Microbiology Chapter 22-26 Case study lecture

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Conjunctivitis

A 1st grader has an eye swollen and blood shot. The lining of the lower lid is bright red. There is a thick yellow discharge in corner of eye. What is the diagnosis?

What is the etiology for Conjunctivitis?

Haemophilus influenzae

What is the treatment for conjunctivitis? Is it communicable?

None, yes by direct contact or fomites.

What sign leads you to believe that the infection is bacteria in origin?

Swollen, red, yellow pus-thick yellow discharge

What are some of the eye's natural defenses?

tears, lysozyme, IgA in secretions

Erysipelas

A women has an extremely swollen right lower leg. It appears she has an old surgical wound in her mid calf, with rough scar tissue surrounded by purplish red skin. She is in a lot of pain. 3 weeks ago she had a lot of moles removed from the area. It appeared to heal up initially but 3 days ago the incision area started looking bigger rather than smaller. She didn't return to the physician hoping it would resolve it's self. The past 3 days the area has begin to swell and become very hot. Patient sent to surgery where would was debrided. Gram (+) cocci growing in chains were recovered from the wound. She is transferred to intensive care and put on a high dose of IV antibiotics for the next 18 hrs, but by the next evening her leg is amputated below the knee. She remained in hospital for 2months following surgery and requires long term antibiotic and mult. skin grafts. on her upper leg. What did this patient have?

What features suggest that it isn't Clostridium perfringens gangrene; instead of Erysipelas?

Because Clostridium is a rod shaped gram (+)
and not cocci shaped

Erysipelas

is an infection of the upper layers of the skin (superficial). The most common cause is group A beta-hemolytic streptococcal bacteria, Gram (+) especially Streptococcus pyogenes. Erysipelas results in a fiery red rash with raised edges that can easily be distinguished from the skin around it. The affected skin may be warm to the touch it's progress can lead to tissue destruction and sepsis which turn into (flesh eating bacteria "Necrotizing Fasciitis")

How is the Erysipelas bacterium begin?

with minor trauma, such as a bruise, burn, wound, or incision. When the rash appears on the trunk, arms, or legs, it is usually at the site of a surgical incision or a wound.

Why was amputation the best solution for the infection in this case of Erysipelas?

Because it had progressed into (Necrotizing Fasciitis- flesh eating bacteria) due to group A streptococci which, can destroy tissue as rapidly as a surgeon can remove it.

Staphylococcus aureus

45yr old male in good health, woke with pain in lateral aspect of his left calf. He thought the pain was due to an ingrown hair and went back to sleep. Next morning he expressed a small amount of pus from the ingrown hair area. Over next 8 hrs the patient developed an area of cellulitis on the lateral aspect of the calf approx. 5 by 10 cm. At that time sm. amount of pus was expressed from the area of the ingrown hair. The next morning the area of cellulitis extended from just below the knee to just above the ankle. Vital signs all within normal limits. Physical exam was significant for an area of cellulitis as described that it was red and warm to the touch but with no area of obvious fluctuance. No lymphadenopathy was observed. Central area of the cellulitis near the area that the patient described where the ingrown hair had been, was punctured 3 times with 20 guage needle but no pus drained. Patient referred to surgery service. Patient was examined and given 2 g of ceftriaxone IM and began oral cephalexin. Patient returned 48 hrs later with obvious area of fluctuance in center of area of cellulitis. Patient reported low grade fever. Aprox. 1 mL of pus was aspirated and was sent for gram stain. Came back as gram (+) cocci in clusters. Blood agar revealed white circular, beta hemolytic colonies. Pus was aspirated and surgeon excise and drained the lesion. Base on gram stain and culture what is the organism most likely causing the patient's infection?

What bacterium did the infected hair follicle cause?

Staphylococcus aureus

Why is it necessary to do an incision and drain the area of cellulitis?

Because of the extra fluid and inflammation , staph infection needed to be drained so antibiotics can be more effective and it also gets rid of additional fluid and debris.

Why would antimicrobial agents alone not be effective in treatment of staph infection?

Because it needs to be drained so antibiotics will be more effective by getting rid of additional fluid and debris

What other types of infections do Staphylococcus aureus cause?

Folliculitis, Sty, Furuncle, Carbundle, Impetigo

Neisseria meningitidis

An otherwise healthy 19-year-old college student was admitted to the emergency room with a fever, bad headache, and a stiff neck, symptoms suggestive of meningitis. A spinal tap was done. The CSF was cloudy, and the cell count on the fluid was 500 WBC/ml. The differential WBC count of the CSF showed predominantly neutrophils. The Gram stain showed gram-negative diplococci.
The most likely etiologic agent is __________.

