Micro Mod 7

Otitis media

-Can be associated with a viral or bacterial infection in the normally sterile middle ear. -Routine use of broad-spectrum antibiotics for treatment has lead to resistance; "watchful waiting" is now the recommendation.

Lyme Disease

-Caused by Borrelia burgdorferi -Transmitted by ticks. -Erythmea migrans (bulls-eye rash)

Diphtheria

-Caused by Corynebacterium diphtheriae, which produces an exotoxin; prevention by DTaP vaccination.

Plague

-Pneumonic and bubonic forms caused by Yersinia pestis. -Transmitted by the regurgitation of fleas when they bite new organism. -Inguinal bubo, hard painful nodule that can rupture.

Case Study Heartache Read the Chapter 18 case file and complete the activities that follow. Donna, a 22-year-old university student, came to the emergency room on a Friday night at the beginning of the school break for Christmas holidays. She had just completed taking her final exams. When she got home to her parents' house, her mother took one look at her and insisted she go to the emergency room. Donna had been complaining to her mother about feeling unwell for several weeks. When Donna had been home for Thanksgiving, she had been her usual self. She had had two wisdom teeth removed at that time but had healed quickly and denied any lingering oral symptoms. Shortly after Thanksgiving, Donna had begun to experience an intermittent fever and weakness. She stated that her joints were often painful. In the past several days, she stated that she had also had palpitations, feeling as though her heart were racing and beating erratically. She complained of feeling exhausted. Donna had chalked up her symptoms to the stress of her workload, too much coffee, and final exams. Donna's mother stated that Donna looked as though she had lost weight since her last visit home a month earlier. On exam, Donna had a temperature of 100.8°F (38.2°C). Her heart rate was abnormally fast at 112 beats per minute. Her blood pressure was low at 95/62 mmHg, and her oxygen saturation was 93%, which was a little lower than I expected for someone of Donna's age and condition. I listened to Donna's lungs, which were clear. When I listened to Donna's heart, I thought I detected a murmur. When I questioned Donna and her mother, Donna's mother stated that Donna had had a heart murmur since she was an infant, but that she had been told it was nothing to be concerned about. Donna was very pale. When I checked her nail beds for signs of inadequate oxygenation, I noted that on several of Donna's fingernails there were dark lines running vertically. Both of Donna's palms had small red spots present. The doctor on call came in to examine Donna. After examining her and noting the heart murmur, the lines on her nails, and the spots on her palms, he ordered an ECG (echocardiogram) and an array of blood tests, including a set of blood cultures. He spent time asking Donna and her mother about Donna's wisdom tooth extraction and her heart murmur. He told Donna and her mother that, based on her symptoms, he believed that Donna had subacute endocarditis. 1. Endocarditis is an infection of ________. 2. Based upon the patient's treatment in this case, it can be inferred that... 3. What risk factors did Donna have that likely led to this infection? 4. Which test performed on the patient would have helped to identify the causative agent of her infection? 5. Which of the following was a sign of subacute endocarditis in Donna? 6. Which of the following is a likely causative agent in Donna's infection? 7. According to the data presented, what are the most common causes of infective endocarditis? 8. Which group of bacteria are the most likely cause of infective endocarditis? 9. If you conducted a Gram stain on organisms growing in the blood cultures from the majority of these cases, what would you be likely to see under the microscope? 10. According to this chart, what is the most common causative agent of endocarditis and according to your textbook, what type does it cause?

1. the inner lining of the heart 2. the infection is likely caused by a bacterium. 3. Mitral valve abnormality and recent dental work 4. Blood culture 5. Discolorations in her nails 6. D) Streptococcus mutans (alpha-hemolytic streptococcus) 7. bacteria 8. Gram-positive cocci 9. Purple spherical bacteria 10. B) Staphylococcus aureus; acute

Which of the following is not part of the upper respiratory tract? A. mouth B. nasal cavity C. trachea D. pharynx E. larynx

C. trachea (lower respiratory tract)

Shigella dysenteriae

Diarrhea containing blood and mucus from the GI tract

Vibrio cholerae

Diarrhea described as rice water stools

Antibiotics are used to treat E. coli O157:H7 caused diarrhea.

