n case 1: at the age of 63 years, mr. o. had an operation to remove a tumor that obstructed his...
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n
Case 1:
At the age of 63 years, Mr. O. had an operation to remove a
tumor that obstructed his stomach.
The surgeon resected part of stomach and connected the
remainder part with the jejunum, bypassing the un-resected
duodenum.
Two years later, Mr. O. developed chronic diarrhea, and his
weight dropped from 139 to 97 pounds.
On examination he was extremely thin, fatigued with short
of breath and numbness and tingling in his hands and feet.
N
Laboratory tests showed a severe anemia with large red
blood cells (ovalocytes) and hypersegmented neutrophils.
Serum levels of Vitamin A, and Carotene were depressed.
Serum Vitamin B12 was undetectable.
Specific test for fat contents in stool analysis revealed
steatorrhea.
109 CFU of Bacteroides fragilis and 106 E.coli CFU per mL
were isolated from small bowel specimens.
N
1- What is your diagnosis?
2- What is the cause of this abnormality?
3-How can you confirm your answer?
4-What is the underlying cause of the numbness
and tingling experienced by Mr. O?
5- What is the mechanism of the diarrhea that
established due to this conditions?
n
Case 2:
Mr. R., an 85-year-old resident of a nursing home was
visited by E., his 3-year-old granddaughter. The two shared
a fast-food hamburger for lunch.
One day later, Mr. R had a watery diarrhea every 15 to 30
minutes, initially with small amount of visible blood. Later
that day, bright red stools consisting of pure blood
appeared. Mr. R was hospitalized and a barium enema
revealed edema of the ascending and transverse colon.
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Routine stool cultures were negative for Salmonella and
Shigella. However, Sorbitol non-fermenting E. coli was
identified by Lab as a serotype O157:H7.
One day after Mr. R fell ill, E. developed watery bloody
diarrhea that increased over the next 2 days. When E.
began to vomit and her urine output appeared to
diminish, her parents took her to the pediatrician. The
laboratory reported a significant decrease in platelets and
red blood cells, many of which looked abnormal. Serum creatinine level was slightly elevated.
N
The patient was treated with intravenous fluids and no
antibiotics were given. No hypertension developed and
she was discharged 1 week later due to improvement in
the blood count and kidney function test.
1-What is the likely source of infection?2-Diagnosis of E. case.3-How can you confirm this diagnosis?4-By which mechanism does the responsible etiological agent cause these diseases in Mr. R and E case?5-What are the principle therapeutic concerns in such case.
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Case 3:
Mr. L., a 23-year-old patient came to the emergency
department because of jaundice. For several days he had
felt increasingly weak, nauseated, and feverish and had
pain on the right side of his abdomen. He reported that he
had experimented with a variety of oral and injectable
drugs. The emergency physician suspected that Mr. L. had
acute hepatitis. The laboratory reported increased SGPT,
Alkaline phosphatase, and total and direct bilirubin.
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HBsAg was detected in serum. Anti-HBsAg Antibodies were
negative.
1-By what route might Mr. L. have become infected?
2-What is the period of Hepatitis B infection seen in this
case?
3- How can you confirm your answer?
4-What follow-up tests will be required to determine his
long-term prognosis?
5-What advice can Mr. L be given to avoid further
transmission of infection.
N
Case 4: An elderly patient is placed on ampicillin and develops fever, and acute diarrhea with blood and mucus. Laboratory results of Complete blood count (C.B.C) reported leukocytosis and elevated neutrophils count.
Which one of the following organisms is the most likely cause of this patient’s diarrhea?A. Staphylococcus aureus.B. Streptococcus pyogenes.C. Clostridium difficile.D. Clostridium perfringens.E. Bacillus cereus.
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Case 5: A 45-year-old tourist returned from a trip to South America and began having cramps and diarrhea. The watery bowel movements came rapidly, one after another, and contained small bits of grayish-white stool. The man was sweaty and nauseated. Upon admission to hospital, 2 liters of fluid were administered intravenously, which was supplemented by oral fluid. The patient was discharged 48 hours after admission. A Gram’s negative non-lactose fermenting non-halophilic rods was isolated by alkaline peptone media.
Which of the following microbes produces these symptoms? A. Vibrio parahaemolyticus. D. Helicobacter pylori.B. ETEC. E. Vibrio cholerae.C. Campylobacter jejuni.