GI INFECTIONS

This child shows a condition of the skin

known as _____ (aka a loss of skin
_____).
What caused this in the patient?

Ah, The Poison Doughnut aka _______ which is what type of toxin and causes
what type of diarrhea disease? Whats the incubation and the duration of the
disease? What kinda diarrhea does it usually cause?

Biggest health
risk? Gimme a
few clinical ways
we define this

A gram neg bug that can cause disease inside and outside of the enteric tract caused this.
Which is it, what gnarly toxin does it produce and what kinda diarrhea does that toxin result in?
is the infectious dose low or high in this strain?
That toxin inhibits ________ in the host cell

Normal

Day 7 after onset

This picture shows platelet and fibrin thrombi in the kidney as a

result of ______ (an e. coli ____:h7 complication)
Whats the major risk factor for developing it?
Whats the famous triad of sequellae that define the condition we are
referencing?

Who am I?
___________________
Second most common cause of bacterial
diarrhea in US
Highest incidence in 20 yr olds
Causes bloody diarrhea
Non-infectious sequelae: reactive
arthritis, Guillain Barre syndrome

_______________________
Usually associated with an underlying
immune deficiency
Bacteremia, vascular infection

Those are chickens, and we associate them with a

tummy infection from ___________
what are 2 big clinical symptoms

Antibiotic Treatment for

Diarrhea
Always indicated
________
________
________

Usually not indicated in normal

host (unless severe illness)
_______
_______
_______
_______

Antibiotic Treatment for

Diarrhea
Treatment usually indicated or not
indicated(?) for infants, elderly,
immunocompromised, chronic
disease, malignancy,
immunosuppressive medications or
severe infection
Campylobacter
Non-typhoidal salmonellae
Non-cholera vibrios
EPEC
ETEC

This is ________ colitis from _______ ________.

Its a gram _____, ______-forming, aerobe/anaerobe (?), that results
usually from __________use and occurs in 25% of nosocomial pts

Viral Diarrhea fill in the

blanks
____________
Winter vomiting disease
Predominantly in young children < 2 yrs of age
Watery diarrhea, not usually with fever

Norovirus
Most common in _______ & _________children
Widespread community epidemics without
seasonality
Explosive bloody or watery(?) diarrhea and
barfing
In recent past, significant problem on cruise
ships, hospitals, extended care facilities

Bacterial Pneumonia

What kinda flora is this & where?

What kinda of cells are pictured?

EM VIEW OF _________?
Mucous

A RSPIRATORY DROPLET IS USUALLY __ MICRONS in DIAMETER AND THE VIABLE INFECTION

RADIUS IS _____FEET? BEYOND THIS DISTANCE THEY ____ INTO _____ WHERE THEY
BECOME LESS VIABLE.
AN EXCEPTION is WHICH BACTERIA? IT CAN SURVIVE THE STATE REFERRED TO IN THE
PREVIOUS QUESTION.
WHEN INHALED THEY WILL COLONIZE WHERE?
BEYOND

TEM of ________ ?
THE ARROW IS POINTING AT A _________?

This organism causes pneumonia. The patient had a

cough and rust-colored sputum. It is alpha hemolytic.
What is it?

CLOSE UP VIEW BELOW

What tissue is this? What happened? Is this permanent?

This patient has COPD and has recently

been diagnosed with pneumonia. It is the
winter time. Gram stain reveals a gram
negative bug. What is it?

This elderly person has pneumonia and gram stain reveals gram (-)
rods. What three bugs could it be?

What is this organ? It shows a lot of necrosis. What

likely caused this?

What is this bug? Who does it usually

affect (ages)? What usually comes
before this infection?

What is this? What is it typical of?

WHAT ARE THE ARROWS POINTING AT?

What would you call this?

What likely caused this?
Spit me some knowledge on where the infiltrate
lives and what WBCs are chillin there
Does it destroy the alveolar architecture?

What is this?

What is this? What usually causes it? This pattern is

usually referred to as __________?
Hangman time: The pneumonia is usually called
I _ t _ r s _ _ _ _ _ l because the infiltrate lies _______ the
alveoli

What happened here? THE INSERT is a closeup shot

What is this? What happens if you

move the patient to take another
CXR?