FALSE

Mumps causes permanent sterility in young male adults.

FALSE

Lyme disease is only seen in people living in Lyme, Connecticut.

False

Treatment for diphtheria requires only penicillin or erythromycin.

False

True or False: The patient in the case should have been adequately protected from infection with Bordetella pertussis from the vaccinations she had already received.

False (Based upon the patient's age she could have only received two of the five recommended doses of the DTaP vaccine. This most likely left her susceptible to infection by this microbe.)

Based upon these results, the pathogen appears to be a bacterium.

False (The specimen was unculturable on blood agar and there were no cells present upon visualizing the Gram stain.)

True or False: The patient's condition is being caused by a prokaryotic organism.

False. (Helminths are eukaryotic parasites.)

Influenza can be completely ruled out due to the negative rapid test.

False. (It is the height of influenza season when the patient gets sick, and false-negative results can occur from this test. It should be confirmed with further testing.)

The RN collects a patient history from the parents. Which of the following statements would raise concern for the potential of serious disease in the patient?

Ingestion of undercooked hot dog at county fair. (The most common cause of shiga-toxin-producing E. coli is ingestion of contaminated and undercooked beef. Any farm product potentially contaminated by cow feces presents a potential source of infection. Please refer to section 20.3 in the textbook for additional information.)

Three days later, the patient is started on dialysis. Which of the following is a serious complication of the patient's infection, causing kidney damage and failure?

Hemolytic uremic syndrome (About 10% of patients with E. coli infection develop hemolytic uremic syndrome, a severe hemolytic anemia that can cause kidney damage and failure. It is most likely to occur in children younger than 5 years of age. Please refer to section 20.3 in the textbook for additional information.)

Secretory ______ can be found on the surfaces of nearly all areas of the GI tract, and _______ is found throughout this system as well.

IgA, GALT

Based upon this diagnosis, what disease is the patient suffering from?

Whooping cough (Bordetella pertussis is the causative agent of pertussis, or whooping cough.)

E. coli O157:H7 secretes shiga exotoxin.

True

In the absence of dietary carbohydrates, bacteria do not cause tooth decay.

True

The primary transmission route for acquiring agents of the common cold is by contact with hands and fomites contaminated with the nasal discharges of an infected person.

True

There are ______ species of Plasmodium known to cause disease.

five (There are five species of Plasmodium known to cause disease.)

The oral cavity harbors over 600 microbial species, including Lactobacillus and Actinomyces; while the _______ has few microbes, the _______ is inhabited by Bacteroides, Clostridium, and other species.

Lactobacillus, upper GI, lower GI

Campylobacter jejuni

Most frequent cause of diarrhea resulting in watery stools, fever, vomiting, headaches, and severe abdominal pain

All of the following are potential differential diagnoses that the RN may anticipate for this patient except:

Otitis media (Otitis media is an ear infection, which may develop secondary to upper respiratory tract infections. A child presenting with nonspecific respiratory symptoms would be expected to have a primary infection affecting the upper and lower airway, such as pneumonia, influenza, or RSV disease. Please refer to section 19.3 in the textbook for additional information about otitis media. Information regarding diseases caused by microorganisms affecting the upper and lower respiratory tracts may be found in section 19.4 of the textbook.)

Which vaccine may a 35-year-old man who will become a father in the next 6 months be advised to receive?

Tdap (The Tdap vaccine provides protection against tetanus, diphtheria and pertussis. Adolescents 11-18 years of age and adults 19-64 years of age should receive a single dose of Tdap. If an adult over the age of 65 will have close contact with an infant, one dose of Tdap should be received if they have never had it administered previously.)

