the host? -Capsule -Neutralization of gastric acids with the ammonia produced by bacterial urease activity. -Secretion of vacuolating cytotoxin A (VacA) -Surface adhesion proteins -Cytotoxin-associated gene (cagA)
Neutralization of gastric acids with the ammonia produced by bacterial urease activity
A 32-year-old immigrant from southeastern Asia complains of intermittent abdominal cramps. He has had multiple respiratory infections over the last two years as well as a persistent, chronic cough. Laboratory results are as follows: Complete Blood Count Hemoglobin 13.0 g/dL Leukocytes 6,800 cells/uL Neutrophils 56% Eosinophils 14% Lymphocytes 26% Monocytes 4% Which of the following findings in this patient would be most suggestive of a Strongyloides infection? -Parasite eggs in the stool -Perianal egg deposition -Proglottids in the stool -Noninfectious larvae in the stool -Trophozoites and cysts in the stool
Non-infectious larvae in stool
While on a cruise a 26 year old patient presents to the physician, presenting with diarrhea, vomiting, headache, mild fever and stomach cramps. The patient shares that she was playing with her toddler nephews when she noticed one of them pooped in the pool, so she grabbed it and disposed of it quickly. Approximately 15 hours later she began experiencing symptoms. After diagnosis from the physician, the patient is healthy within 3 days. What virus does the physician suspect the patient is suffering from? -Norovirus -Salmonella -Giardia Lamblia -Rotavirus -Poxvirus
Norovirus
A 26-year-old male presents to the emergency department with complaints of abdominal cramps and watery diarrhea but no fever, nausea, or vomiting. Last night he ingested leftover turkey with gravy, with clinical symptoms manifesting within 8 hours. The physician suspects food poisoning and laboratory results indicate gram positive, rod shaped and spore forming bacterium. Which of the following would be the most appropriate clinical intervention? -Oral rehydration -Antibiotic therapy -Vaccination -Metronidazole -Surgical debridement
Oral rehydration
A 34-year-old woman presents to the clinic after reporting having fatty stools, indigestion, and cramps for about a week. The physician believes there may be a disruption in the production of enzymes needed to digest triglycerides causing malabsorption. Which of the following enzymes is the most important enzyme for digestion of triglycerides? A. Lingual lipase B. Bile C. Enteric lipase D. Pancreatic lipase E. Elastase
Pancreatic lipase
5. A 70 year old man presents to the emergency room with severe upper abdominal pain that radiates to his back, nausea, and vomiting. His medical history includes hyperlipidemia and hypertriglyceridemia. He drinks 13 beers daily. Which of the following is the most likely cause of his symptoms? A. Sprue B. Pancreatitis C. Gastritis D. Enteritis E. Ulcerative colitis
Pancreatitis
Which of the following is true regarding autonomic stimulation of alimentary (GI) tract glandular secretion? -Parasympathetic stimulation of the alimentary tract inhibits glandular secretion. -Sympathetic stimulation of the alimentary tract always promotes glandular secretion. -Autonomic stimulation always stimulates alimentary tract secretion. -Parasympathetic stimulation of the alimentary tract promotes glandular secretion. -Sympathetic stimulation of the alimentary tract only occurs when parasympathetic stimulation is absent.
Parasympathetic stimulation of the alimentary tract promotes glandular secretion.
