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USMLE HY notes > acute Diarrhea > Flashcards

acute Diarrhea Flashcards

1
Q

what is the most common pathogen for viral gastroeneritis?

A

Norovirus-
מונו מונו אני “לבד” וטוב לי- הפוכה, בתי ספר, קרוזים , בתי אבות.
חשיפה – אחרי יומיים הקאות ושלשולים – עובר אחרי 72 שעות

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2
Q

מה הפתוגנזה של רוטה וירוס

A

Duedonum + proximal jeujonum&raquo_space; villi blunting, prolifration of crypts cells and loss of brush border enzymes

no fecal luekocytes

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3
Q

what Administration of moderate to severe dehydration in childrens?

which fluid and how

A

Bolus IV istotonic fluids

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4
Q

whats the pathogen?

Raw /prepared food (potato salad)&raquo_space; 3 hrs later&raquo_space; VOMITING + wattery stool

vomiting > diarrhea

A

S.aureus

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5
Q

what is the DDx for vomiting dominant gastroenteritis?

2

A

S. aureus
Bacillus Cereus

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6
Q

whats the pathogen?

Vomiting dominant Gastroenteritis after reheating rice

A

Bacillus cereus
סיראוס- סיר אוז
Enterotoxin

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7
Q

Whats the pathogens?
return from india w/acute onset od diarrhea and abdominal pain

A

Traveler’s diarrhea = ETEC E.coli (Exterotoxigenic)

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8
Q

what are the 2 types of ETEC toxin

A

Heat-labile = activation of adenylate cyclase = increase cAMP

Heat stable = activation oc Gunelate cyclase = increase cGMP

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9
Q

Whats the most common causeses (3) of acute onset bloody diarrhea?

A
  • E.coli O157:H7
  • Compylobacter
  • Shigella
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10
Q

whats the diagnosis?

31 yr old&raquo_space; 7 days of lower abdominal pain + bloody diarrhea (wakes at night). Hb 8. MCV 67, PLT 55K, WBC 11K, Cr 2.4, coombs negetive, schistocyts on blood smear

what cause it

A

Hemolytic Uremic Syndrome = HUS
Thrombocytopenia - around 40-60K

Diagnosis- E.coli O157:17 (STEC- shiga toxin) or Shigella dysenteriae

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11
Q

who have the greater risk for HUS

A

children < 10

E.coli (STEC O157:H7) or Shigella dysentheria

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12
Q

What the patogenesis of O157:H7 EHEC + Shigella dysenteriae

A

inhibition of 60S&raquo_space; block protein synthesis&raquo_space; cell death&raquo_space; watery diarrhea that may become bloody

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13
Q

True / False

pt with EHEC will always present with fever

A

False
will not have fever

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14
Q

how to EHEC transmitted

A

Contaminated / undercook foood

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15
Q

How to destinguisah Inflammatory diarrhea with non inflammatory?

A

preseance of fecal blood and leukocytes

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16
Q

which medicaiton can cause diarrhea

A
  1. Metformin
  2. allopurinol- prevent gout, lower uric acid levels
  3. orlistat- for loosing weight
  4. SSRI
  5. cholinesterase inhibitor
  6. PPI
  7. NSAIDS

MOCA PAN

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17
Q

How can we resolve osmotic diarrhea comapre to secretory diarrhea

A

osmotic diarrhea- can be resolved by fasting

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18
Q

what do Shigella cuease to the intestital epithelium

A

Invade and enter enterocytes&raquo_space; cell death of epithelium&raquo_space; ulcerationd and bloody / mucoid diarrhea

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19
Q

whare are the 2 classic symptoms of shigella infection?

A
  1. High fever
  2. Left side abdominal pain (rectosigmoid)
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20
Q

Which complecation can shigella cause in pediatrics?

A

Siezures

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21
Q

why shigella species rq low infection dose to cause disease?

A

survive in acidic enviroment of the GI tract

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22
Q

What are the characterstic of shigella on labratory:
1. lactose fermantation
2. which agar

A
  1. Non lactose fermentation
  2. Non hydrogen sulfide on triple sugar iron agar
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23
Q

What cause Campylobacter gastroeneritis?

2

A

Poultry (fram chickens) and domasticated animals (dogs..)

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24
Q

whats the diagnosis?