Based upon the staining results, the pathogen appears to be a(n):

gram-negative (Staining revealed the presence of small non-acid-fast (<1 micrometer) gram-negative coccobacilli.))

Based upon these results, the pathogen appears to be a

helminth.

In addition, the GI tract encounters millions of new microorganisms every day, requiring this system to possess a variety of defenses against _______.

infection

Based upon all of this information, what additional testing should be done on the patient to identify the pathogen most rapidly?

Serological testing (would provide the most helpful information most rapidly in this case.)

Why does malaria mainly occur in equatorial or tropical areas and rain forests?

That is a major habitat for mosquitoes that transmit the disease (Mosquitoes prefer warm, moist areas, and more effective mosquito control measures are used in other parts of the world.)

Capillary

The smallest blood vessels which connect arterioles to venules

Found in more distinct locations, though, are ________ (saliva), _______ (upper GI), and ________ (lower GI).

lactoferrin, low pH fluids, bile

The gastrointestinal (GI) tract is a long tube, extending from the ________ to the ________, which carries a large variety of _________.

mouth, anus, normal biota.

The oval structure visualized by bright-field microscopic analysis of the patient's fecal sample is a(n)

ovum (egg).

Although previously thought to be sterile, the _______ is now known to harbor at least 128 different species.

stomach

The best treatment for acute diarrhea is oral replacement of electrolytes and water.

TRUE

NCLEX: Clinical Application Read the clinical scenario, and then answer the questions that follow. A 3-year-old boy presents to the emergency department. His parents report 3 days of fever, lethargy, and poor feeding intake. They report diarrhea and visible blood in his stool for the past day. During assessment by the RN, the patient is irritable and shows signs of moderate dehydration. The patient is admitted to the hospital and worked up for gastrointestinal illness. The patient's symptoms are most concerning for which of the following infectious organisms as the cause of acute diarrhea? A. E. coli O157:H7 B. Clostridium difficile C. Vibrio cholerae D. Campylobacter

A. (The presence of blood in the stool and fever are most indicative of shiga-toxin-producing E. coli among the listed organisms. Please refer to section 20.3 in the textbook for additional information.)

Which antibody is concentrated in the respiratory tract? A. IgA B. IgE C. IgG D. IgM E. All of the choices are correct.

A. IgA

The presence of viruses in the blood is called A. viremia. B. fungemia. C. hemovirus. D. bacteremia. E. septicemia.

A. viremia.

Which hypothesis could explain the recent outbreaks of pertussis in Australia and California?

All of these (Although a large percentage of children in the U.S. (~85%) and other countries are properly vaccinated against pertussis, a number of parents are choosing to not vaccinate their children making them vulnerable to infection by Bordetella pertussis. Additionally, outbreaks of the disease are most likely being spread by adults whose own immunity has dwindled due to the fact that they have not received the Tdap vaccine. Antigenic changes in Bordetella pertussis have been identified to occur, leading to infection even in fully vaccinated children.)

Which of the following types of cells are infected and destroyed by HIV?

All of these (HIV infects and destroys the helper class of lymphocytes, monocytes, macrophages, and B lymphocytes. Please refer to section 18.3 in the textbook for additional information.)

The most common infectious disease in humans is the common cold. A. dental caries. B. pharyngitis. C. diarrhea. D. gastritis.

B. dental caries.

The RN expects all of the following to be ordered as treatment for this patient, except

antibiotics. (The treatment for shiga-toxin-producing E. coli involves supportive therapy by treating dehydration and possible plasma transfusions. Antibiotics are contraindicated as they are ineffective and may worsen the course of the disease. Please refer to section 20.3 in the textbook for additional information.)

One characteristic of the Plasmodium lifecycle is:

asexual division, called schizogony, occurs in the liver. (Plasmodium has a unique life cycle characterized by an asexual phase, which occurs in a human host, and a sexual phase, occurring in a mosquito. The asexual phase produces sporozoites which migrate to the liver. The production of merozoites then occurs, which then erupt from the liver and travel to infect red blood cells. The completion of the lifecycle cannot occur in humans, and the parasites must regain access to a mosquito to do so.)

