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S. Volkar. Ohio Wesleyan University.

The chart on the next page summarizes the added characteristics of the Haemophilus spp discount 100 mg voveran sr overnight delivery spasms left side. Chocolate agar and Mueller–Hinton agar with X factor added Microbiology/Select methods/Reagents/Media/Bacteria/ Identification/2 412 Chapter 7 | Microbiology H generic voveran sr 100mg without a prescription spasms just below ribs. Te majority of Haemophilus influenzae infections Answers to Questions 25–28 are caused by which of the following capsular serotypes? Serotyping of Haemophilus is Microbiology/Correlate clinical and laboratory data/ performed by mixing colonies with agglutinating Bacteria/Haemophilus/2 antibodies available as commercial agglutination kits best 100mg voveran sr muscle relaxant with alcohol. Which Haemophilus species is difficult to isolate genital lesions referred to as “soft chancres order voveran sr 100 mg with amex spasms under rib cage. Most specimens are recovered from Microbiology/Correlate clinical and laboratory heterosexuals, and outbreaks in the United States data/Bacteria/Haemophilus/2 are traced to female prostitutes. All of these options Microbiology/Apply fundamental biological characteristics/Bacteria/1 7. A The X factor requirement for growth is the cause of Which is the most likely identification? Haemophilus aphrophilus colonies transferred from primary media containing Microbiology/Evaluate laboratory data to make blood. Nasopharyngeal swabs were cultured on 15% blood, chocolate, Bordet–Genjou, and Regan–Lowe (with 10% charcoal) agars. Bordetella bronchiseptica Microbiology/Evaluate laboratory data to make identifications/Bacteria/3 414 Chapter 7 | Microbiology 33. Francisella tularensis Answers to Questions 33–36 Microbiology/Evaluate laboratory data to make identifications/Bacteria/3 33. Tularemia is one of the most common organism grew on 5% sheep blood and chocolate laboratory-acquired infections, and it is recommended agars displaying a yellow pigment. On MacConkey that specimens be sent to a reference laboratory for agar, it appeared as a non–lactose fermenter. Acinetobacter baumannii septicemia and meningitis in neonates and immunocompromised adults. The ability to Microbiology/Evaluate laboratory data to make encapsulate, produce proteases, and survive in identifications/Bacteria/3 chlorinated tap water are factors that contribute to 35. A 46-year-old dog warden was admitted to the hospital-acquired infections with this bacterium. Pseudomonas aeruginosa cases caused by gram-negative rods result from one Microbiology/Evaluate laboratory data to make of them. A suspected case of Legionnaires’ disease was Answer to Question 37 noted on the request form for a culture and sensitivity ordered on a sputum sample. Te test used most often to separate the Answers to Questions 1–3 Micrococcaceae family from the Streptococcaceae family is: 1. Members of the Microbiology/Select methods/Reagents/Media/Bacteria/ Streptococcaceae family are negative. Micrococcus and Staphylococcus species are endocarditis following cardiac catheterization; they differentiated by which test(s)? A Both micrococci and staphylococci are catalase-positive and gram-positive cocci. On Microbiology/Select methods/Reagents/Media/Bacteria/ direct smears, they both appear as pairs, short Identification/1 chains (resembling Streptococcus spp. Lysostaphin is used to differentiate Staphylococcus However, the micrococci fail to produce acid from which other genus? Planococcus Open tube + + Microbiology/Select methods/Reagents/Media/Bacteria/ (oxidation) Identification/2 Closed tube + Neg (fermentation) 3. C Lysostaphin is an endopeptidase that cleaves the glycine-rich pentapeptide crossbridges in the staphylococcal cell wall peptidoglycan. The susceptibility of the staphylococci to lysostaphin is used to differentiate them from the