4/13/2019 Chapter 24 Homework

Chapter 24 Homework
Due: 1:59pm on Monday, April 22, 2019
You will receive no credit for items you complete after the assignment is due. Grading Policy

Video Tutor: Bacterial Urinary Tract Infections

Watch the Video Tutor on Bacterial Urinary Tract Infections and then answer the questions below.

Part A
Which condition is associated with bacterial infection of the bladder?

Hint 1.

The bladder is a hollow organ that fills with urine.

ANSWER:

cystitis

pyelonephritis

bacteremia

urethritis

Correct
A cyst describes a hollow organ filled with fluid, as is the bladder.

Part B
Some strains of E. coli have __________ allowing them to bind and then enter into epithelial cells of the urethra.

Hint 1.
This virulence factor is primarily for attaching to host cells and not for motility.

ANSWER:

flagella

gram-negative cell wall

fimbriae

cilia

Correct
The fimbriae allow for attachment and entry into host cells.

Part C
What is the primary source of infection for UTIs?

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Hint 1.
Think about the natural habitat of E. coli.

ANSWER:

Sexual intercourse

Dehydration

Fecal contamination

Contaminated drinking water

Correct
E. coli is the primary cause of UTIs and is commonly found in feces.

Part D
Which demographic is most likely to develop a urinary tract infection?

Hint 1.
UTIs are more likely due to anatomy.

ANSWER:

Men with enlarged prostates

Dehydrated persons

Diabetics

Females

Correct
Women and girls are more prone to a urinary tract infection due to the close proximity of the source of infection and the portal of entry.

Part E
What might a clinician expect to observe in the urinalysis of a patient with a UTI?

Hint 1.

A UTI involves the presence of bacteria where they are not normally found.

ANSWER:

Epithelial cells

Leukocytes

Dark urine

Crystals

Correct
Leukocytes are a clear indication that an infection is present in the urinary system.

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Part F
Which of the following measures would be most effective in preventing a UTI?

Hint 1.

Think about the common source of infection and the portal of entry.

ANSWER:

The use of a catheter

Daily use of topical antifungals

Drink cranberry juice

Wiping front to back after defecation

Correct
Wiping front to back will prevent the introduction of E. coli to the urethra.

Clinical Case: A Very Sick Man

A Very Sick Man A 25-year-old homosexual man was admitted to the hospital with oral candidiasis (thrush), diarrhea, unexplained weight loss, herpes lesions,
and pneumonia. Cultures of pulmonary fluid revealed the presence of Pneumocystis jirovecii. The man admitted to frequently paying for sex.

Part A
Given the man’s symptoms and described history, what diagnosis could be made?

Hint 1.
What could you say about this patient’s immune system if he has contracted so many infections at one time?

ANSWER:

Chances are this patient is suffering due to the diarrhea and weight loss, which have led to a state of immunosuppression allowing the other
infections to set in.

Immunosuppression has allowed for multiple infections, all of which may be explained by the patient’s sexual activity.

The oral thrush and diarrhea have led to the patient being immunocompromised and allowed for the additional infections.

Chances are this patient is HIV positive and is now severely immunocompromised due to AIDS.

Correct
The symptoms and number of concurrent infections lead to the conclusion that this patient has developed AIDS.

Part B
According to the patient’s history, how did this man most likely acquire the infection?

Hint 1.
The patient’s history and activities must be taken into account.

ANSWER:

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by exposure to someone with pneumonia

by ingestion of contaminated food or water

through unprotected sex with a prostitute

It is impossible to tell.

Correct
The patient’s history of paying for sex with male prostitutes means that if he has had unprotected sex his chances of acquiring HIV are statistically
higher than those of any other groups.

Part C
If this man is HIV positive, what changes to the man’s immune system allowed the opportunistic infections of Candida (thrush) and Pneumocystis
(pneumonia) to arise?

Hint 1.
The focus is on the impact the virus will have on the immune system to develop AIDS.

ANSWER:

The virus has lowered his CD8 T cell count to the point that his immune system is compromised.

The virus has lowered his CD4 T cell count to the point that his immune system is compromised.

The virus has lowered his blood monocyte count to the point that his immune system is compromised.

The virus has lowered his T cell count to the point that his immune system is compromised.

Correct
The lowering of the CD4 T cells to or below a count of 200 is the threshold for AIDS.

Part D
What laboratory tests should be performed to confirm the patient’s status and current diagnosis in this case?

Hint 1.

“HIV positive” means that a person has antibodies to the virus.

