By E. Brenton. Saint Joseph College.

Transport so that temperature is maintained at of collection and transfused within 6 hours 20°C–24°C D discount 100 mcg fluticasone with visa. Which of the following is true regarding apheresis the outdate of the unit and washed and transfused or platelets? What method can be employed to detect bacteria longer be used as a screening test for platelets discount fluticasone 100 mcg. Cryoprecipitate may be used to treat all of the Answers to Questions 11–18 following generic 500mcg fluticasone visa, except: A. D A unit having a noticeable clot should not be issued for transfusion to a patient. The clot may be an Blood bank/Select best course of action/Hemotherapy/ indication of contamination or bacterial growth. Centrifuge/sterile connecting device platelets may be given to a transplant in which the D. Cell washer/heat sealer donor is A and the recipient is O; once the stem cells Blood bank/Apply knowledge of standard operating engraft, platelets/plasma must be compatible with procedures/Blood components/Platelets/2 type A cells. If only type O single-donor platelets are available, the product can be spun down using a 15. What component(s) is (are) indicated for patients centrifuge and plasma can be removed. C Patients with anti-IgA antibodies should not receive components containing plasma. Washed or Blood bank/Select course of action/Hemotherapy/2 deglycerolized red cells can be issued. Ultraviolet radiation induces apoptosis of Blood bank/Select course of action/Hemotherapy/ lymphocytes Irradiation/2 Blood bank/Apply knowledge of standard operating procedures/Blood components/Stem cells/1 20. Platelet concentrates Blood bank/Apply knowledge of standard operating Blood bank/Apply knowledge of standard operating procedures/Blood components/1 procedures/Blood bank/Expiration date/1 21. Which of the following is true regarding Answers to Questions 19–26 granulocyte concentrates? C A red cell unit that has been leukocyte reduced must retain 85% of original red cells. Blood bank/Apply knowledge of standard operating procedures/Blood components/2 21. C Granulocyte concentrates contain a large amount of red cells and must be crossmatched with the 22. A Pooled cryoprecipitate is a closed system; however, it has an outdate of 4 hours once thawed. Blood bank/Apply knowledge of standard operating Platelet concentrates expire in 5 days. All of the following are advantages of using single- Answers to Questions 27–30 donor platelets as opposed to random donor platelets, except: 27. Less antigen exposure for patients prepared by apheresis, which may require 1–3 hours C. No pooling is required random donor platelets in equivalent amounts may require only a few minutes. Blood bank/Apply principles of special procedures/ Blood components/Platelets/1 28. A When individual Cryo units are pooled in an open system, the expiration time is 4 hours; if Cryo is 28. What is the expiration of cryoprecipitate once pooled using a sterile connecting device, the pooled? What is the number of white blood cells permitted Platelets may be needed to control bleeding, and in a unit of leukoreduced red cells? Te patient’s hemoglobin is 8 g/dL owing to chemotherapy with a drug known to cause bone marrow depression and immunodeficiency. Platelet count of 75 × 109/L in a donor who is a vaccine last week frequent platelet donor B. A 54-year-old man who tested positive for Blood bank/Apply knowledge of standard operating hepatitis C last year, but has no active symptoms procedures/Donor requirements/1 of disease Blood bank/Apply knowledge of standard operating Answers to Questions 1–5 procedures/Donor requirements/2 1. She is currently on Persons who lived in an area endemic for malaria warfarin and vitamin B12. No, her hemoglobin is too low However, because she is currently on warfarin, only red cells can be prepared from her donation. Blood bank/Apply knowledge of standard operating procedures/Donor requirements/2 3. Which immunization has the longest deferral influenza and yellow fever vaccines is 2 weeks. Yellow fever vaccine interval must pass between all other types of Blood bank/Apply knowledge of standard operating donations. A To be eligible for plateletpheresis, the platelet count should be >150 × 109 for a frequent platelet donor.

