CASE Studies PDF

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cases studies gone over in class, all categorized into simple bulleted terms to study...

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#1 Streptococcus pyogenes (strep throat) - Beta-hemolytic, Group A - 5 yr. good health - white patchy, enlarged tonsils - rapid strep and agar plate - ABX 10 days - Acute infection - Sequela (acute chronic infection) #2 Friends driving to mall, hear about flu shot - Vaccine cant give flu, inactivated virus - RNA virus; rapidly changes year to year - Drift: slow Shift: fast - Respiratory not GI #3 Histoplasmosis (Spelunker’s disease) - Didn’t respond to abx, meaning its fungul - Park ranger in Arizona - CA: Histoplasma Capsulatum o fungus in bat/ bird droppings - Fever,chest pain,cough,chronic mouth sores - inhalation of spores in the droppings - Antifungul meds #4 Hantavirus pulmonary syndrome - CA: Sin nombre - Cabin seldom rodents contaminated - Found in mouse droppings, when aerosol released into air - Not only southwest America - Fever, muscle ache, vomiting, diarrhea, cough, shock - No treatment - Zoonosis #5 Adenovirus pharyngitis - Sore throat but from a virus - 22 month black female - Runny nose, hoarse cough, Lg fever - No evidence of strep negative, staph infects skin - Viral, no overt sign of infection - Responded well w vaporizer

#6 (RSV) Respiratory Syncytial Virus - CA: Paramyxovirus that produces syncytia - Viral pneumonia - 3 month son weezing, trouble breathing, fever temp rising, disky color - Seen several cases in past week - Older child already exposed, stronger immune

#7 Legionnaires Disease - CA: Legionella pneumonia - ABX - Contaminated water source in building - Multiplies w/n phagocytes - Protozoan - Muscle aches, headache, fever, cough, abdominal pain, vomit, diarrhea #8 Conjunctivitis (pink eye) - Thick yellow discharge - Eye drops 24 hr very contagious - Strep, staph, haemophilus - CA: Adenovirus echovirus can cause - Bacterial #9 Influenza 22 male college - Moderate fever pain in lungs - Headache , no pneumonia - Tight productive cough, no strep - Can turn to bacterial #10 Klebsiella (bacterial pneumonia) - 68 w Alzheimer - lethargic -gram – grown on agar is slimy - damage to lings and inflammation - bacterial #11 Pediatric Pharyngitis - Had several cases - Treat ABX (rheumati, scarlett, endocarditis) - Michael crying, mouth hurts - Breath smells rotten - White packet on left tonsil - Rapid and throat culture

Skin #1 Fertility treatment Rubella( German measles) vaccination - Don’t get when pregnant, birth defects - Most children treated 12-15 mon. 4-6 years - Rubella virus, RNA virus of toga - Nonspecific treatment #2 Lyme Disease - Gram -, spirochete - ****Borrelia burgodorferi*** - Deer tick bite, normally in northeast, bullseye - Mimics arthritis - 14 yr with rash - ABX treatment #3 Measles - Epidemic bc back then people weren’t getting vaccinated 1908 - Spots close together on kids - 12-15 mon. 4-6 yrs. #4 Shingles - Varicella-zoster virus; enveloped - 6 mon. w lesions back left of spine (7-8) blister like - Chix pox exposed - Passive immunity and contacted herpes zoster w no symptoms - Fighting it w antibodies from breast milk, stopped feeding lost immunity #5 Fifth Disease - Parvovirus B19 - John bright red face, milder rash on arms and legs - Symptoms appear no longer contagious - Common, asymp.