ANSWER:

An antibody test to determine if the patient has seroconverted for HIV and a PCR test should be performed to determine the type of herpesvirus
that is infecting the patient.

A CD4 T cell count to determine AIDS status should suffice.

A serum antibody test to determine if the patient has seroconverted for HIV and a CD4 T cell count to determine AIDS status should be
performed.

An antibody test to determine if the patient has seroconverted for HIV should suffice.

Correct
Determining HIV status will help in determining the cause of immunosuppression since there are other diseases and cancers that may suppress
the immune system.

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Part E
What treatments should be prescribed for this patient?

Hint 1.

Review the treatment options for AIDS patients.

ANSWER:

supportive therapies to minimize any discomfort

antimicrobial medications for the opportunistic infections and antiretroviral therapy to try to control the HIV infection

antibiotics for the infections, as well as supportive therapy

antiretroviral therapy for the HIV infections and allowing the patient’s immune system to clear the opportunistic infections

Correct
Medications should be prescribed to alleviate the opportunistic infections before they overwhelm what is left of the patient’s immune system while
also trying to limit the spread of HIV through the remaining T cells by starting the HIV drug cocktail.

A Burning Question

A 20-year-old woman comes to the local clinic complaining of lower abdominal pain and sharp burning pain on urination (dysuria) that has gone on for 1 week.
She also complains of mild fever and chills. Her history and physical reveal that she has had eight sexual partners in the previous year and has used condoms
only on occasion because she has been taking birth control pills. She has not visited her physician or gynecologist for 2 years. The clinic physician performs a
pelvic exam and sample collection to determine the causative agent, telling the patient that she likely has contracted a sexually transmitted infection (STI).

Part A
Sexually transmitted infections (STIs) are a significant problem in the world. The symptoms described in the case thus far are fairly general and may apply
to multiple STIs. However, many STIs can be discerned by other visual signs that accompany the general symptoms.
Drag each of the organism labels onto the picture that best matches the MOST identifiable trait/symptom associated with each disease
appearance.

Hint 1. Descriptions of sexually transmitted infections

STIs are generally classified into three categories: discharge, ulcerative, or wartlike. Discharges can be thick and pus-like (purulent) or thin and
watery. Ulcerations and warts can be described as raised or flat, open or crusted/scabbed. Small differences in the appearances are part of the
diagnosis because certain signs and symptoms are commonly associated with one disease more than others.

ANSWER:

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Reset Help

Neisseria Treponema
gonorrhoeae pallidum

Herpes simplex Chlamydia

virus (HSV) trachomatis

Human
Candida
papillomavirus
albicans
(HPV)

Correct
Checking patients for STIs is difficult because of the wide range of signs and symptoms that may or may not be present. Many STIs share
symptoms. Clinical diagnosis of STIs starts with looking for the most obvious and commonly seen signs.

On further examination, the physician finds no obvious external lesions on or around the patient’s genitalia. However, the physician does note the presence of a
discharge.

Part B
The physician performs a pelvic exam, which reveals the presence of an abnormal thin, watery vaginal discharge and inflammation of the cervix. The
physician then palpates the abdomen (examines by touch and pressure) and finds that the uterus, fallopian tubes, and ovaries are enlarged and tender.
The physician takes a swab sample of the cervix and sends it to the laboratory to determine the causal organism. Light microscopy and simple staining of
the sample in the lab reveal an organism with a very unique life cycle. The organism is classified as gram-negative, but it stains very poorly compared to
other classic gram-negative STI pathogens. The stain shows both a nonreplicating, extracellular infectious elementary body and a replicating, noninfectious
reticulate body inside mucosal cells from the cervical epithelium swab. Based on the symptoms and these new laboratory findings, which of the following
would be the most likely diagnosis for the patient?

Hint 1. Causes of nonspecific urethritis

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Because of its growth cycle, this is a tough organism to detect. This image shows the cycle, which is mentioned in the laboratory reports. The
microbe requires special growth conditions or DNA detection (such as by PCR), which may not be available in some labs. As such, this infection is
often diagnosed by symptomatic appearance and swabs or by serology testing for urinary antigens.

ANSWER:

chlamydia

syphilis

gonorrhea

leptospirosis

Correct
The physician makes a clinical diagnosis of chlamydia. Additionally, the exam shows that the patient has signs of progressive chlamydial pelvic
inflammatory disease (PID).

This just went from bad to worse for the patient. Untreated STI cases can lead to progression of disease beyond the borders of the urinary and reproductive
tracts, with potentially serious complications.