Antibiotic treatment for otitis media is standard procedure today.

False

Tularemia

-Causative agents is one of the most infectious bacteria known, -Transmitted to humans from rabbits through aerosols/arthropod vectors.

Mononucleosis

-Most of the world is infected with agent, but timing of infection is related to the severity of infection. -Signs/symptoms are fatigue, sore throat and enlarged lymph nodes.

Sinusitis

-Often caused by mixed bacterial infections: S. pyogenes, S. pneumoniae and H. influenzae which are treated with broad-spectrum antibiotics. -Inflammation of the sinuses caused by allergies, bacterial and/or fungal (less common) infections or structural problems.

Endocarditis

-Subacute form caused by ahemolytic streptococci that are typically normal biota. -Acute form caused by Streptococcus species and Neisseria gonorrhoeae.

Rhinitis

-The common cold, caused by 200+ viruses transmitted by indirect or droplet contact. -Symptoms due to the localized inflammatory reaction mounted against virus, similar to those of inhalant allergies.

Pharyngitis

-Viral forms of this disease are typically less severe but are associated with hoarseness. -S. pyogenes causes and often severe form of disease, due to its generation of surface antigens, toxins and enzymes.

Normal Biota and Natural Defenses of Respiratory System -arrange the sentences in a logical sequence.

1. Most clinicians divide the ______ into two parts: the upper and lower tracts. (respiratory system) 2. The ______ respiratory tract is made up of the mouth, the nose, the nasal cavity and sinuses, the throat, and the epiglottis and larynx. (upper) 3. The larynx then leads into the ______ respiratory tract, which begins with the ______, a structure that feeds into the bronchi and bronchioles in the lungs, and finally ending in the sac like ______. (lower, trachea, alveoli) 4. Microbial defenses present in the upper tract consist of nasal hairs, the ciliary escalator, mucus, coughing/sneezing, and secretory ______ in the mucus. (IgA) 5. This variety of defenses is needed because this area is exposed to the external environment, and it therefore also harbors a large number of commensal microorganisms, such as Pseudomonas, Fusobacterium, ______, and many others. (streptococci) 6. In contrast, the lower respiratory tract has few, if any, ______ and its defense mechanisms are reduced to the action of mucus, ______ in the alveoli, and secretory IgA. (normal biota, macrophages)

Pathway Through the Heart -starting with deoxygenated blood from the body, through the heart and lungs, and ending with oxygenated blood to the body.

1. Superior vena cava 2. Right atrium and right ventricle 3. Pulmonary arteries to the lungs 4. Pulmonary veins from the lungs 5. Left atrium and left ventricle 6. Aorta