Their develop- ment from bacterial cells in a “vegetative” state does not involve assimilation of additional external nutrients buy fluticasone 500mcg fast delivery. They are spherical to oval in shape and are characterized by a thick spore wall and a high level of resistance to chemical and physical noxae order fluticasone 100 mcg online. Among human pathogen bacteria trusted 100 mcg fluticasone, only the genera Clos- tridium and Bacillus produce spores. The heat resistance of these spores is their most important quality from a medical point of view, since heat ster- Dental Plaque Fig. Potential contributing factors to spore heat resistance include their thick wall structures, the dehydration of the spore, and crosslinking of the proteins by the calcium salt of pyridine-2,6-dicarboxylic acid, both of which render pro- tein denaturing difficult. When a spore’s milieu once againprovides favorable conditions (nutrient medium, temperature, osmotic pressure, etc. They derive energy from the breakdown of organic nutrients and use this chemical energy both for resynthesis and secondary activities. Bacteria oxidize nutrient substrates by means of either respiration or fermentation. In respiration, O2 is the electron and proton acceptor, in fer- mentation an organic molecule performs this function. Human pathogenic bacteria are classified in terms of their O2 requirements and tolerance as fa- cultative anaerobes, obligate aerobes, obligate anaerobes, or aerotolerant anaerobes. Nutrient agar contains the inert substrate agarose, which liquefies at 100 8C and gels at 45 8C. The growth curve for proliferation in nutrient broth is normally characterized by the phases lag, log (or exponential) growth, sta- tionary growth, and death. They can be subdivided into anabolic (synthetic) reactions that consume en- ergy and catabolic reactions that supply energy. In the anabolic, endergonic Kayser, Medical Microbiology © 2005 Thieme All rights reserved. The Physiology of Metabolism and Growth in Bacteria 161 reactions, the energy requirement is consumed in the form of light or chem- ical energy—by photosynthetic or chemosynthetic bacteria, respectively. Catabolic reactions supply both energy and the basic structural elements for synthesis of specific bacterial molecules. Bacteria that feed on inorganic nutrients are said to be lithotrophic, those that feed on organic nutrients are organotrophic. Human pathogenic bacteria are always chemosynthetic, organo- trophic bacteria (or chemo-organotrophs). Bacterial exoenzymes split up the nutrient substrates into smaller molecules outside the cell. Nutrients can be taken up by means of passive diffusion or, more frequently, specifically by active transport through the membrane(s). The substance to which the H2 atoms are transferred is called the hydrogen acceptor. In anaerobic respira- tion, the O2 that serves as the hydrogen acceptor is a component of an inor- ganic salt. The main difference between fermentation and respiration is the energy yield, which can be greater from respiration than from fermentation for a given nutrient substrate by as much as a factor of 10. Fermentation processes involving microorganisms are designated by the final product, e. The energy released by oxidation is stored as chemical energy in the form of a thioester (e. Anaerobic respiration is when the electrons are transferred to inorganically bound oxygen. Oxygen is activated in one of three ways: & Transfer of 4e– to O, resulting in two oxygen ions (2 O2–). The Physiology of Metabolism and Growth in Bacteria 163 Bacteria are categorized as the following according to their O2-related behavior: & Facultative anaerobes. These bacteria can oxidize nutrient substrates by means of both respiration and fermentation. Their metabolism is adapted to a low redox potential and vital enzymes are in- 3 hibited by O2. These bacteria oxidize nutrient substrates with- out using elemental oxygen although, unlike obligate anaerobes, theycan tol- erate it. The principle of the biochemical unity of life asserts that all life on earth is, in essence, the same. Thus, the catabolic intermediary metabolism of bacteria is, for the most part, equiva- lent towhat takes place in eukaryotic cells.