Diarrhea mucoid / bloody + fever + pseudoappendecitis (oliocetis) in a pt that have a dog

A

Compylocabter

25
Q

which pathogs are the 2 most common cuase of
psuadoappendicitis
in USMLE

A
  • Yersinisa enterolitica
  • Campulobacter jejuni
26
Q

whats the diagnosis

trip to india&raquo_space; eat local food&raquo_space; 2 weeks later&raquo_space; fever 1 week&raquo_space; severe abdominal pain + distenaion + salomon colur (rose spots) circular lesions

also, who is the pathogen and how transmitted

A
  • Thypoid fever
  • Slamonella Thypi
  • Feco-oral transmittion
27
Q

Which pathogen associated with contaminated food and water can cause Hemorrhagic enteritis (Bowl perforation)

A

Salmonella Thypi

28
Q

How Slamonella thypi invade the immune sys?

A

Via capsular antigen&raquo_space; inhibit nuetophils&raquo_space;replication in macrophages

29
Q

Which Hematological disease can present with Non-typhoidal salmonella osteomoylietis

A

Sickle cell

30
Q

What the presentation of Non typpoidal salmonella?

A

bloody diarrhea after eating a lot of eggs / contact with turtules/pets

31
Q

which pathogen cause a foul smelling amniotic fluid + gram positive bacilli

A

Listeria monocytogenes

32
Q

Which pathogen is presented with “ Thumnling motility in room Tm”

A

Listeria monocytogenes

facultative anaerobe

33
Q

Listeria monocytogenes:
in adult
in pregnent women

what the presentation?

A

Story of expose to deli meet / cheeses
adults- Self limiting Gastroenteritis
Pregnant- Intrauntrine fetal demise = death (Hepatic abcess)

34
Q

When we will give Abx for acute diarrhea?

A
  1. Severe with systemic symptoms > 7 days
  2. immunocompromised
35
Q

How to diagnosed C.difficle

A

**stool PCR analysis or enzyme Immunoassay **
for C.diff toxins
or
Glutamtate dheydrogenase antigen

36
Q

Whats the diagnosis?

inpatint stay / use of antiontics in pat 12 wks , on day 3 on hospital present with fever, Watery diarrhea with trace of mucus and blood

A

C.difficile

37
Q

All the following are major risk factor for ___________

Abx use, PPI, cytotoxic Chemotherapy, age >65, recent hospitalization

A

C. difficile

38
Q

Whats C.difficle typical finding on colonoscopy

A

psuedomembranes

Fibrin & inflammatory cells

39
Q

how so psuadomembranous form?

A

Ingestion of pores&raquo_space; Toxin A &Toxin B&raquo_space; inflammatory reaction&raquo_space; actin cytoskeletal structre disrapture

C. difficile (gram positivie)

40
Q

Tx for C.difficile?

A

Vanco or Fidaxomicin (macrolide)

41
Q

What is the mechanism of aciton of macrolide?

A

inhibit RNA polymerase&raquo_space; Bactericial

42
Q

Tx for toxic mega colon after C.difficle

A

Bowl rest + NG tube + PO and rectal fidaxomicin / vanco and consider Metronidazole + Stop antinotility agents

if severe = consider colectomy

43
Q

Which of the following wont prevent/ kill bacterial spoers of C.difficile?
1. handwashing
2. Alcohol
3. Nonsterile gloves + Gown

A

Alcohol woldn’t kill bacterial spores

44
Q

Watery diarrhea after return from trip

A

ETEC

45
Q

Watery diarrhea with “rice water stool”

A

Vibrio cholera

46
Q

Watery diarrhea on cruise ship

A

Norovirous/ Norwalk virus

47
Q

Watery diarrhea in HIV

A

Cryptospardium parvum

48
Q

Bloddy diarrhea + consuming meat

A

Shigella
(or maybe EHEC, Compylobacter)

49
Q

Bloddy diarrhea + lactose ferment

A

EHEC

50
Q

Most common cause of bloddy diarrhea in usa

A

c. jujuni

51
Q

Diarrhea that feels like Appendicitis

A

Yersiniea enterolitica

52
Q

Protozoal cause bloody diarrhea

A

Entamoeba hystolitica

53
Q

Blodody diarrhea + HUS

A

EHEC or Shigella

54
Q

Diarrhea after consuming oysters / seafood

A

Vibrio parahemolyticus

55
Q

Diarrhea after consuming oyster / seafood + elevated liver enzymes

A

Vibrio vulnificus

56
Q

Diarrhea after sweimming in fresh water- (also aquarium association)

A

Aeromonas

57
Q

Diarrhea after reheat rice

A

Bacillus cereus

58
Q

Diarrhea 6-15 hrs after meat/ poultry left out long

A

Clostirdium Perfingens

59
Q

Rash + slapped cheeks apprerance

A

parvo B12

USMLE HY notes (24 decks)

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