micrococci. Staphylococci are susceptible and show a 10–16 mm zone of inhibition, while micrococci are not inhibited. Which of the following tests is used routinely to Answers to Questions 4–9 identify Staphylococcus aureus? All of these options of the cell wall, which reacts with the fibrinogen in the plasma. This test is not positive for all strains of Microbiology/Select methods/Reagents/Media/Bacteria/ S. Latex agglutination Microbiology/Apply knowledge of fundamental procedures utilize fibrinogen and IgG-coated latex biological characteristics/Bacteria/1 beads that detect protein A on the staphylococcal cell wall. Staphylococcus saprophyticus penicillin and ampicillin, making the organism resistant to these antibiotics. All of these options recovered from sites other than the genital area and Microbiology/Correlate clinical and laboratory produces fever and life-threatening systemic damage data/Bacteria/Staphylococcus/2 as well as shock. It is of special data/Bacteria/Staphylococcus/2 concern in nosocomial infections because of its 9. Microbiology/Apply knowledge of fundamental biological characteristics/Bacteria/1 418 Chapter 7 | Microbiology 10. Which of the following tests should be used to β-lactam antibiotics by standardized disk diffusion differentiate Staphylococcus aureus from and broth microdilution susceptibility methods Staphylococcus intermedius? Plasmid altered Microbiology/Select methods/Reagents/Media/Bacteria/ Microbiology/Apply knowledge of fundamental Identification/2 biological characteristics/Bacteria/1 Answers to Questions 10–14 11. Staphylococcus saprophyticus is best differentiated from Staphylococcus epidermidis by resistance to: 10. The resistant population Microbiology/Correlate clinical and laboratory data/ grows more slowly than the susceptible one and Bacteria/Staphylococcus/2 can be overlooked. Using the standardized agar = β (acid production) Kirby–Bauer sensitivity procedure, a 6–12 mm zone of growth inhibition is considered resistant. Staphylococcus hominis tube method calls for an incubation of 4 hours at 35°C–37°C and 18–24 hours at room temperature. Microbiology/Evaluate laboratory data to make Both must be negative to interpret the result as identifications/Bacteria/3 coagulase negative. Staphylococcus aureus recovered from a wound positive and, therefore, identified as S. D Vancomycin, along with rifampin, is used for strains pattern by the standardized Kirby–Bauer method of S. Their heteroresistance results Cephalothin = R Cefoxitin = R in a film of growth consisting of very small Vancomycin = S Methicillin = R colonies formed within the defined inhibition Which is the drug of choice for treating this zone surrounding the antibiotic disk. Which of the following tests will rapidly ulcer from a 31-year-old diabetic patient showed differentiate micrococci from staphylococci? The catalase differentiates the identifications/Bacteria/3 Micrococcaceae family (positive) from the Streptococcaceae family (negative). Urine cultured from the catheter of an 18-year-old female patient produced more than 100,000 col/mL 16. Colonies were catalase positive, possibilities because they are both catalase positive, coagulase negative by the latex agglutination slide coagulase negative, urease positive, and ferment method as well as the tube coagulase test. Novobiocin susceptibility is the test of choice single test for identification is: for differentiating these two species. The tube (cellulitis) was negative for the slide coagulase test test should be performed because the slide test was (clumping factor) and negative for novobiocin negative. A Staphylococci are susceptible to furazolidone, identification is (are): giving zones of inhibition that are 15 mm or greater. Furazolidone (Furoxone) susceptibility is a test greater is considered susceptible. The Staphylococcus used to differentiate: species are resistant and grow up to the disk, while A.