Infant botulism

A 10-month-old infant has become constipated and demonstrates muscular weakness by her inability to sit up or crawl. Her muscle tone is continuing to deteriorate, and she is beginning to have difficulty holding her head up. While questioning her mother to get more information, the doctor noted that the infant's cereal had been sweetened with honey for the last 10 days. What is a likely diagnosis?

Dungue Fever

A 34-year-old Caucasian male is being examined in the emergency room of a Boston hospital, complaining of a high fever and severe muscle pain and joint pain. He returned to Boston two days ago, after spending 10 days travelling throughout Brazil on business. He indicated that he was bitten by mosquitoes several times while on the trip. Which of the following is the most likely diagnosis?

Relapsing fever

A patient is hospitalized with fever, jaundice, and rash. Spirochetes are observed in her blood. What is the diagnosis?

Relapsing fever

The disease is characterized by fever, sometimes in excess of 40.5°C, jaundice, and rose-colored skin spots. After 3 to 5 days, the fever subsides. Three or four relapses may occur, each shorter and less severe than the initial fever. Each recurrence is caused by a different antigenic type of the spirochete, which evades existing immunity. Diagnosis is made by observing the bacteria in the patient's blood, which is unusual for a spirochete disease. Tetracycline is effective for treatment.

bacillus anthracis

A 67-year-old man works in a textile mill that processes imported goat hair into fabrics. One morning, he notices a painless, slightly swollen pimple on his chin. He later develops a 1-cm ulcer at the pimple site, and it has a black scab. Gram-positive, endospore-forming rods are cultured from the ulcer. What is the etiology?

Lyme diease

A patient has flu-like symptoms and a bull's-eye rash on his leg. Investigation reveals that he had been hiking in Connecticut and was bitten by two ticks. What is the diagnosis?

toxoplasmosis

A 25-year-old HIV-positive man is hospitalized with a severe headache and lesions in his right eye. Cultures from the lesions are negative. Microscopic examination of the lesions reveals cysts. The disease is __________.

bubonic plague

A man found living in a rat-infested building develops a high fever and swollen lymph nodes, called buboes, in the armpit and groin. A gram-negative bacillus is isolated from the patient, and the rats are found to be infested with Xenopsylla cheopis, a flea. What is the disease?

Rocky mountain spotted fever

An 8-year-old girl in rural North Carolina is hospitalized with a fever, severe headache, and macular rash on her body, including her palms and feet. A tick had been removed from her hairline 1 week earlier. An ELISA test is positive for anti-rickettsial antibodies. The girl has __________.

human granulocytic anaplasmosis

A 24-year-old woman in Minnesota complained of a flu-like illness accompanied by a high fever and headache a week after being bitten by a tick. During examination of a blood smear, it was noted that some of her monocytes contained clumps of tiny bacteria (morulae). What is the most likely diagnosis?

brucellosis

A slaughterhouse worker develops fever and chills, with the fever reaching a high of 40°C each evening. Oxidase-positive, gram-negative coccobacilli are isolated from a lesion on his arm. What is the diagnosis?

human herpesvirus-4

A 20-year-old woman goes to the college health center complaining of sore throat, fever, and chronic fatigue. Physical examination reveals that she has an enlarged spleen. A heterophile antibody test is positive. What is the etiology?

Corynebacterium diphtheriae

A 22-year-old American woman working in southern Ukraine is hospitalized with a sore throat. Physical examination of the throat reveals a tough gray membrane. What is the etiology?

I AM SURE
Chlamydia psittaci

A patient has a rapid onset of fever, headache and chills. He recently returned from Mexico, where he drank local water and stayed in an air-conditioned room. Several weeks ago, he purchased a parrot. After a physical exam, his physician prescribes tetracycline. What is the cause of the patient's illness?

Histoplasma capsulatum

A 45-year-old male demolition worker is hospitalized with an acute respiratory illness. Yeast cells are seen in microscopic examination of a lung biopsy, and a mold is cultured. What is the etiology?

reactivation tuberculosis

An 85-year-old man has been experiencing weight loss, night sweats, and a dry cough for several months; recently, he has begun coughing up sputum with tinges of blood in it. Following a chest X-ray showing some white spots on his lungs, an AFB stain and culture were ordered, and both were positive for the presence of AFB. He has been PPD (purified protein derivative) positive since his 20s. Which of the following most accurately describes his current situation?