Wound #1 Staphylococcus Aureus - Gram +, cocci - Coagulase + - Fever, wound oozing w pus, enlarged lymph nodes - Diarrhea and vomiting - TSS - Redness, swelling, pain at wound site - ABX

#2 Necrotizing fasciitis - Streptococcal pyogenes Beta, A - Women w surgical wound - Confusion, shock, discoloration, swelling at wound site - Not clostridium perf. Bc these are cocci in chains - Gram – rods - Amputation bc spreads quickly, aggressive treatment, removal of infected tissue - FOMITE #3 Gangrene (clostridum) - Clostridium perfrigens - Foul odor, brown fluid - Rotten - Farmer cut w manure turner - Leg swelled - Need to get rid of dead tissue - Result in death if not amputated - Diabetics at risk; poor circulation #4 Lockjaw (tetanus) - Lawyer punctured left arm w nail - Clostridium tetani - Treated w tetanus immune globin - Muscle relaxants, artificial respiration - Receive booster injections - Restlessness, irritability, difficult swallowing, muscle pain, and spasms

Digestive #1 Ecoli- Escherichia coli O157:H7 breakout - Eat steaks bc it is muscle, which is not contaminated unlike beef. - Veggies can be infected also - Kidney failure, bloody diarrhea - Don’t eat raw meat, change eating habits #2 Clostdrium difficle: chp. 24 - Nurses fourth bathroom trip today - Was on abx for sinus infection - Opportunist - Elderly/very young - Constant diarrhea to toxins produced - Fecal transplant/ABX #3 Pam w husband opposing vaccination HBV - Doc says needs it , husband thinks other - transmitted through saliva person-person, bodily fluids - cause liver failure later in life - HEP A is fecal oral not HEP B - Genetically engineered antigen that cant turn into toxin #4 Ghiardia lambila, (Giardiasis) Traveled in Greece - Not Staph Auereus bc incubation period long, or food poisoning - Source was the water - Fecal-oral #5 Cholera - Causative: Vibrio cholerae - Receptionist @ church mother from Peru ill - Constant diarrhea - Come from Peru; endemic o Rice water stools o Family member could have already had disease o Brought infected food o Asymptotic carrier - IV fluids and vaccines #6 HEP C is the only viral infection w a cure #7 Stomach Ulcer - Heliobacter pylori - ABX, inhib stomach acid production - Asymptomatic o Abdominal pain o Tenderness, bleeding

Blood and Lymphatic #1 Subacute endocarditis - CA: streptococcus viridians/ epidermidis - Dad faints at baseball game - Tooth extraction - Fingernails petechial hemorrhages  o2 in the bloodstream - Connect w rheumatic fever bc damage to heart valves lead bacteria attaching - BAP alpha hemolytic - Bactericidal abx #2 Dengue Fever - Ades aegypti  vector born - DENV1-5 Flavivirus family - 6 yr old girl no english - “Broke bone” “in her blood” - Deep tissue pain - Tropical places, mosquitos (control vector pop)

#3 Malaria - CA: plasmodium malariea (72 hr cycle) - Intermittent high fever/ constant chills - Ask where he’s traveled - Euk. Protozoan - Most dangerous species to cause is plasmodium o falciparum (cerebral malaria) o malariae o ovale o vivax o knoelesi - Liver blood cells - Have to be bitten by mosquito #4 Malaria exodus scpaularis - Peace corps, south Africa - Several children high fever, sweating, prostration - Mosquito net - In adult clients test for malaria HIV/AIDS

#5 Lyme Disease - People spraying pesticides - Borrelia burgdorferi bacteria - Heavily forested areas w deer - Rocky mountain fever similar rickettsia rickettsi

#6 HIV + - Fred steel worker visits more than often - Lost 15 lbs, ordered HIV (negative) - Experience genital herpes - ELISA test to detect antibodies in blood - Had HIV but tested negative bc of a window frame where no antibodies were produced - Should use western lot tests #7 Septicemia - Severe allergic reaction to toxin from bug bite - Fever from poision - Insect bite at lake Michigan - Cellulitis - ABX and blood tests