In addition discount 100 mg voveran sr fast delivery muscle relaxant patch, a thorough safety assessment discount voveran sr 100mg free shipping spasms of pain from stones in the kidney, including gait/joint examinations and safety laboratory assessments were performed purchase voveran sr 100 mg on-line muscle relaxant m 751. All procedures except for safety labs were to be repeated at the first follow- up visit (Day +28 to +42) voveran sr 100 mg with amex spasms multiple sclerosis. In addition, a pyuria assessment was to be made and the patient’s caregiver was to be asked to complete the caregiver questionnaire at this visit. At these visits, a gait/joint examination was performed and adverse event data referable to the musculoskeletal or neurological systems was collected. The caregiver was also asked to complete the caregiver questionnaire at the 1-year follow-up visit. Interim telephone calls were conducted at the 6- and 9-month time points to assess musculoskeletal and neurological safety. The study flowchart (Table 5) summarizes the timing of efficacy and safety measurements assessments obtained during the study. In this group, a serum pregnancy test was also performed at the pre-treatment baseline and repeated at the Test-of-Cure (Day +5 to +9). Events referable to the neurological or musculoskeletal system were reported through the 1-year follow-up. The safety population was defined as all randomized patients who took at least one dose of study drug. The primary population for analysis was to be the patients considered valid for safety. Clinical response, a secondary analysis, was performed on the subset of patients considered valid for efficacy, as well as on the subset of patients considered valid for safety. Bacteriological response, another secondary analysis, was performed on the subset of patients considered microbiologically valid as well as on the subset of patients microbiologically valid for safety (those having bacteriological response recorded). Demographic and baseline characteristics were to be summarized by treatment group, and for the population overall, using the mean and standard deviation, median, quartiles and minima/maxima (quantitative data), or frequency counts (qualitative/categorical data). The two treatment groups were to be compared using a one-way analysis of variance with treatment as the main effect for continuous variables like age and weight, or using a chi-squared test for categorical data. The primary safety variable was to be the arthropathy event rate at the first follow-up visit (Day +28 to +42). A two-sided 95% confidence interval for the weighted difference between treatment groups in arthropathy incidence rates was to be constructed using Mantel-Haenszel weights reflecting disease stratum/treatment type. Treatment by country (Canadian sites versus non-Canadian sites) interaction tests were to be performed for the rate of arthropathy and for the primary efficacy variables. However, in the final analysis, this interaction test was not performed by the applicant due to low enrollment by Canadian sites. This is acceptable because the enrollment in Canadian sites was 19 patients total (8 in the ciprofloxacin group and 11 in the comparator group). Of these patients only 9 (3 in the ciprofloxacin group and 6 in the comparator group) were valid for efficacy. Non-inferiority was to be defined statistically in this case as the upper limit of a two-sided 95% confidence interval for the weighted difference in arthropathy incidence rates being less than 6%. Stratum by treatment interaction was to be assessed using a Breslow- Day or Zelen’s test. If this test of homogeneity of the odds ratios indicates a significant interaction, exploratory analyses were to be attempted to define its source. Laboratory data was to be analyzed using descriptive statistics and identification of values outside of the normal range. Comparison of incidence rates of all types of adverse events was to be done in a descriptive manner. Adverse event tables were to be calculated at the first follow-up (Day +28 to +42) and the 1-year follow-up (Day +355 to +375). Descriptive statistics were to be presented across the 4 age groups; • ≥ 12 months but < 24 months; • ≥ 2 years, but < 6 years; • ≥ 6 years, but < 12 years; and • ≥ 12 years, but < 17 years. Age group was not to be used as a stratification factor in the final analyses and no statistical testing was to be performed within age groups. Missing and indeterminate data were to be treated as failures in the intent to treat population. The primary efficacy response variable was to be the clinical success (resolution) rate at the Test-of-Cure visit (Day +5 to +9 after the end of therapy). A two-sided 95% confidence interval for the weighted difference between treatment groups in clinical success rates was to be constructed using Mantel-Haenszel weights based on disease stratum/treatment type. Non-inferiority was to be defined statistically in this case as the lower limit of a two-sided 95% confidence interval for the weighted difference in clinical success rates being greater than -12%. Stratum by treatment interaction was to be assessed using a Breslow-Day or Zelen’s test. If this test of homogeneity of the odds ratios indicates a significant interaction, exploratory analyses were to be attempted to define its source. Overall clinical success rates and microbiological success rates were also to be examined and weighted confidence intervals calculated with equivalence as defined above. Age