Haemophilus influenzae

A 40-year-old diabetes patient has typical symptoms of pneumonia. A Gram stain of his sputum reveals gram-negative coccobacilli. What is the etiologic agent?

Pneumocystis

A 35-year-old male is hospitalized for cough, fever, and shortness of breath. He is HIV+. Bronchial washings reveal cysts. What is the etiology?

pertussis

A 35-year-old woman presents with violent, uncontrollable coughing fits and reports that she is just getting over a cold. Her sputum does NOT contain blood. Which of the following is the most likely diagnosis?

histoplasmosis

An 81-year-old female has a mass in her lower left lung. Her tuberculin skin test is negative. Microscopic examination of her lung biopsy reveals large, ovoid cells. The patient has __________.

Staphylococcus saprophyticus

A 22-year-old female college student visits the campus health center, complaining of low pelvic pain, dysuria, and hematuria. A clean-catch urine specimen is collected; and upon culture, it grows >100,000 cfu/ml of a catalase-positive, coagulase-negative, gram-positive cocci. Screening with a novobiocin disk demonstrates novobiocin resistance. What is the most likely identification of this etiologic agent?

tularemia

A patient has a skin ulcer from which a gram-negative bacillus is cultured. This patient has regional lymph nodes that are enlarged and filled with pockets of pus. He reports keeping pet rabbits. Which of the following is a possible diagnosis?

Chagas' disease

Which disease, resulting in damage to heart muscle or the nerves controlling peristalsis in the gastrointestinal tract, is transmitted by the reduviid bug?

Jamie is more likely to develop subacute bacterial endocarditis.

As a child, Jamie suffered from rheumatic fever, which caused some major damage to one of her heart valves. She is OK, in general. However, she's been advised against getting body piercings, and her dentist gives her antibiotics before performing some dental procedures. What is the concern?

scarlet fever

An individual presents with a pinkish red rash and a red sore throat. Gram-positive cocci are cultured from a throat swab. The cocci are growing in chains. Which of the following is the most likely conclusion?

Staphylococcus aureus

John went to a picnic. He took some leftover chicken and rice home, heated it on the stove, ate it, and got sick two hours later. John thought the heating made his food safe because it would have killed any bacteria present. He didn't know that __________ produces a heat-stable toxin.

Escherichia coli gastroenteritis

A patient exhibits hemorrhagic colitis and is treated via intravenous rehydration. The pathogen is a gram-negative rod. It is isolated and differentiated from related organisms based on its inability to ferment sorbitol. Which of the following is a likely diagnosis?

giardiasis

A patient presents with diarrhea that has lasted for weeks and is accompanied by malaise, flatulence, weight loss, and abdominal cramps. You detect the odor of sulfur on his breath. Based on the signs and symptoms, you suspect __________, a protozoan. It is not easily found in stool samples, so you do a string test.

small intestine

Bacteria present in the __________ can be phagocytosed by Paneth cells

Ascaris lumbricoides

Worldwide, __________ cause one of the most common helminthic infections. Diagnosis is frequently made when a worm emerges from the anus, mouth, or nose.

The virus is present in urine approximately 10 days after the onset of symptoms.
The virus is transmitted in saliva and respiratory secretions.
The testes can become inflamed about 2 to 3 weeks after the onset of symptoms.
The illness frequently begins with painful swelling of one or both parotid glands

Which of the following statements concerning mumps virus infection is FALSE?
3

3-2-1-4

Which is the correct sequence of events regarding the stages of tooth decay? 1. Dentin decay 2. Enamel decay 3. Plaque 4. Pulp decay

may cause hallucinogenic symptoms

Ergot poisoning __________.

tertiary

Al Capone contracted syphilis in his youth. By the time he was imprisoned in Alcatraz, he was suffering from syphilis-induced confusion and disorientation. What stage of syphilis did Mr. Capone have at this time?

It may never progress to tertiary syphilis.

Which of the following is true of the latent stage of syphilis infection?

attenuated

Which of the following terms does NOT describe syphilis?

metronidazole

If a patient is diagnosed with trichomoniasis, which treatment should be prescribed?

salpingitis

Which type of infection can result in infertility?

skin rashes of varying appearance especially on soles of hands and feet

Which of the following is associated with secondary stage syphilis?

Staphylococcus aureus

A surgical patient of acquires a nosocomial infection. The primary organism isolated from the surgical wound is Coagulase positive and resistant to penicillin. What is the probable etiologic agent?