A patient comes into the emergency department complaining of nausea, vomiting, and fullness after eating. After some testing, the attending physician diagnosed her with chronic gastritis. The physician informs the patient that they may develop pernicious anemia as a side effect because of failure of red blood cell maturation in the absence of vitamin B12. Knowing this information, what cells are being disrupted and what gland of the stomach are they located in? -Parietal cells located in the oxyntic glands -Chief cells located in the oxyntic glands -Parietal cells located in the pyloric glands -Gastrin cells located in the oxyntic glands -Gastrin cells located in the pyloric glands
Parietal cells located in the oxyntic glands
What primarily controls the regulation of attachment, engulfment, and replication on the Salmonella bacterial chromosome? -Pathogenicity island I and II -Colonization factor -LEE pathogenicity island -Plasminogen activator (pla) protease gene -pInv genes
Pathogenicity island I and II
A 27-year-old woman presents to the urgent care with abdominal pain and bloating over the last month. She also complains of intermittent, copious, non-bloody diarrhea over the same time. Last month, she first noticed a small rash on her leg, and then developed a cough that has since improved but has not completely resolved. She has no sick contacts and has not left the country recently. Physical examination is notable for a small pink streak on her right leg. Serum laboratory studies are pending. Examination of her stool reveals the causative organism. This organism is most likely transmitted to the human host through which of the following routes? -Inhalation -Penetration of skin -Animal bite -Insect bite -Sexual contact
Penetration of skin
After a strenuous kickboxing workout, a medical student goes back to her apartment to make scrambled eggs for breakfast. Most of this protein will be digested in the upper small intestine by pancreatic proteolytic enzymes, which include all of the following EXCEPT: A. Trypsin B. Pepsin C. Carboxypolypeptidase D. Elastase E. Chymotrypsin
Pepsin
An 8-year-old patient arrives to the clinic with his mother with complaints of bloody diarrhea. He and his mother had just returned from Kansas while visiting extended family on their farm. His mother notes that he has eaten the same foods as the rest of the family, except for drinking fresh milk when he was helping his uncle with farm chores. The physician suspects a Campylobacter infection. What clinical feature is most likely not associated with Campylobacter jejuni? -Traveler's diarrhea -Reactive arthritis -Fever -Dysentery -Pharyngitis
Pharyngitis
A patient has been suffering from gastritis. A monoclonal immunoassay for H. pylori antigens excreted in the patient's stool was ordered and returned positive for the presence of H. pylori antigens. What is the most effective treatment course for this patient? -Nothing, H. pylori infection is self limiting. -Antibiotic -Bismuth + Antibiotic -Proton pump inhibitor -Proton pump inhibitor + Antibiotics
Proton pump inhibitor + Antibiotics
While doing rounds on nightshift, a GI resident reads a new patient's medical history that states he has not had a regular bowel movement in the past 3 days and is experiencing severe abdominal distention and pain. The medical history states that he was recently treated for a Vibrio infection 4 days ago and given Azithromycin while at a different hospital. After an abdominal exam and sigmoidoscopy, the resident suspects toxic megacolon. What would most likely be the cause of the patient's megacolon? A. Microvillus inclusion disease B. Whipple disease C. Trichuris trichiura infection D. Pseudomembranous colitis E. Cryptosporidium infection F. Intestinal obstruction
Pseudomembranous colitis
The microbe responsible for being the most common cause of bacterial diarrhea in the United States can be transmitted via all of the following except? A) Milk B) Fecal-oral C) Person-to-person D) Rodents E) Cattle
Rodents
Which of the following viruses is known to selectively infect and destroy mature enterocytes in the small intestine with a very specific compensatory immature epithelial cells of the villus surface? -Retrovirus -Norovirus -Adenovirus -Rotavirus -Rhinovirus
Rotavirus
A 50-year-old male presents to the emergency department with a fever, abdominal cramping, and mucous diarrhea that is progressively getting worse. He recalls that he attended a birthday picnic yesterday and the weather was very warm. He states that he didn't feel like eating much but did end up eating an egg salad sandwich. Which of the following pathogens is the most likely reason for his diarrhea? -Salmonella enteritidis -Salmonella typhi -Shigella dysenteriae -Enterotoxigenic Escherichia coli -Vibrio cholerae
Salmonella enteritidis
A patient presents with bloody diarrhea, lesions, hemolytic uremic syndrome, and ischemic colitis. The patient is a cow farmer. Their diet includes frequent beef consumption with meat being prepared in many ways. They state that those who he supplied the beef to, are also experiencing similar symptoms. Which toxin is causing the lesions that may also resemble the lesions produced by a different bacterial infection? -Heat-stable toxin -Shiga-like toxin -Shigella -EHEC -Cholera toxin
Shiga-like toxin
A 4 y/o female is brought to the emergency room by her mother, complains of watery diarrhea that started 2 days after they took a trip to the apple orchard, where they consumed cider donuts and apple cider juice. The mother notes that the symptoms started off as a watery diarrhea and then progressed into grossly bloody diarrhea 2 days later. She also notes that the child experienced emesis but denies any fever. Which virulence factor associated with E. coli is responsible for causing the above symptoms? -Sta toxin -HlyA -Entero-aggregative heat-stable toxin -Stx2 -LT-I
Stx2
A patient presents to the emergency department with complaints of abdominal pain, nausea, vomiting and abdominal tenderness on palpation. The patient is found to have Yersinia enterocolitica. Which of the following is least associated with the infection caused by this organism? Pork Raw milk Summer months/weather Winter months/weather Contaminated water
Summer months/ weather
A 26 year old male was seen in a hospital in Haiti 3 days after an earthquake. The natural disaster severely damaged the water supply and sanitation of waste removal systems. The patient complains of malaise, fatigue, and severe watery diarrhea. Which of the following virulence factors least likely contributes to the actions of the most likely causative pathogen? -Zonula occludens toxin -Accessory cholera enterotoxin -TCP -TDH -Chemotaxis proteins
TDH
. A 16 year old female arrives at the ER stating that she is experiencing severe motion sickness leading to vomiting, after riding multiple rollercoasters in Universal Studios, Orlando. It is well known that rapidly changing direction/rhythm of motion of the body can lead to some patients experiencing vomiting. What is the correct order of the following phenomenon mechanism? A. The impulses are transmitted mainly via the cerebellum to the vestibular nuclei into the brainstem, to the chemoreceptor trigger zone, to the vomiting center causing the vomiting. B. The impulses are transmitted mainly via the brain stem, to the chemoreceptor trigger zone, to the vestibular nuclei into the cerebellum then to the vomiting center causing the vomiting. C. The impulses are transmitted mainly via brainstem to the vomiting center, to the vestibular nuclei into the cerebellum, and to the chemoreceptor trigger zone causing the vomiting. D. The impulses are transmitted mainly via the cerebellum to the vestibular nuclei into the brainstem, to the vomiting center and to the chemoreceptor trigger zone causing the vomiting. E. The impulses are transmitted mainly via the brainstem to the vestibular nuclei into the cerebellum, to the chemoreceptor trigger zone, to the vomiting center causing the vomiting.