THIS IS WHAT HAPPENS IF YOU MOVE THE PATIENT? BIG

EFFIN DEALWE CARE WHY? SOOO THIS PROVES THIS
PATIENT HAS _______ & NOT AN (SEE OTHER PIC FOR A
HINT)

CHECK OUT THE LEFT LUNG, WHATS THERE? WHAT

BUGS ARE USUALLY RESPONSIBLE FOR THIS CRUD.
THERE IS A FEATURE OF THIS UNUSUAL FINDING THAT
HELPS US DETERMINE THE IMPLICATED BUG, WHAT IS
IT?

Sexually Transmitted
Infections

1. What is this called? (Sorry Shankar!)

2. This chancre is caused by syphilis in what stage?
3. How do we treat syphilis in this stage?

1. What are we looking at?

2. What is the diagnosis?
3. What are two bacteria that can cause this?

In a wet mount, you can see the pathogen swimming

around. What is the pathogen, and what is this
condition called?

1. The causative organism has many types. Which type most likely
caused this lesion?
2. What central nervous system manifestation are commonly caused
by this organism?
3. If this lesion was in the mouth, what would be its most likely cause?
What CNS manifestation could it cause?

1. What is this caused by?

2. At this stage in the infection, can we use VDRL and RPR to
diagnose?
3. What will you treat this with?

1. What does this person have?

2. What other symptoms might they be experiencing?
3. If this infection progresses to the next stage, what are two major
possible manifestations?

1. There was an outbreak of this in the Netherlands in 2003 among

MSMs- what is it?
2. What type of chlamydia causes this?
3. How would you treat this

1. This is called urethritis. What type of chlamydia causes this? Be

specific!
2. Comment on the prevalence of this in the US
3. How would you diagnose this?
4. How would you treat this?

This is a chancroid. It sounds like chancre, but they are different.

1. What are some similarities between chancres and chancroids?
2. What are some differences between chancres and chancroids?

1. This is a chancroid. What organism caused this? (Name two

other types of bacteria in its family!)
2. How would you treat this?

1. What symptoms might accompany these manifestations of

primary HSV?
2. How do you treat this?

1. What is this called and what organism caused it?

2. What makes this genital lesion different from others?
3. What is diagnostic of this disease on tissue smear?

1. Want long term complications can this cause in men?

2. What is the mechanism by which it causes cancer?

1.
2.
3.
4.
5.

This is an epithelial cell full of bacteria. What is this called?

What is it a sign of?
What pH helps diagnose this condition?
What might discharge from this patient smell like?
What are some complications of this?

1. What other symptoms would accompany this pathogen?

2. How would you treat it?

1. What parts of the body does this pathogen affect?

2. How common is its infection of the vagina?
3. What are accompanying symptoms of its infection of the
vagina?

1. What vegetable does this resemble?

2. What is the causative agent? What subtype caused this lesion?
3. If this were to cause cervical carcinoma, what types would be
involved?
4. What can be given to prevent this, and what types does it

1. What bacteria causes this infection and what family is it from?

2. Give an example of another spirochete and the disease it
causes.

1. What does this discharge remind you of?

2. How would you treat this infection?
3. What is often a precursor event to infection with this
pathogen?
4. What is the name of this condition?

1. Although its hard to see, these are diplococci isolated from

penile discharge. What media was used to grow this organism?
2. If this was collected from a women, would it be considered
diagnostic?
3. How would you treat this infection?

1. This disease results when what is replaced with high

concentrations of anaerobic bacteria?
2. What is this disease called?
3. What would you treat this with?

1. Which disease are these ulcerations associated with? What

exactly do we call the lesions?

TICK BORNE DISEASES

WHAT KINDA TICK AM I AND WHAT DISEASE DO I CAUSE? Heres a hint, it can cause 2 of the 3 major types of this disease. Can you name them?
What are the clinical symptoms of this disease and what organs are most likely affected?
How would you treat?