Nervous system #1 MMR Pollio immunization - 12 mon, vaccination distracted mother - Receive MMR polio immunizations - Booklet shows signs and symptoms, side effects - Immunocompromised not strong enough to defend dead virus - Also administer HIV , hep B, varicella (chix pox) #2 Hemophilis influenzae - Gram- Small children respiratory - Cloud CSF - Is a vaccine but child didn’t have - WBC that die are causing cloudy - Also cause pneumonia, epiglottis, ear infection

#3 cryptococcal memingoencephalitis - CA: Cryptococcus neoformans - Antifungal medication - Stiff neck, think meningitis - Look of CSF w spinal tap - Not bacterial, encapsulated yeast/fungal infection - Immunocompromised AIDs - Inhalation of bird droplets that get aerosolized - CNS, brain, respiratory - RUN HIV and AIDS #4 Clostridium botulinum - Neurotoxin that can cause paralysis - Infant botulism, weakness nausea - Gram + - 13 week old w no focus or muscle control - Foodbourne - Too dangerous for normal lab tests #5 Meningococcal meningitis - CA: Neisseria meningitidis - Gram – diplococcus - Fecal oral entry - Swab wouldn’t help - Send infected students home/ vaccinate everyone - Fever, stiff neck, vomiting, petechiae, pain headache, mild cold

#6 West Nile encephalitis - Flavivirus - Via mosquito aedes aegypti - Birds - Climate change, shipping containers - Central park closed, west Nile outbreak - Encephalitis; inflammation of brain - Epizootic - Abrupt onset, fever, headache, disorientation, paralysis, seizures, deafness, coma

#7 Syphilis - CA: treponema pallidum - Dwight homeless man, feet cracked and blistered, seeping sores in wrists and under arms - Feeling crazy-> sexual exploits - Cant transmit, tertiary - No ABX nervous system already infected - HIV test #8 Polio - Neurological infection or parasite - Missionary couple in south Africa, home in Minnesota to visit - Boy mild episode of diarrhea, trouble walking, lethargic - Need the serum antibody against polio - Receive vaccines would have helped prevent - Headache, fever, stiff neck, nausea, pain, muscle spams #9 Neisseria meningitides induced meningitis - 17 yr. wrestler - Several areas of purpilish spots on skin - Headache, vomit, stiff neck - Worsen until shock and die

Genitourinary Tract #1 Pelvic Inflammatory Disease - Community service, local STD clinic, intake interviews - Association b/w belly pain and STD o Std works way up genitourinary tract when untreated o Pelvic inflammation - Lead to infertility - Test for Neisseria gonorrhea and chlamydia - ABX - BF needs treatment

#2 UTI Bacterial cystitis - CA: gram – bacteria from large intestine (ecoli) - Call line, women complains of painful urination - Ask questions like frequent urge to pee, fever, lower back pain? - Kidney pain to determine if kidney damage has been done

#3 Candida albicans (yeast infection) - Yeast around area keeps getting reinfected - Jane intense vaginal itching - Diabetes, HIV, douches, immunocomp. - See doctor #4 Bacterial Vaginitis - CA: Gardnerella vaginalis, mycoplasma sp. - Pregnant women with clue cells - Gray-white discharge, fishy odor - Clues bc bacteria contained in them - Can be dangerous to fetus - Test for chlamydia, gonorrhea, yeat, trich #5 Gential herpes - Jack has steady GF w herpes - Virus spread even if lesion free - Cant go through latex but uncovered pubic areas affected - Safest is lesion free, female condom, antiviral meds - Antiviral meds can shorten outbreaks and lessen viral load but no cure

#6 Genital herpes HSV type 2 - Herpes simplex virus type 1 is the ORAL - Ask about sex history - Abnormal pap smears - After first abnormal antiprotozoal to look for cancerous cells probably found Trich - History of pap not important - Test for syphilis and HIV #7 -

Normal pregnant women test + for gonorrhea Thinks husbands been unfaithful Asymptomatic or one could have had it before Treat women with something that wont effect baby PA felt uncomfy discussing...