Case Study "Blood and Guts" Read the Chapter 20 case file and complete the activities that follow. I was working as an LPN in a rural facility when Peter came into the emergency room one evening. My supervising RN and I realized almost immediately that Peter was very ill, and we worked together quickly to obtain Peter's history and vital signs. Peter stated that he had been ill since the morning, when he woke up earlier than normal with diarrhea. He stated that he had been well the night before when he went to bed and had awoken in the morning with severe abdominal cramping. The diarrhea started almost immediately after the cramps began. Peter estimated that he had had approximately 20 bouts of watery, foul-smelling diarrhea throughout the day. He also stated that there was fresh blood present in his stool. I took Peter's vital signs. He had a fever of 38.4°C (101°F). He was tachycardic with a heart rate of 118 beats per minute. His blood pressure was low at 100/50 mmHg. He was pale and diaphoretic (sweaty) and complained of chills and a headache. He also complained of intermittent severe cramping. His abdomen was tender in all four quadrants on palpation and his bowel sounds were hyperactive on auscultation. His mucous membranes were dry and he complained of thirst. His skin turgor was poor. My supervising RN called the physician to report Peter's symptoms and vital signs. The doctor stated that he would be coming in right away and to notify the lab. He asked us to start an intravenous on Peter. We inserted a large-bore IV and started an infusion of normal saline at 250 mL/hour to rehydrate Peter. The physician and lab technician arrived almost simultaneously, and blood was drawn by the lab tech while the physician examined Peter and asked about his symptoms. Peter was asked to provide a stool sample for culture and an ova and parasites test (O&P test), which he was able to provide in a short time. The physician asked if Peter's wife and daughter were ill and if they had eaten the same food as Peter had in the last few days. Peter's blood work came back. His white blood cell count was elevated and his potassium level was low. Peter was admitted to the hospital for rehydration and was started on broad-spectrum intravenous antibiotics for full coverage of potential pathogens while he awaited the stool culture results. The doctor felt that Peter likely had bacterial food poisoning. Peter's stool cultures came back, revealing that Peter had Shigella, which was sensitive to sulfamethoxazole/trimethoprim and ciprofloxacin. Peter had an allergy to ciprofloxacin, so he was started on sulfamethoxazole/trimethoprim in oral form twice a day and IV fluids were continued. After 5 days in the hospital, Peter had recovered enough to go home. He continued the antibiotic therapy for another week and eventually fully recovered. The source of the infection was never determined. 1. Shigella is a ________. 2. According to the case file, which type of stool test do you think came back positive for Shigella? 3. What category of diarrheal disease is caused by Shigella? 4. If the patient in the case had a negative stool culture but a positive O&P test, which acute diarrheal disease might have been implicated instead of shigellosis? 5. Why can Shigella also be transmitted directly from an infected person to another person? 6. True or False: The patient could have protected himself from infection through vaccination. 7. What age group has the highest incidence of shigellosis? 8. Males have a higher incidence rate for shigellosis in which age groups? 9. True or false: In the 30-39 age group, the incidence rate was very similar for males and females.

1. bacterium 2. Stool culture 3. Acute diarrhea 4. Cryptosporidium 5. It has a low infectious dose. (The infectious dose of Shigella is 100-200 cells, meaning that in close contact, it can be transmitted easily from one person to another.) 6. False 7. Infants and children 8. 40-49 9. True

Introduction Very Sick, Very Fast Read the Chapter 19 case study below and complete the activities that follow. I was a respiratory therapist student completing a rotation in pediatrics when I became involved in caring for Michael, a 6-month-old who was admitted to the pediatric unit with a respiratory infection. Michael was a healthy infant who was born at term (39 weeks' gestation). He was current with all of his immunizations. Michael was the youngest of three children, with two older siblings who were school age. Michael attended day care on a part-time basis when his mother worked. Michael and both his siblings had become ill during recent days with cold symptoms. At first, Michael had a runny nose and a slight cough. He was fussy and irritable and his mother stated he had been sleeping more than usual. Michael was being breast-fed. However, when he became ill, he fussed at the breast and fed less often, even though his mother offered him the breast frequently to encourage fluid intake and provide comfort. Having three children, Michael's mother was well versed in caring for a sick child and was not prone to panic over a common cold. However, on the third day of his illness, Michael took an alarming turn for the worse. Although he acted as though he was hungry, he would stop feeding almost as soon as he started. Michael had copious nasal discharge, and his mother rightly tried to clear his nostrils using a bulb syringe, but Michael still fed poorly. He had only had one slightly wet diaper over the course of the night and had not urinated at all in the morning. He was running a high fever of 39.6°C (103.3°F). His eyes appeared sunken in his face and there were no tears when he cried, both signs of dehydration. He was coughing frequently. Most concerning, Michael's respiratory rate was 48 breaths/minute. His nail beds were cyanosed (blue) and he was very pale in color. His oxygen saturation was 89% on room air. Michael was seen in the emergency room and was immediately admitted to the pediatric unit by the physician on call, who was very concerned. My preceptor and I were called to assess Michael on the unit. When we arrived, Michael had a chest X ray and blood work done. He was lying in a crib with a nasal cannula supplying humidified oxygen taped to his face. His color was still very pale but his nail beds were pink. His oxygen saturation had increased to 95% with oxygen flow at 5 L/minute. I listened to Michael's chest and heard wheezes throughout Michael's lungs. After I assessed Michael, my preceptor asked me what I thought might be going on with Michael. Hedging my bets, I replied that all I could tell for certain was that Michael had a respiratory tract illness and a virus was the likely culprit. My preceptor promptly replied, "You're right that Michael has a viral illness of the respiratory tract, but which one?" When I confessed that I did not know, my preceptor informed me that Michael's symptoms were consistent with respiratory syncytial virus (RSV). Michael's tests would prove him right. 1. RSV is a _______. 2. RSV is an infection of the __________ respiratory tract. 3. What age group is the most susceptible to serious RSV infection? 4. What other disease(s) affect both upper and lower respiratory tracts? 5. How is pertussis different from RSV infection? 6. In this case, Michael likely contracted RSV from his ______. 7. RSV infection is prevented with _______ immunity in high-risk groups like premature infants. 8. RSV infections are at the highest rate during the ______ months. 9. RSV is most commonly diagnosed with _____. 10. During June, the graph indicates less than _____ % are positive by antigen detection.