This is a Babesiosis smear: tell me whether I should use a thick or thin smear to diagnose?
Which parasite causes this and what tick carries it?
Whats the familiar name of this disease (it will give away the typical geography that may or
may not be super close to us here in RI).
What season is associated with this?
Lastly, how do we treat (there are a couple options.)?

The left shows the _____phase which begins in the (name the body parts) and the right shows
the _____ phase of _______ after it has migrated to the (name the body parts). Caused by
rickettsia rickettsii from the ______ tick. The tickettsii invade ________ cells (shown below) to
cause a _________ small vessel vasculitis and the characteristic rash.
Trt with ________

RMSF: Skin
Biopsy

All these arrows are pointing at

the same characteristic histo
finding in a patient that has
_________? What is it called?
In a blood smear you might see
them in peripheral blood cells,
macros and neutrophils.
How do you treat?

Daughter: Hey mom and dad, I

found this squirrel in the woods,
can I keep it? I think hes just
sleeping.
Dad: Child please, you must be
crazy! That little varmint is
dead as a door nail and
probably has a gram negative
___________ called _______ ______
which is the result of the
common ______ ______ aka
xenopsylla cheopis.
Daughter: but doesnt he
deserve a proper burial ? It
looks like he had a tough life.
Dad: well I guess we can do
that. Go on and get the
backhoe.
Fast forward a few weeks,
the child ended up getting
__________.

Urinary Tract
Infections

Here we see bacteria adhering to the uroepithelial surface.

1. Supposing the bacteria are E. Coli, what virulence factor has
helped their adherence?
2. What other roles can these virulence factors play in causing
UTIs?

This finding is seen on wet mounts in a condition that causes

dysuria.
1. What are they called?
2. What disease does it help to diagnose?

This is a wet mount of vaginal fluid.

1. What pathogen do we see?
2. Lets say you have a patient with dysuria and you need to
distinguish between cystitis or a yeast infection without using a
wet mount. What do you ask and how will that help you make
the right diagnosis?

The adhesion of this bacteria to the uroepthelium

causes a UTI.
1. Name 2 host defenses and how they might have
been compromised to allow this infection.
2. Is the patient most likely to be male or female and
why?
3. What is the most common symptom she may be
experiencing?

What condition is shown here?

In the histo, what do we see thats
characteristic (orange circles)?
What can happen to that business thats
encircled in orange?

This is a urine culture.

1. What do you see?
2. What does its finding mean?
3. What are 3 ways to collect urine samples.

a. Name this condition

c. whats up with the left kidney? Should

that thing enhance with IV contrast?

b. whats in the left kidney? What

features do we see?

d. What do we see in the right kidney? What

condition? How should severe cases be treated?

1.
2.
3.
4.

What is this called?

What is it diagnostic of?
In this condition, where is the infection?
In the acute version of this, what are likely
symptoms?
5. What are diagnostic clues that a patient has the
subacute version?

What is the arrow pointing to (see hint)? Into

what is it sticking? How do we treat? What
disease?

1. What diagnostic procedure is this?

2. What is it used to visualize?
3. What are the drawbacks?

What are these and in what kind of infection would we find them?
What are they made of? In what pH do they form?

1. What type of image is this?

2. Is it invasive?
3. What can we detect in UT?

1. What kind of diagnostic picture is this?

2. What do we see on the left and the right?
3. This patient has chronic relapsing infections of the UT. What
are 3 things you could you treat them with?

Osteomyelitis &
Endocarditis

Its time to
play.name that
lesion!

1. What is this manifestation of endocarditis called?

2. How is it described?
3. What causes it?

This guy drilled a hole through his finger.

1. What was the likely route of infection?
2. What might you see in his blood?
3. He is not diagnosed quickly, why might this be?
4. When would his infection be considered chronic?

This is a slide of a heart valve with _________ & __________.

What is the clinical halmark of endocarditis? (hint, 4 things & an
acronym made famous by the artist pictured)

There is a vegetation of bacteria sitting on this heart valve.

1. What symptom will this likely cause?
2. What other 3 symptoms would clinch a diagnosis of
endocarditis?
3. What makes this vegetation so beneficial to the pathogen?
4. Which two bacteria can aggregate platelets to allow better
adherence?

