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|SubCategory=Neurology | |SubCategory=Neurology | ||
|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? | |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 | |Explanation=This patient has symptoms and history suggestive of [[Guillain-Barré 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). GBS is thought to be caused by a Type IV hypersensitivity reaction in which schwann cells are targeted for destruction. Most patients recover spontaneously from the disease. | ||
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. | 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. | ||
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* Clostridium tetani. Associated with spastic paralysis. Toxin inhibits the release of inhibitory neurotransmitters. | * 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. | None of these species are most commonly associated with the development of [[Guillain-Barré syndrome]]. | ||
|AnswerC=Staphlococcus aureus | |AnswerC=Staphlococcus aureus | ||
|AnswerCExp=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. | |AnswerCExp=[[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 | |AnswerD=Campylobacter species | ||
|AnswerDExp=''[[Campylobacter jejuni]]'' is the most common cause of Guillain-Barré syndrome. | |AnswerDExp=''[[Campylobacter jejuni]]'' is the most common cause of [[Guillain-Barré syndrome]]. | ||
|AnswerE=''Neisseria meningitidis'' | |AnswerE=''Neisseria meningitidis'' | ||
|AnswerEExp=''Neisseria meningitidis'' is not associated with the development of Guillain-Barré syndrome. ''Neisseria meningitidis'' is an encapsulated, gram negative diplococcus that ferments maltose (M for maltose in the name). Neisseria meningitidis typically causes meningitis in adults. | |AnswerEExp=''Neisseria meningitidis'' is not associated with the development of [[Guillain-Barré syndrome]]. ''Neisseria meningitidis'' is an encapsulated, gram negative diplococcus that ferments maltose (M for maltose in the name). ''Neisseria meningitidis'' typically causes meningitis in adults. | ||
|EducationalObjectives=Campylobacter jejuni is the most common cause of Guillain-Barré syndrome | |EducationalObjectives=''Campylobacter jejuni'' is the most common cause of [[Guillain-Barré syndrome]] | ||
|References=First Aid 2014: page 484 | |References=First Aid 2014: page 484 | ||
First Aid 2013 page 444 | First Aid 2013 page 444 | ||
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|WBRKeyword=Neurology, Neuropathy, Paralysis, Hypersensitivity, Autoimmune, Schwann | |WBRKeyword=Neurology, Neuropathy, Paralysis, Hypersensitivity, Autoimmune, Schwann | ||
|Approved=Yes | |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 17:52, 30 June 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::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::Clostridium species include:
None of these species are most commonly associated with the development of Guillain-Barré syndrome.]] |
| Answer C | AnswerC::Staphlococcus aureus |
| Answer C Explanation | [[AnswerCExp::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::Campylobacter jejuni is the most common cause of Guillain-Barré syndrome.]] |
| Answer E | AnswerE::''Neisseria meningitidis'' |
| Answer E Explanation | [[AnswerEExp::Neisseria meningitidis is not associated with the development of Guillain-Barré syndrome. Neisseria meningitidis is an encapsulated, gram negative diplococcus that ferments maltose (M for maltose in the name). Neisseria meningitidis typically causes meningitis in adults.]] |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::This patient has symptoms and history suggestive of Guillain-Barré 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). GBS is thought to be caused by a Type IV hypersensitivity reaction in which schwann cells are targeted for destruction. Most patients recover spontaneously from the disease.
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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Neurology, WBRKeyword::Neuropathy, WBRKeyword::Paralysis, WBRKeyword::Hypersensitivity, WBRKeyword::Autoimmune, WBRKeyword::Schwann |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
Image [[WBRImage::|]] Caption WBRImageCaption::no-display Position [[WBRImagePlace::|]]