The impulses are transmitted mainly via the brainstem to the vestibular nuclei into the cerebellum, to the chemoreceptor trigger zone, to the vomiting center causing the vomiting.
A scientist is creating a new drug that inhibits the ileum and large intestines from secreting bicarbonate (HCO3-) and absorbing chloride ions (Cl-). If successful what would this drug most likely interfere with? A. The effects of aldosterone. B. The absorption of nutrients through SGLT1 and GLUT2 co-transporters. C. The digestion of fats through emulsification. D. The neutralization of acid products formed by bacteria. E. The function of Kerckring folds.
The neutralization of acid products formed by bacteria
Why is it advised to abstain from consuming food or drink prior to being placed under deep anesthesia? A. The possibility of developing muscle dystrophy. B. Achalasia could occur. C. Could lead to a damaged protective gastric mucosal barrier. D. The reflex mechanism of swallowing becomes blocked. E. The esophagus becomes spastically contracted and leads to complications
The reflex mechanism of swallowing becomes blocked
A 30 year old woman is admitted to her local hospital after presenting to the ED with abrupt onset diarrhea, vomiting, and severe dehydration. While admitted, her care team is careful to note any signs of metabolic acidosis and hypokalemia. There has been a community-wide increase in similar cases and infectious disease is concerned there may be an outbreak. Which of the following criteria sufficiently indicates an epidemic strain as the cause of these cases? -Contamination occurs only in warm months -The strain originate in contaminated water -Hyperinfectivity is lost within 24 hours of shedding -Contamination occurs year-round -The strain is monoclonal
The strain is monoclonal
A 45-year-old male presents to the ER with severe rapid onset of pain in his left leg. Physical examination reveals a laceration to the lower leg that is dark red and purple in color. The patient states the laceration occurred 3 days prior while he was digging up ground for a new pool he is installing. Lab tests show this is a gram positive, spore forming rod. If this patient did not come in for any medical intervention, what other symptoms could present in the following days? -Nothing, the wound would have self-resolved in the following week. -This could lead to muscle necrosis, renal failure, shock, and death without medical intervention -This could lead to a pseudomembranous colitis with profuse diarrhea, abdominal pain, and fever. -This could lead to bilateral flaccid paralysis that is ascending from the laceration. -This could lead to spastic paralysis, lock jaw, and trouble breathing.