Coagulase buy fluticasone 250mcg without prescription, glucose fermentation generic fluticasone 100 mcg online, lysostaphin Optochin but viridans streptococci are resistant generic fluticasone 100 mcg with amex. Microbiology/Evaluate laboratory data to make Other means of successful identification are rapid identification/Gram-positive cocci/3 urease test on biopsy material; urea breath test; and serological tests for the detection of antibodies to H. A catalase-positive, gram-positive short rod was Answers to Questions 39–41 recovered from the blood of a prenatal patient. Te following tests were 5% sheep blood agar, which often mimics group B performed, indicating the patient was infected β-hemolytic streptococci. Exposure through direct contact Voges–Proskauer = + (respiratory or cutaneous lesions) is the most likely A. An emergency department physician suspected chocolate agars, but Tinsdale agar is the preferred Corynebacterium diphtheriae when examining the culture medium because the potassium tellurite in sore throat of an exchange student from South the agar causes C. Clue cells (vaginal epithelial cells with gram-variable coccobacilli on the cell margins) 41. A 25-year-old pregnant patient complained of are seen in vaginal washings and the organism grows vaginal irritation. Staphylococcus saprophyticus Microbiology/Evaluate data for identification/ Gram-variable rods/3 7. Anaerobic gram-positive, spore-forming bacilli experiencing neurological difficulties after a were recovered from the feces of a chemotherapy pulmonary infection. Clostridium difficile negative, but the blood cultures revealed a Microbiology/Evaluate laboratory data for gram-positive short rod that grew aerobically on identification/Anaerobic gram-positive rods/3 blood agar. Immunocompromised Glucose = + (Acid) Esculin hydrolysis = + patients are susceptible to infections, especially pulmonary, which then disseminate to other organs, A. If it is not detected and treated, infection of the fetus, resulting Microbiology/Evaluate laboratory data for in stillbirth, abortion, or premature birth may result. Anaerobic, nonpigmented, gram-negative rods formers) were cultured from two separate blood were recovered from an anaerobic blood agar plate culture bottles (at 5 days) obtained from a after 48 hours of incubation. Te Gram-stained 25-year-old patient admitted to the hospital with smear showed thin bacilli with pointed ends. Microbiology/Evaluate laboratory data for Microbiology/Evaluate laboratory data for identification/Anaerobic gram-positive rods/3 identification/Anaerobic gram-negative rods/3 46. Anaerobic gram-positive bacilli with subterminal Answers to Questions 45–48 spores were recovered from several blood cultures obtained from a patient diagnosed with a 45. It is were recorded: one of the most common organisms isolated from Indole = Neg Urease = Neg Lipase = Neg blood cultures and is often a contaminant. Anaerobic gram-negative bacilli were recovered from fluid obtained from drainage of a 47. Te following indigenous flora of the large bowel and is recovered test results were recorded: most commonly from postoperative abdominal fluids. A A slender gram-negative rod with pointed ends that Urease = Neg Lipase = Neg does not grow on 20% bile agar rules out B. Microbiology/Evaluate laboratory data for identification/Anaerobic gram-negative rods/3 7. A 2-month-old infant in good health was Answers to Questions 49–50 scheduled for a checkup at the pediatrician’s office. What is the most likely organism skin, mucous membranes, and gastrointestinal tract. Invasive aspergillosis seen in neutropenic Microbiology/Evaluate laboratory data to make patients exhibits sinusitis, and is disseminated identification/Mycology/3 throughout the body. A 69-year-old male patient who was a cigarette smoker visited the doctor’s office complaining of a cough and congestion of the lungs. A fungal culture was also ordered that grew the following on Sabouraud dextrose agar after 3 days: Hyphae = Septate with dichotomous branching Spores = Produced by conidial heads with numerous conidia Colonies = Velvety or powdery, white at first, then turning dark greenish to gray (reverse = white to tan) Vesicle = Holding phialides usually on upper two-thirds only What is the most likely identification? Aspergillus fumigatus Microbiology/Evaluate laboratory data to make identification/Mycology/3 490 Chapter 7 | Microbiology 51. A dehydrated 25-year-old male patient was visited the podiatrist for relief from the itching. Serological that grew after 8 days on Sabouraud dextrose testing proved negative for recent streptococcal agar. Colonies were powdery pink with concentric infection, Epstein–Barr virus, and hepatitis. Measles virus conidiophores Microbiology/Select tests for identification/Virology/3 Red pigment on cornmeal (1% dextrose) = Neg In vitro hair perforation = + Answers to Questions 51–53 Te most likely identification is: 51. Aspergillus niger In vitro Hair Red Pigment Microbiology/Evaluate laboratory data to make Perforation on Cornmeal identification/Mycology/3 Urease Test Agar 52.

