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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=Anonymous (Reviewed by Will Gibson)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Microbiology
|MainCategory=Microbiology
Line 19: Line 20:
|MainCategory=Microbiology
|MainCategory=Microbiology
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=A 32-year-old man is brought to the emergency room and he states that for the past month he has been losing feeling and motor function of both his lower extremities. This problem has progressed until now when he cannot walk and must be carried onto the exam bed. He states that he has not had a history of trauma and the only illness was nausea, vomiting, and diarrhea 3 months earlier, although he recovered fully without medications. On exam, motor strength is 1/5 in both legs and deep tendon reflexes are impaired. What is the most likely organism responsible for this illness?
|Prompt=A 32-year-old man is brought to the emergency room by his wife for progressive loss of sensation and motor function of both his lower extremities over the past month. The patient can no longer walk and must be carried onto the exam bed. He denies any recent history of trauma and the only illness he can recall consists of an episode of nausea, vomiting, and diarrhea 3 months ago, from which he recovered fully without medications. On exam, motor strength is 1/5 in both legs and deep tendon reflexes are impaired. What is the most likely organism responsible for this illness?
|Explanation=This patient has symptoms and history suggestive of Guillian-Barre syndrome. This disease usually occurs after a self-limited abdominal infection in which Campylobactor species is involved.
|Explanation=This patient has symptoms and history suggestive of Guillian-Barre syndrome. This disease usually occurs after a self-limited abdominal infection in which Campylobactor species is involved. Guillain-Barré syndrome (GBS) is a serious neurologic disease, in which the patient must be monitored as an inpatient because of its high likelihood for progression to respiratory failure (mechanical ventilation is required in 30% of patients).
|AnswerA=Streptococcus pyogenes.
 
|AnswerB=Clostridium species.
Campylobacter jejuni is a major cause of bloody diarrhea that is often spread through fecal-oral transmission.  Spoiled poultry, meat and unpasteurized milk are common sources of gastrointestinal infection.  Campylobacter jejuni is known for its ability to grow at 42<sup>o</sup>C.
|AnswerC=Staphlococcus aureus.
 
|AnswerD=Campylobactor species.
'''Educational Objective:''' Campylobacter jejuni is the most common cause of Guillain-Barré syndrome
 
'''References:'''
 
First Aid 2014: page 484
First Aid 2013 page 444
|AnswerA=Streptococcus pyogenes
|AnswerAExp='''Incorrect:''' Guillain-Barré syndrome is not commonly caused by Streptococcus pyogenes.  S pyogenes infection is associated with [[Scarlet fever]], Rheumatic fever, pharyngitis, as well as many other clinical manifestations.
|AnswerB=Clostridium species
|AnswerBExp='''Incorrect:''' Clostridium species include:
* Clostridium botulinum: Associated with laccid paralysis due to toxin
* Clostridium difficile: Associated with pseudomembranous colitis.
* Clostridium tetani.  Associated with spastic paralysis.  Toxin inhibits the release of inhibitory neurotransmitters.
 
None of these species are most commonly associated with the development of Guillain-Barré syndrome.
|AnswerC=Staphlococcus aureus
|AnswerCExp='''Incorrect:'' Guillain-Barré syndrome is not commonly cause by Staphylococcus aureus.  S. aureus is a gram positive cocci that is a component of normal skin flora. However, it commonly causes rapid onset food poisoning, cellulitis and pneumonia.  Rarer conditions caused by S. aureus include toxic shock syndrome,and scalded skin syndrome. 
|AnswerD=Campylobacter species
|AnswerDExp='''Correct:  '''Campylobacter jejuni is the most common cause of Guillain-Barré syndrome.
|AnswerE=Neisseria meningitides.
|AnswerE=Neisseria meningitides.
|RightAnswer=D
|RightAnswer=D
|Approved=No
|WBRKeyword=Neurology, Neuropathy, Paralysis, Hypersensitivity, Autoimmune,
|Approved=Yes
|Answer=Streptococcus pyogenes.,Clostridium species. C. Staphlococcus aureus.,E. Neisseria meningitides.
|Answer=Streptococcus pyogenes.,Clostridium species. C. Staphlococcus aureus.,E. Neisseria meningitides.
}}
}}
{{WBRImage}}
{{WBRImage}}

Revision as of 20:27, 16 February 2014
Author PageAuthor::Anonymous (Reviewed by Will Gibson)
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Microbiology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 32-year-old man is brought to the emergency room by his wife for progressive loss of sensation and motor function of both his lower extremities over the past month. The patient can no longer walk and must be carried onto the exam bed. He denies any recent history of trauma and the only illness he can recall consists of an episode of nausea, vomiting, and diarrhea 3 months ago, from which he recovered fully without medications. On exam, motor strength is 1/5 in both legs and deep tendon reflexes are impaired. What is the most likely organism responsible for this illness?]]
Answer A AnswerA::Streptococcus pyogenes
Answer A Explanation [[AnswerAExp::Incorrect: Guillain-Barré syndrome is not commonly caused by Streptococcus pyogenes. S pyogenes infection is associated with Scarlet fever, Rheumatic fever, pharyngitis, as well as many other clinical manifestations.]]
Answer B AnswerB::Clostridium species
Answer B Explanation [[AnswerBExp::Incorrect: Clostridium species include:
  • Clostridium botulinum: Associated with laccid paralysis due to toxin
  • Clostridium difficile: Associated with pseudomembranous colitis.
  • Clostridium tetani. Associated with spastic paralysis. Toxin inhibits the release of inhibitory neurotransmitters.

None of these species are most commonly associated with the development of Guillain-Barré syndrome.]]

Answer C AnswerC::Staphlococcus aureus
Answer C Explanation [[AnswerCExp::'Incorrect: Guillain-Barré syndrome is not commonly cause by Staphylococcus aureus. S. aureus is a gram positive cocci that is a component of normal skin flora. However, it commonly causes rapid onset food poisoning, cellulitis and pneumonia. Rarer conditions caused by S. aureus include toxic shock syndrome,and scalded skin syndrome.]]
Answer D AnswerD::Campylobacter species
Answer D Explanation AnswerDExp::'''Correct: '''Campylobacter jejuni is the most common cause of Guillain-Barré syndrome.
Answer E AnswerE::Neisseria meningitides.
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::D
Explanation [[Explanation::This patient has symptoms and history suggestive of Guillian-Barre syndrome. This disease usually occurs after a self-limited abdominal infection in which Campylobactor species is involved. Guillain-Barré syndrome (GBS) is a serious neurologic disease, in which the patient must be monitored as an inpatient because of its high likelihood for progression to respiratory failure (mechanical ventilation is required in 30% of patients).

Campylobacter jejuni is a major cause of bloody diarrhea that is often spread through fecal-oral transmission. Spoiled poultry, meat and unpasteurized milk are common sources of gastrointestinal infection. Campylobacter jejuni is known for its ability to grow at 42oC.

Educational Objective: Campylobacter jejuni is the most common cause of Guillain-Barré syndrome

References:

First Aid 2014: page 484 First Aid 2013 page 444
Educational Objective:
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::Neurology, WBRKeyword::Neuropathy, WBRKeyword::Paralysis, WBRKeyword::Hypersensitivity, WBRKeyword::Autoimmune
Linked Question Linked::
Order in Linked Questions LinkedOrder::


Image [[WBRImage::|]] Caption WBRImageCaption::no-display Position [[WBRImagePlace::|]]

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