A two-year-old male was brought to the Emergency Room in November because of vomiting and diarrhea. He was admitted to the hospital because of fever (39.5) and dehydration. He had a slight tachycardia (124 beats/min) and respirations of 34/min.
Question 1 - Single Best Answer
Which would you consider to be the most likely type of diarrhea in this child?
A) infectious
B) non-infectious
Question 2 - Single Best Answer
What are the three major kinds of infectious agents that might be the cause?
A) ETEC, EPEC, EHEC
B) viruses, parasites, bacteria
C) E. coli, rotaviruses, Campylobacter
D) rotaviruses, Norwalk viruses, enteroviruses
Question 3 - Single Best Answer
What are the two major kinds of diarrhea that it is important to differentiate?
A) secretory and watery
B) inflammatory and secretory
C) viral and bacterial
D) bacterial and parasite
E) dysentery and inflammatory
Initial tests showed that his urine had a high specific gravity and that there were no fecal leukocytes.
Question 4 - Single Best Answer
The high urine specific gravity is consistent with the child's dehydration. What is the significance of the fact that no fecal leukocytes were found?
A) he does not have an infection
B) he has a viral diarrhea
C) he has diarrhea caused by a parasite
D) he has a noninflammatory or secretory diarrhea
Question 5 - Single Best Answer
What are some causes of noninflammatory or watery diarrhea?
A) E. coli and rotaviruses
B) Shigella and Campylobacter
C) Vibrio cholera and Epstein-Barr virus
D) Epstein-Barr virus and Norwalk virus
Question 6 - Single Best Answer
Besides rotaviruses, what are some other viral causes of watery diarrhea?
A) Herpes and CMV
B) Rubella and rubeola
C) Norwalk and adeno
D) E. coli and Vibrio
Question 7 - Single Best Answer
What is the first thing you should initiate for this child?
A) oral rehydration
B) intravenous rehydration
C) fever reduction
D) antibiotics
E) A or B, depending on the circumstances
Question 8 - Single Best Answer
The child was started on intravenous fluids. Microscopic examination of a fecal smear revealed no indication of parasites. Routine stool cultures were done and were all negative. This latter result indicates?
A) he had no bacteria in his GI tract
B) his diarrhea was not caused by an infectious agent
C) his diarrhea was not caused by a parasite
D) his diarrhea was viral or caused by a parasite
Question 9 - Single Best Answer
How would you diagnose a case of viral diarrhea?
A) virus isolation
B) IgG antibodies in the serum
C) DNA probe of a fecal smear
D) detection of viral antigen in the stool
Question 10 - Single Best Answer
The child was shown to have rotavirus diarrhea. What is a risk factor for this disease?
A) malnutrition
B) under 5 y.o.
C) daycare centers
D) all of the above
Question 11 - Single Best Answer
What is the mechanism by which rotaviruses cause diarrhea?
A) they produce a toxin that stimulates adenyl cyclase
B) they cause a low osmolarity in the lumen of the intestine and this causes water secretion
C) they inhibit water adsorption by the columnar epithelial cells
D) they coat the brush border cells with virus so that no water can be adsorbed
The child recovered uneventfully and could return to his daycare center the next week. His mother found, when she took him back, that many of the other children had a similar illness.
Question 12 - Single Best Answer
What is the best way to prevent this disease?
A) don't eat raw oysters
B) wash hands
C) don't drink unpasteurized milk
D) cook hamburger meat well