Acanthamoeba keratitis

A 43-year-old patient consulted his physician concerning mild inflammation of his eyes. The patient was instructed to avoid wearing his contact lenses for one week. The symptoms worsened over the next few days. After eliminating the possibility of the bacterial agent, the physician ordered a corneal scraping. What etiologic agent it is the physician suspect?

the causative agent was probably Staphylococcus aureus, Streptococcus pyogenes or another organism associated with dental infections.

After examining a patient with acute bacterial endocarditis, that the problem cause her physician completed was a chronic tooth infection. What is the probable etiologic agent?

Pelvic inflammatory disease

At a clinic for sexually transmitted diseases at a 22-year-old woman states on her questionnaire her chief complaint is pain in her belly what Is the Association between belly pain and STDs?

Gardnerella vaginitis

A pregnant woman arrives at your practice because she is noticed a copious vaginal discharge and is worried that may indicate problems with her pregnancy. After pelvic examination, the physician says there is a whitish, smooth coating on the walls of the vagina. Microscopic examinations of vaginal fluids reveals the presence of " clue cells". The physician writes bacterial vaginitis on the chart, prescribes mamma bought it and moves on. What usually causes bacterial vaginitis?

Gonorrhea

A 15-year-old male was brought into the emergency room. He gave a 24-hour history of dysuria and noted some pus-like drainage in his underwear and on the tip of his penis. Urine appeared clear, urine culture was negative although your analysis was positive for leukocyte esterase and multiple WBC's were seen on microscopic examination of urine. He gave a history of being sexually active with 5 or 6 partners in the last 6 months. He claimed that he and his partners had never had any sexually transmitted diseases. His physical exam was significant for yellow urehtral discharge and tenderness at the tip of the penis. A Gram stain done in the emergency room showed gram (-) cocci. He was given entry microbial agents and scheduled for follow-up in one week. Based on the Gram stain results what organism is this patient infected with?

Trichomoniasis

The 26-year-old woman was referred to a public health clinic in result of contact tracing the case of gonorrhea. She recently had unprotected sex and had no symptoms. Physical examination was normal. Pelvic examination demonstrated white vaginal discharge that was otherwise unremarkable. Cervical culture was obtained for Neisseria gonorrhea, in the specimen was submitted for Chlamydia trichomatis tested by ligase chain reaction. Examination of the wet mount of vaginal discharge revealed the presence of a protozoan with a characteristic jerky motility. A Giemsa stain of the organism revealed flagellated, ovoid cells with distinct nuclei. What organism did the wet mount preparation demonstrate?

Bacterial vaginosis

What other organism can cause vaginitis and be detected by wet mount?

Histoplasmosis

Doug hasn't felt well for the past 10 days. He has congestion and he's very tired. This temperature is 101 F. The doctor gave him some oral amoxicillin which he took until it was gone but he's still sick. He just moved to Ohio from Arizona. Doug is a Park Ranger and he loves his job but for the past 3 days he's been 2 sick to go to work. His respiratory symptoms have not improved. What is your tentative diagnosis, based on the history?

Respiratory syncytial virus (RSV)

A 3 month old boy has wheezing and a slight fever of 99.8 F. The babies fever is rising and is having trouble breathing. He is taken to the emergency room the examining doctor commits him to intensive care. Pneumonia is suspected; a dozen or so pediatric cases have been diagnosed with same type of pneumonia in the last week or so. He is given supportive therapy, including an inhaled spray but no antibacterial drugs. The doctor says they are sure the child will recover since the infection was caught early. What kind of pneumonia is it?

Legionella pneumophila , water

In autumn, a number of people came ill working at a single building at an industrial plant in Baltimore Maryland. Their symptoms range from simple coughing and other respiratory symptoms to pneumonia. At least 1 of the 70 people reported symptoms died. The company voluntarily closed the building upon the recommendation of the Maryland department of health. After all the water systems at the plant were evaluated and disinfected, it was reopened in no new cases were reported. What is the causative organism and its source?

Streptococcus pyogenes (GAS)

A 5-year-old male awoke on the day prior to evaluation with a sore throat and fever. His mother treated him with Tylenol and kept him home from school. He slept well, but the next day he awoke still complaining of sore throat and fever along with a headache and abdominal pain. He has no siblings and neither parent are sick. On examination he has a fever of 38.4 C. this physical examination was significant for a 2+ (on a scale of 1 to 4) Red interior a pharynx, tonsillar region, and soft palate. His anterior cervical lymph nodes at the angle of the mandible or slightly enlarged and tender. No skin lesions or rashes or seen. A beta- hemolytic organism was isolated on blood agar. What is the most likely organism causing this patient's infection?