This could lead to muscle necrosis, renal failure, shock, and death without medical intervention
A 29-year-old female presents to the ED with nausea, vomiting, and diarrhea. Her medical/surgical history is significant for having underwent a medically induced abortion six days ago. The patient's blood pressure falls to 80/40 and is rushed to the operating room where she dies. A pathology report of her uterine tissue is done and comes back with DNA from a gram-positive organism that is anaerobic and rod-shaped. What is the most likely organism that took host in this woman's uterus? -Toxic shock syndrome from Clostridium tertium is the most likely cause as this woman ingested soil during her pregnancy -Because of the stress of her abortion, this woman's immune system is compromised and Gardnerella vaginalis of her vaginal microbiome took host and caused a septic infection -The instruments used during her abortion were likely contaminated with Staphylococcus aureus leading to her subsequent septic infection -The woman lost so much fluid from her uncontrolled diarrhea that her blood pressure dropped due to an infection with Giardia lamblia -Toxic shock syndrome is likely the cause of death from Clostridium sordelli as this is associated with abortions
Toxic shock syndrome is likely the cause of death from Clostridium sordelli as this is associated with abortions
A 52-year-old female presents to the ER with upper abdominal pain as well as an abrupt onset fever. The physician diagnoses the patient with acute pancreatitis based on these symptoms. What is most likely the primary factor for this patient's condition? -Inhibition of enterokinase -Trypsin inhibitor is overwhelmed -Decreased activation of pancreatic enzymes -Trypsin inhibitor is working normally -Increased pancreatic secretion
Trypsin inhibitor is overwhelmed
A patient comes into the ER complaining of abdominal pain and stool that could be perceived as rice water like. After a conversation with the patient you discover they just came back from vacation and ate prominently seafood throughout their trip. What infection do you suspect this patient is suffering from? -Shigella -Salmonella -Vibrio cholerae -Enterotoxigenic Escherichia coli -Shiga toxin- producing E. coli
Vibrio cholera
Which of these organisms causes a disease state when there is consumption of freshly contaminated water, and in extreme cases can cause rapidly fatal diarrhea? -Vibrio parahaemolyticus -Aeromonas hydrophila -Aeromonas caviae -Vibrio cholerae -Vibrio vulnificus
Vibrio cholerae
A 25-year-old female presents to her physician with complaints of on-going diarrhea. She tells the physician that the diarrhea has lasted for 3 days, upon her return home from her honeymoon, where she ate a lot of shellfish. A stool sample was collected and processed for examination. Assessment of the stool sample showed the presence of a gram-negative curved rod, that is a fermentative, facultative anaerobe, that requires salt to grow. Also present was the Kanagawa hemolysin. Which of the following is most likely responsible for the patient's diarrhea? -Vibrio cholerae -Vibrio vulnificus -Vibrio parahaemolyticus -Aeromonas caviae -Aeromonas hydrophila
Vibrio parahaemolyticus
A group of students goes to a seafood restaurant to celebrate after a big midterm exam. The group enjoys a variety of shellfish and other local delicacies. The next morning, they head home but on the way several of them begin to feel a really urgent need for a rest area. Within the next hour, everyone is enjoying an explosive watery diarrhea, vomiting, nausea, abdominal cramps, and headaches. Once they got back home, they were still feeling intense symptoms, so they decided to go for a checkup. Vitals were normal and no one had fever. Which of the following diseases does this resemble? -Vibrio cholera -Vibrio parahaemolyticus disease -Aeromans wound infection -Vibrio vulnificus -Aeromonas veronii
Vibrio parahaemolyticus disease
A 30 year old female presents to the clinic with diarrhea, bloating, fatigue, and weight loss. She has been experiencing these symptoms ever since she has increased her gluten intake. Her physician thinks she may be presenting symptoms of celiac disease, which is an autoimmune disease that damages the lining of the small intestine. What is in the lining of the small intestine and what is its significance? A. Villi; increases the surface area of the absorptive mucosa B. Amylase; digestion of the starches C. Bile salts; digestion of fats D. Secretin; increases bile secretion E. CCK; increases digestive enzymes by acinar cells
Villi; increases the surface area of the absorptive mucosa
Which of the following statements is not true regarding laboratory diagnosis of enterobacteria infection? -Nucleic Acid Amplification Tests allow for simultaneous identification of multiple species. -Most species of enterobacteria can be identified by characteristic mass spectrometry of their protein profiles. -Use of differential agars help differentiate between lactose fermenting and lactose non-fermenting enterobacteria. -Warm Enrichment is a common culturing technique for certain species such as Y. enterocolitica. -Serologic testing is useful in identifying certain species such as E. coli 0157.
Warm Enrichment is a common culturing technique for certain species such as Y. enterocolitica. This is false because old enrichment NOT WARM is a common culturing technique for Y enterocolitica
A 24-year-old male patient with β-thalassemia calls into the clinic where he regularly goes for transfusions stating he has come down with a stomach bug and does not feel well enough to come in for his next appointment. When he fails to show up for the scheduled follow-up, the clinic learns he has been hospitalized with sepsis and is on the verge of death. Which of the following pathogens is the most likely cause of his "stomach bug"? -Vibrio cholera -Salmonella enterica typhi -Enterohemorrhagic Escherichia choli (EHEC) -Yersinia enterocolitica -Shigella dysenteriae
Yersinia enterocolitica
A 7-year-old child is brought to the pediatric office by his mother with a chief complaint of hypersalivation. A drug that affects salivary flow is administered. The goal of the drug is to decrease salivary flow. Which of the following changes in salivary ion secretions would this drug most likely trigger? down up down up
down up down up
A person previously exposed to rats develops a high fever, malaise, and painful bubo around their armpits and groin. They go to their doctor and are diagnosed with bubonic plaque. What gene is responsible for this organism's ability to degrade fibrin clots and spread rapidly? -pla -fl -YopH -YopE -YopJ/P
pla