1. virus 2. upper and lower 3. Children under 6 months 4. B) Influenza and C) Pertussis 5. Pertussis is caused by a bacterium. 6. day care or siblings 7. artificial, passive (A monoclonal antibody preparation is used to prevent RSV infection in premature infants and those with cardiac or lung issues at birth. This is an example of artificial, passive immunity. No vaccine currently exists but researchers are getting closer to developing one) 8. winter 9. direct antigen testing 10. 4 %

The lab calls to notify the RN that the 12-hour growth on the respiratory bacterial culture is negative. Based upon this result, which of the following is the most likely causative organism in this otherwise healthy 5-month-old child?

A virus (A negative bacterial culture would eliminate gram-negative and gram-positive organisms as a source of infection. Fungal infection is unlikely in an otherwise healthy child. Respiratory syncytial virus (RSV) is the most common cause of respiratory infection in infants and affects most children by age 2. Please refer to section 19.4 in the textbook for additional information.)

HIV is a retrovirus in the genus Lentivirus. Which of the following is true of retroviruses?

All of these (Retroviruses reverse the order of transcription. They contain reverse transcriptase that catalyzes the replication of DNA from RNA. Structurally, retroviruses display features of enveloped RNA viruses. Please refer to section 18.3 in the textbook for additional information.)

What group of protozoans does Plasmodium belong to?

Apicomplexans (sporozoans) (Plasmodium belongs to the Apicomplexan (also known as sporozoan) group, which is entirely parasitic.)

In addition to the previous test results, additional blood tests were performed to help confirm the patient's diagnosis: Blood analysis: low red blood cell count; vitamin B12 deficiency ELISA for pathogen-specific antibody: patient serum was positive for antihelminth antibodies. Based upon all of the information obtained through specimen testing, along with the patient's symptoms, the pathogen is most likely A. Taenia solium. B. Diphyllobothrium latum. C. Schistosoma mansoni. D. Entamoeba histolytica.

B. (Based upon all of the information obtained through specimen testing, along with the patient's symptoms, the pathogen is most likely Diphyllobothrium latum.)

The main causes of dental caries seem to be A. Streptococcus pyogens. B. Streptococcus mutans. C. Streptococcus pneumoniae. D. Both A and B are correct. E. Both B and C are correct.

B. Streptococcus mutans.

All of the following are associated with subacute endocarditis except A. occurs in patients that have prior heart damage. B. caused by immune system autoantibodies that attack heart and valve tissue. C. oral bacteria get introduced by dental procedures to the blood. D. bacteria colonize previously damaged heart tissue resulting in a vegetation. E. signs and symptoms include fever, heart murmur, and possible emboli.