Staphylococcus pneumonia

A 60 your old has a medical history of extensive facial reconstruction for squamous cell carcinoma of the head and neck. He has a 30 year history of smoking. The patient presented with progressive shortness of breath; a persistent, productive cough; purulent sputum; and fever 39.0 C 2 days prior to mission. On physical examination, he had a temperature of 37.3 C, respiratory rate 18/min., pulse rate of 103/ BPM and a BP of 154/107 mm Hg. Chest auscultation revealed course breath sounds at the base with a babasilar fine crackles. He has left lower lobe infiltrate on x-ray. His WBC is 10,600 with 70% neutrophils, his hemoglobin is 9.4. Sputum Graham revealed > than 25 polymorphonuclear cells and > than 25 squamous epithelial cells. Because of the high numbers of the squamous epithelial cells, the specimen was not processed further. 2 blood cultures reveal alpha-hemolytic colonies. Gram stain reveals gram (+)
diplococci. This was the patient's 3rd espisode of illness in the past month. What organism is causing the individuals infection?

Mycobacterium TB/multidrug resistant TB

18-year-old female admitted to the emergency room has a one-month history of cough, fever, and night sweats. Her medical history was notable for a positive PPD skin test at age 8 and a chest x-ray at the same age demonstrating right upper lobe volume loss. She did not adhere to the isoniazid therapy at the time. At age 10, she had unchanged chest x-ray and began again on isoniazid, but only took the medicine for one month. The patient has a recent history of heavy cocaine use. Her x-ray at the time of hospitalization demonstrates a right upper lobe infiltrate. The results of an acid fast stain of sputum reveals pink bacilli. Organism was grown on solid media after several weeks of incubation appears as dry, crusty colonies. Given her medical history which organism is likely to because and affection?

Bordetella pertussis

A 5 1/2 a week old infant is transferred to emergency room with a 10 day history of choking spells. The child spells began with repetitive coughing and progress to his turning red and gasping for breath. In the prior 2 days he's had 3 espisodes of vomiting in association with his choking spells. Physical examination was significant for pulse rate 160 BPM and respiration rate 72 per min. (both highly elevated). X- ray is clear and there are no tracheal abnormalities. His WBC count is 15,500 with 70% lymphocytes. What organism is affecting this child?

Blastomyces dermatitidis

38-year-old North Carolina man in good health until 2 months prior to admission, has developed a low-grade fever, myalgias, and a nonproductive cough. He was given oral erythromycin. After 2 weeks of therapy his condition has not improved. Chest x-ray demonstrated "right middle lobe airspace disease" in therapy with oral ampicillin was begun. Over the next month his condition worsened. He noted daily fevers, chills, night sweats, and a 15 pound weight loss. A PPD skin test was negative with positive controls, and oral antibacterial agent was given. Patient symptoms continued and he was admitted to the hospital. Patient has unremarkable travel history and no animal exposure, non-smoker and has no HIV risk factors. He worked for power company cutting tree limbs and tops. On physical examination he was febrile to 38.3 C. The skin examination was notable for tender, raised erythematous papule (1 by 1 cm) on the bridge of the nose. A chest x-ray subsequent CT scan were notable for densely consolidated right middle lobe, a 3.5cm subcarinal mass, and a small right hilar mass. Bronchoscopy was performed. KOH Examination an acid fast, modified acid fast, and Gram stain and gave negative results. Examination of the skin Legion uses silver stain demonstrated a large, round budding yeast with a broad base connecting to the mother cell to the daughter cell. What organism is causing his illness?

Giardiasis

One summer a group of tourists from the United Kingdom became ill after they stayed at the same hotel in Greece. Epidemiologists conducted surveys among the people who stayed at the hotel during the 2 1/2 week period which people reporting their illnesses. They did this in attempt to determine the cause of the symptoms, which were primarily diarrhea and nausea. They surveyed 239 people; 224 of them reported having been ill while they were on vacation or shortly after their return. Only 2 types of food available in the dining room seemed to be associated with illness: raw vegetables and salads. There was also a statistically significant relationship between illness and having consumed orange juice made from a mix with hotel water. The diarrhea symptoms lasted 10 to 15 days. 70 of the 224 people he reported illness were classified as having definite cases of gastrointestinal disease. A case called " definite" is when a pathogen could actually be recovered from her stools. The vast majority tested positive for one particular microorganism. Microscopic analysis of the stool samples revealed the presence of a small oval shaped structures, with defined outer walls and 2 to 4 nuclei that look like seeds. What is your diagnosis?