Cases Case 1 A 46-year-old male police officer noticed mild pressure in his abdomen when he bent to tie his shoes buy 500mcg fluticasone with visa. Further question- ing revealed early satiety fluticasone 500 mcg overnight delivery, and physical examination revealed a large epigastric mass that was firm but not hard buy fluticasone 500 mcg lowest price. Physical examination revealed a midline epigastric mass along with an enlarged spleen. Case 4 A 48-year-old man presented with increasing abdominal girth and decreased appetite. Case 5 A 45-year-old man presented with intermittent nausea and blood in his stools. Introduction Abdominal masses may be caused by a large variety of pathologic con- ditions. All abdominal masses need to be thoroughly and expeditiously evaluated, sometimes with significant urgency. A detailed history and physical examination, combined with knowledge of normal anatomy, allow the physician to generate a reasonable differential diagnosis. In certain situations, notably rupturing abdominal aortic aneurysms, the physician must take the patient directly to the operating room without further testing to avoid exsanguination. Several classification systems are available to help guide evaluation of a patient with an abdominal mass (Table 22. Organ based Liver Pancreas Spleen Renal Vascular Gastrointestinal Connective tissue Location based Abdominal wall Intraperitoneal Pelvic Right lower quadrant Left lower quadrant Mid-pelvis Retroperitoneal Flank Epigastric Right upper quadrant Left upper quadrant anatomic systems (Table 22. These systems can be divided into an organ-based system or a location-based system. As always, the physician must be sure the patient does not have an emergency situation requiring immediate operation. General Evaluation A detailed history must include information about the onset of the mass (sudden vs. Neoplastic Benign Malignant Primary Metastatic Infectious Bacterial Parasitic Fungal Traumatic Inflammatory Congenital Degenerative 412 T. These symptoms could include nausea, vomiting, diarrhea, melena, jaundice, vaginal bleeding, and hematuria. The physician should ask about the presence of pain along with details about pain quality, location, radiation, timing, severity, and factors that alleviate or exacerbate the pain. Physical examination should include an evaluation of the patient’s general status, including vital signs and any evidence of impending cardiac or respiratory collapse. Evidence of bowel perforation, such as diffuse abdominal tenderness or tympany from free air, should be sought. Masses that are tender and associated with signs of sepsis (fever, hypotension) or masses associated with perforation require urgent evaluation. Upon completion of the history and physical examination, the physician usually knows if urgent evaluation and treatment are needed or if more leisurely evaluation is safe. Plain radiographs of the chest and abdomen combined with basic laboratory evaluation (com- plete blood count with differential, electrolytes, renal and liver func- tion, urinalysis, pregnancy test) are the first steps in further evaluation. The plain radiographs should include a flat and upright abdominal film along with posteroanterior and lateral chest radiographs. Masses of the uterus and ovaries usually are evaluated initially with ultrasound, either transabdominal or transvaginal. Ultra- sound also is useful for suspected biliary disease as well as for evalua- tion of nonurgent abdominal aortic aneurysms. Cystoscopy is useful for bladder evaluation and should be included in any evaluation of hematuria. Angiography occasionally is used in the evaluation of operative approaches for abdominal masses. Mag- netic resonance angiography is an evolving technique that may provide similar information less invasively than angiography. Liver Masses Liver masses may present with symptoms or may be discovered inci- dentally on scans done for other reasons. Tumors Cysts Abscesses Benign Acquired Pyogenic Hemangioma Parasitic (hydatid) Adenoma Traumatic Focal nodular hyperplasia Malignant: primary Congenital Amebic Hepatoma Single Cholangiocarcinoma Multiple Angiosarcoma Malignant: metastatic Fungal Unresectable Resectable tenderness could represent an infectious etiology, such as abscess. A personal history of cancer, particularly colon and rectal cancer, could be a clue to hepatic metastases. Patients with a history of alcoholism or hepatitis leading to cirrhosis are at risk for hepatocellular cancer. His occupation as a police officer may have exposed him to blunt abdominal trauma while arresting a suspect. The patient’s symptoms were managed with mild analgesics, and the decision was made to avoid surgical resection in this patient. Heman- gioma is the most common benign tumor of the liver, occurring in up to 20% of patients in some autopsy series.