B. caused by immune system autoantibodies that attack heart and valve tissue.

The mucinous glycoprotein covering teeth that streptococci attach to is called the A. enamel. B. pellicle. C. gingiva. D. lactoferrin. E. oral membrane.

B. pellicle.

Vein

Begin as small venules in the periphery and coalesce into larger blood vessels carrying deoxygenated blood back to the heart

Escherichia coli O157:H7

Bloody diarrhea with development of hemolytic uremic syndrome in 10% of patients

Artery

Carry oxygenated blood away from the heart under relatively high pressure

The viral antigen studies come back positive for respiratory syncytial virus (RSV). The parents are anxious that their older children (ages 10 years and 12 years) may have been exposed. Which of the following statements by the RN is most appropriate regarding the susceptibility of the other children?

Children younger than 2 years of age are the most susceptible to serious disease from RSV. (No RSV vaccination is currently available. Older children and adults may become infected by the virus, but typically experience a less serious course and fewer complications that those younger than 2 years of age. The most appropriate statement by the RN is that children under 2 years of age are most susceptible to serious disease from RSV. Please refer to section 19.4 in the textbook for additional information.)

Based upon all of the information obtained through specimen testing, along with the patient's symptoms, the pathogen is most likely: A. Mycobacterium tuberculosis. B. Influenza A. C. Streptococcus pyogenes. D. Bordetella pertussis.

D. (Although all of these pathogens are capable of causing a cough, only Bordetella pertussis is a gram-negative coccobacillus that grows well on Charcoal Agar. Specimen testing was negative for viral pathogens (eliminates Influenza A), revealed non-acid-fast bacterial cells (eliminates Mycobacterium tuberculosis) and did not grow on Blood Agar (eliminates Streptococcus pyogenes).)

Which organ of the GI tract has a large commensal population of microorganisms? A. liver B. salivary glands C. pancreas D. large intestine E. small intestine

D. large intestine

The fibrous sac that encloses the heart is the A. epicardium. B. myocardium. C. endocardium. D. pericardium. E. ectocardium.

D. pericardium.

Based upon this identification, what was the most likely mode of transmission of this pathogen?

Droplet contact (The most common mode of transmission for Bordetella pertussis is via droplet contact.)

Which form of treatment should be administered to the patient at this time? A. Rifampin B. Erythromycin C. Supportive care as needed, including breathing support from a ventilator and IV fluids D. Amphotericin B E. B and C

E. (Treatment of whooping cough patients is mainly supportive, but erythromycin is generally given to decrease communicability of the disease)

Defenses of the GI tract against pathogens include A. mucus, acid, and saliva. B. secretory IgA and lysozyme. C. peristalsis. D. GALT. E. All of the choices are correct.

E. All of the choices are correct.

Normal biota of the upper respiratory tract include A. Corynebacterium. B. Candida albicans. C. Haemophilus influenzae. D. Staphlococcus aureus. E. All of the choices are correct.

E. All of the choices are correct.

The common causative agent of acute endocarditis is A. Staphylococcus aureus. B. Streptococcus pneumoniae. C. Streptococcus pyogenes. D. Neisseria gonorrhaeae. E. All of the choices are correct.

E. All of the choices are correct.

What features of the respiratory system protect us from infection? A. nasal hairs B. cilia C. mucus D. macrophages E. All of the choices are correct.

E. All of the choices are correct.

______ occurs when bacteria flourish and grow in the blood stream. A. Viremia B. Fungemia C. Hemovirus D. Bacteremia E. Septicemia

E. Septicemia

Which of the following is not part of the lower respiratory system? A. alveoli B. bronchi C. bronchioles D. trachea E. sinuses

E. sinuses (upper respiratory tract)

A vaccine for Lyme disease is available.

False

True or False: The patient must present the "whooping" sound during coughing to be positively diagnosed with pertussis.