Vibrio cholera

A family recently moved to the United States from Peru 6 weeks ago. A woman calls and identifies herself as Leslie and says the mother of a young family became ill yesterday and seems extremely ill now. Her symptoms started out as stomach cramps and quickly progressed to a very watery diarrhea. The sick women is moaning in the background and Leslie tells you the women is pointing to her calves and crying you ask Leslie how many stools woman has had in the last 12 hours. She replies that it's almost constant and that the woman can no longer leave her bed at all. When asked, Leslie says there's no blood in the excreta. It's clear with lots of white flecks in it. What do you suspect the organism is?

Campylobactor

An 18-year-old male is being evaluated for diarrhea and abdominal discomfort. The patient 1st noted mild abdominal discomfort and 3 loose bowel movements per day for 1 week prior to evaluation. 2 days prior to evaluation he noted intermittent, crampy, periumbilical abdominal pain. He denies drinking well water. He reports no fever, blood in the stool, relation of the pain to meals, dysuria or hematuria. On examination the patient normal vital signs. abdominal examination was noted for mild lower abdominal tenderness. The fecal examination demonstrated a greenish, watery stool that was negative for occult blood. He has a normal WBC, hemaocrit, and platelet count. Examination of the feces was remarkable for the presence of WBCs. Gram stain of fecal culture showed pink curved rod shaped bacteria. Based on the laboratory findings what is the etiology of this patient's diarrhea?

Shigella

4-year-old male admitted to emergency room with a two-hour history of vomiting, diarrhea, fever, irritability, and lethargy. Grandmother awoke and found child covered in feces at 3 AM. She carried him to the bathtub and noticed he was febrile and she bathed him and brought him to the emergency room. Patient's medical history is significant for his participation in group day care. In the emergency room he had 2 episodes of vomiting, his temperature is 38.9C, pulse rate 160 bpm, respiration 36 bpm and he is dehydrated. Stool contains bloody streaks; methylene blue stain of feces is significant for the presence of WBC's. Cerebrospinal fluid examination was within normal limits. Peripheral WBC 13,200 with 85% neutrophils; negative blood culture; negative stool examination for ova and parasites. A McConkey agar plates culture of the organism produce light tan, raised, shiny colonies. The sample was positive for glucose fermentation, negative for sucrose or lactose fermentation, negative for hydrogen sulfide production, negative for indole production. Given this clinical picture, what bacterial pathogens are likely in this patient?

Rotavirus

1-year-old male infant admitted to hospital because of fever and dehydration. Parents reported 1 day history of fever, diarrhea, emesis, and decreased urine output. Temperature is 39.5 Celsius, slight tachycardiac with pulse rate 126/minute, and respiration rate 32/minute. He is very somnolent. Physical examination was remarkable only for hyper active bowel sounds. Lab showed leukocytosis with WBC 14,200 with 80% polymorphonuclear leukocytes. Your analysis was significant for high specific gravity and ketones consistent with the patient's dehydration. Stool, blood and urine sent in for testing. Stool was also checked for ova and parasites. There were no fecal leukocytes. Patient was given IV of normal saline and have nothing by mouth. Over the next 48 hours his emesis abated. Once rehydrated he was tolerating oral feedings and was discharged to go home. All cultures for bacterial pathogens were negative, but a rapid viral diagnostic test was positive. What is the cause of this patient's gastroenteritis?

measles

A 4-year-old boy with history of cough, conjunctivitis in fever (38.3 C) now has a macular rash that appears on the face and then spreads to the rest the body following a period of cold like symptoms. The presence of koplik's spots inside the mouth is a diagnostic for?

Chickenpox

A 8-year-old boy has a rash consisting of vesicular lesions of 5 days duration on his neck and stomach. Within 5 days, 73 students in his elementary school has elements matching the case definition for this disease.

Scabies

A 11 month old boy came to the clinic with a one-week history of an itchy red papular rash under his arms. He seems more bothered at night and has no fever. Lesions are measured at 1 mm. Microscopic examinations were done. What could be the cause of these patchy red pimple like conditions?

Bacterial conjunctivitis

20-year-old man has eye redness with dried mucus crust in the morning the condition resolved with the topical antibiotic

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