1. What ruptured here?

2. What valve is most commonly affected?
3. If this presented acutely, was the valve likely normal beforehand or
previously damaged?

1.
2.
3.
4.

What is going on here? What imaging modality?

What is the most likely pathogen?
Could we diagnose this with an X-ray?
Where does this condition most commonly affect
children 1-15?

a. Emboli of the ______ that

probably involved the ___ ____
artery.

b. What do we call the condition

affecting this part of the kidney?
Possible end result?

c. The white dots are

splenic infarts, can they be
detected clinically

1. What imaging
modality? How
do you know?
2. What is
happening here?
What is causing
this (most
likely)?

This valve stiffened due to a fibrotic reaction from antibody

attachment
1. What pathogen likely caused this and what is the disease
called?
2. What kind of infection may have preceeded this?
3. Would this likely present acutely or subacutely?
4. Name 3 virulence factors of this pathogen
5. Name 2 surface proteins of this pathogen.

1. This vessel was weakened by an infective process. What is

that called?
2. To treat the infection, what types of antibiotics do we need to
use?
3. Everybody and their mom knows that staphlococci &
streptococci usually result in endocarditis, what are some of
the LEAST LIKELY ones to cause it but, when they do, result

a. Based on the numbers, what

valve is this most likely? Tricuspid,
pulmonic, or mitral?

b. What am I pointing to? Likely

from what bacteria?

c. This is showing ______ of the

aortic valve

d. This is a Fibrotic valve, its a

good site for __________?

1. What are these called?

2. How are they different from Osler nodes?

1. This bug caused a right sided endocarditis. What is the likely

bug?
2. Who tend to be at the greatest risk for this (pictured above)?
What is the mechanism by which the bug gets to the rt side
of the heart
3. What are other common sources of endocarditis in this risk

1. What is the symptom

on the left called?
2. What is the symptom
on the right called? Is it
painful? Where are they
usually?

1. Where are we?

2. Is this pathological or normal?
3. If pathological, what caused this?

This patient presented with a large ulcer on the bottom of her

foot.
1. What would help determine if its osteomyelitis?
2. What is a likely co-morbidity of this patient?
3. What about this co-morbidity predisposes her to this
infection?

1. What pathogen do you see?

2. How many sets of blood cultures should usually be drawn to isolate
the pathogen?
3. What other diagnostic tools can be used to diagnose endocarditis?

This is showing destruction of the

aortic valveso what bacteria is
most likely responsible?

A. What is the arrow pointing to?

Skin & Soft Tissue

Infections
An identification exercise rather than
individual questions for this one!

CNS Infections

1. What is this called? What is it a sign of?

2. What would you look for in a kid to diagnose the
same thing?
3. Should the patient get a CT or LP first?
4. CT shows no focal lesions, and a LP is done which
shows increased neutrophils, elevated protein and
decreased glucose. What are you thinking?
5. How characteristics must your antibiotic have?
6. What is one antibiotic you could use that fit these
criteria?

This 10 year old also presents with vomiting, stiff neck and
fever.
1. What is the likely pathogen?
2. What does it gram stain, and what is its major virulence
factor?
3. Purple, blotchy hemorrhages associated with this is called
what?
4. What is the mortality of this when acquired in the

1.
2.
3.
4.

What do we see in the cerebellum?

What symptoms does it likely cause?
How should it be treated?
What areas of the brain are susceptible to this?

MENINGITIS

1. What is this characteristic of? Which family of

viruses? What is a rare (6-10%) complication? What
do the CBC and CSF (hint) workups look like with
this complication?

RANDOS

1. This is _________ and it is nearly always associated

with o_po_t_n_s_ _c infections. With what immuno
defects might you associate this type of infection?

The pathogen is the

initiating cause of sepsis

NAME IT!!!

Activated human macrophage

(lets just say in the enteric tract))

What
bacteria am I
likely to be?

Hepatic
Microcirculationbaseline

30 min later, after a sublethal dose of LPS

(a) Whats this ?

(b) How about this?

(c) What condition is likely responsible for this? I know this is

broad.think Opals lecture.