False (Although a hallmark symptom of pertussis, many patients do not exhibit the "whooping" sound during the presentation of their disease. In most cases, PCR testing is performed to confirm the diagnosis of pertussis in a patient but only if symptoms and culture data point to infection with Bordetella pertussis.)

Based upon the patient history information, the patient appears to be in which stage of disease?

Paroxysmal (There are three stages of pertussis (whooping cough). The catarrhal stage begins when bacteria in the respiratory tract produce cold-like symptoms most notably a runny nose; this lasts 1-2 weeks. It is followed by the paroxysmal stage, which is characterized by severe coughing and at times the production of a distinct "whooping" sound during these bouts of coughing. Recovery occurs in the convalescent phase, where there are fewer bacteria and symptoms disappear. However, it is during this phase when the patient is extremely susceptible to other respiratory infections due to the pathogenicity of the bacterium.)

Culturing of many respiratory pathogens is time consuming. What additional diagnostic test could be performed on the specimen to provide genotypic information on the pathogen in a rapid manner?

Polymerase chain reaction (Polymerase chain reaction (PCR) provides genotypic information on microbes in a short period of time. Cell culture is a phenotypic method, while ELISA and Western blotting provide immunologic information on a pathogen.)

What is the most appropriate type of isolation for this patient while awaiting the results of the bacterial and viral studies?

Respiratory precautions (droplet mask, gown, and gloves) (The causative agents of pneumonia, influenza, and RSV disease are transmitted by droplet and indirect contact. Respiratory precautions with a droplet mask in addition to gown and gloves would be most appropriate to prevent exposure and spread of the disease. Please refer to Disease Table 19.8 in the textbook for additional information.)

All of the following are essential education points by the RN, except:

Restriction on blood donation until viral levels are undetectable (HIV transmission occurs mainly through sexual intercourse and transfer of blood products. Barrier protection should be used by sexually active persons. An HIV-positive patient may never donate blood. AIDS-defining illnesses are opportunistic infections, indicating increasing immune compromise. Patients who are HIV-positive but asymptomatic can remain healthy if compliant with antiretroviral therapy. The toxic side effects may cause patient noncompliance so this should be addressed in education. Please refer to section 18.3 in the textbook for additional information.)

Once a diagnosis of HIV is confirmed, HAART is initiated. Which of the following best describes the action of HAART?

Reverse transcriptase inhibitor and protease inhibitor (HAART (highly active antiretroviral therapy) combines two reverse transcriptase inhibitors and one protease inhibitor to interrupt the virus in different phases of its cycle. Please refer to section 18.3 in the textbook for additional information.)

Which of the following statements by the patient demonstrates an understanding of AIDS?

There is no cure for HIV. (Though antiretroviral therapy exists, there is no cure for HIV. Not every HIV-infected person develops AIDS and those who do not are termed nonprogressors. HIV is transmitted through body secretions and blood, but not saliva. No vaccine currently exists for HIV. Please refer to section 18.3 in the textbook for additional information.)

Aedes mosquitoes are the vectors involved in yellow fever and dengue fever.

True

Pertussis outbreaks still occur in the United States.

True

Plague is a zoonotic disease.

True

Secondary bacterial infections may occur with the common cold.

True

The cardiovascular and lymphatic systems have no normal biota.

True

Salmonella typhi

Typhoid fever characterized by progressive, invasive infection that leads to septicemia

In addition to the previous test results, additional blood tests were performed to help confirm the patient's diagnosis: Blood analysis: low red blood cell count; vitamin B12 deficiency ELISA for pathogen-specific antibody: patient serum was positive for antihelminth antibodies. Based upon this identification, what was the most likely mode of transmission of this pathogen?

Vehicle through contaminated food

Based upon these results, the pathogen appears to be a:

bacterium (Growth on agar medium occurs only with bacteria; viruses and prions would not be visualized by Gram staining nor acid-fast staining.)

The boxlike repeated structures seen through bright-field microscopic analysis of the patient's fecal sample are

proglottids.