Part C
The two most common STI organisms associated with PID in the United States are Chlamydia trachomatis and Neisseria gonorrhoeae. There are many
similarities between these STIs. Which of the following statements comparing chlamydia and gonorrhea are true?
Select all statements that are TRUE.

Hint 1. Comparison of two common STI organisms

Although clinicians consider symptoms in diagnosing diseases, asymptomatic conditions are also very prevalent. This adds a layer of complexity in
determining an etiology of an STI (including whether or not the patient has a single or mixed infection) and an initial causative case. Thankfully, we
can control most of the issues with antibiotics.

ANSWER:
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It is impossible to contract chlamydia and gonorrhea from a single unprotected exposure.

Chlamydia and gonorrhea infect only the cells of the urinary and reproductive tracts.

Chlamydia and gonorrhea can infect a patient and be transmitted without causing obvious symptoms.

Without prompt treatment, chlamydia and gonorrhea have a significantly high mortality rate.

Chlamydia is found more often in women, whereas gonorrhea is found more often in men.

Patients may be coinfected with both gonorrhea and chlamydia.

Correct
STIs not only are hard to detect, but also are not mutually exclusive. When a patient has one STI, others may be “hiding in the shadows.” STIs
spread rapidly and can have consequences outside the urinary and reproductive tracts.

The laboratory needs more time to rule out a mixed infection but does confirm the presence of Chlamydia. The patient’s symptoms suggest that this infection
has been going on for a while and has progressed beyond a simple case of Chlamydia urethritis to pelvic inflammatory disease (PID). As discussed in the
above question, these STIs aren’t just for the genitals anymore!

Part D
Chlamydia PID is just part of the overall spectrum of disease caused by Chlamydia organisms. Even though we now understand more about STIs and their
complications, we are still exploring how the organisms “branch out” beyond just a single infection. Which of the following diseases have Chlamydia
infection as an etiology?
Select all diseases associated with Chlamydia.

Hint 1. Additional diseases caused by STI organisms

The definition of what currently constitutes sexual intercourse varies. Some sexual practices that were once associated only with certain groups,
such as homosexual males and anal sex, are broader than once speculated. And the diseases that were once “reserved” only for specific groups
are now affecting wider populations. Multiple sexual practices mean additional modes of transmission to other body locations, including horizontal
spread (from mother to fetus/newborn). Also keep in mind that STIs are not always a single-species infection!

ANSWER:

pneumonia

infertility

trachoma

acquired immunodeficiency syndrome (AIDS)

lymphogranuloma venereum (LGV)

cervical cancer

inclusion conjunctivitis

fetal birth defects (teratogenicity)

Correct
Mixed STI infections (which may involve both different species and different strains of the same species) are able to manifest in an infected
patient with more than just the classic “clap” symptoms. The caregiver should always be aware that more may be going on in the patient than
meets the eye and act appropriately to instruct the patient on routes of spread the person might not anticipate.

Having identified the STI and potential consequences, we now need to turn to appropriate treatment for her conditions.

Part E
Our patient needs antibiotics to overcome this infection and prevent any further complications. Which of the following would be the best choice?

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Hint 1. Treating STIs

Antibiotics target structural components of a bacterium. A very common target is the cell wall. Because eukaryotic host cells do not contain
peptidoglycan, antibiotics that target the cell wall have a selectively toxic effect. Prokaryotic ribosomes also differ slightly from eukaryotic ribosomes,
making them another potential target of antibiotic therapy. To choose an antibiotic that will efficiently target the pathogen, you should identify which
organism(s) you are dealing with as well as consider Gram typing and structural components. Finally, remember that until the final lab report comes
back, you should assume that coinfection is present and treat accordingly.

ANSWER:

cephalosporin-class antibiotics, such as ceftriaxone.

macrolide-class antibiotics, such as azithromycin.

No treatment is recommended; provide patient with educational materials on STIs, and remind her of proper condom usage.

a combination therapy of cephalosporin-class AND macrolide-class.

Correct

Conclusion
After 3 days of hospitalization for antibiotic therapy, monitoring, and laboratory testing to assess the function of her reproductive systems, the patient is released
to go home. She is discharged with a short course of antibiotics, educational materials about STIs (with multiple copies so that she can notify and inform her
partners), and instructions to follow up with her gynecologist for yearly checkups.
Score Summary:
Your score on this assignment is 98.3%.
You received 1.97 out of a possible total of 2 points.

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