group was not to be used as a stratification factor in the final analyses and no statistical testing was to be performed within age groups. The results for these two disease groups will be reported separately (as well as combined) in the Results section of this review. Note: if the incidence be as high as 4%, the study would still have minimum power of 80% for detecting a lower limit of equivalence of 6% with alpha=0. The first secondary objective of the study was to compare the clinical success (resolution) rates at the Test-of-Cure visit (Day +5 to +9 after the end of therapy) between the patients receiving ciprofloxacin and the active control patients. Based on assumed true clinical success rates of 90% in both groups and a clinically meaningful difference (delta) of 12 percentage points, the sample size of 436 patients calculated for the safety comparison would provide 93. Clinical Reviewer’s Comment: A delta of 6% and 12% for the safety and efficacy analyses, respectively, was agreed upon by the applicant and the Division during protocol development. By October 2001, it consisted of 4 members, including a pediatric neurologist and a pediatric orthopedic surgeon. The definition of arthropathy was generally considered as any condition affecting a joint or periarticular tissue where there is historical and/or physical evidence for structural damage and/or functional limitation that may have been temporary or permanent. This definition was seen as broad and inclusive of such phenomena as bursitis, enthesitis and tendonitis. Evidence of arthropathy was characterized as either physical or historical evidence. Physical evidence of arthropathy may have included but was not necessarily limited to: warmth, redness, joint effusion, tenderness, synovial thickness, abnormal gait or limp, weakness, and/or limited joint mobility/motion. Diagnostic imaging demonstrating structural damage or change was also accepted as evidence of arthropathy. Evidence of arthropathy may have been further categorized as weak or strong evidence. Historical data was considered weak evidence; joint effusion, synovial thickness, limited motion and diagnostic imaging findings were examples of strong evidence. Relevant modifiers of evidence included severity, duration, and the presence of concurrent factors such as trauma, infection, and other confounding diseases (e. In addition, concurrence of parameters or change in parameters over time was given greater weight (e. In making the determination of relationship to study drug, multiple factors were considered. The 3 major considerations were any pre-existing conditions, conditions with clear alternative etiology (i. Generally, conditions that began more than 1 year after the administration of study drug were not considered related to study drug.

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What is the expiration of cryoprecipitate once pooled using a sterile connecting device generic voveran sr 100mg fast delivery muscle relaxant use in elderly, the pooled? What is the number of white blood cells permitted Platelets may be needed to control bleeding purchase voveran sr 100mg without a prescription knee spasms pain, 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 order voveran sr 100mg line muscle relaxant herbal supplement. Platelet count of 75 × 109/L in a donor who is a vaccine last week frequent platelet donor B buy 100mg voveran sr otc spasms shoulder. 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. A donor may donate July 23rd 24 times a year, but not as frequent as once every B. A 23-year-old woman who donated blood for her aunt on August 14th Blood bank/Apply knowledge of standard operating procedures/Donor requirements/2 154 4. Continue the donation; rapid breathing is not a opiate abuse reason to discontinue a donation B. A woman in her 14th week of pregnancy paper bag Blood bank/Apply knowledge of standard operating D. Tell her to sit upright and apply a cold compress procedures/Donor requirements/2 to her forehead Blood bank/Select course of action/Donor processing/ 7. Which physical examination result is cause for Donor adverse reactions/3 rejecting a whole-blood donor? Drug addiction is cause Blood bank/Apply knowledge of standard operating for permanent deferral, as is a major illness. The procedures/Donor requirements/1 deferral period following treatment for syphilis or gonorrhea is 12 months. Male currently on dutasteride (Avodart) Donors weighing less than 110 lb may donate up to B. Donation of a unit of blood that transmitted 12% of their blood volume (volume = weight in kg/50 hepatitis B virus to a recipient × 450 mL). Accidental needle stick 1 year ago; negative for 180 mmHg for systolic and 100 mmHg for diastolic infectious disease pressure. A To determine the amount of anticoagulant to remove when the donor is less than 110 lb, divide weight by Blood bank/Select course of action/Donor processing/ 110 lb and multiply by 450 mL; divide that number by Unacceptable donors/3 100 and multiply by 14 (this gives the anticoagulant 10. How much anticoagulant would have to be volume needed); then subtract this from 63 mL, removed from the collection bag given a donor which is the standard volume of anticoagulant in a who weighs 90 lb? Te weight for a female is at least 150 lb blood flow does not resume, withdraw the needle C. Check and reposition the needle if necessary; if Blood bank/Apply knowledge of standard operating blood flow does not resume, withdraw the needle procedures/Apheresis/1 D. Withdraw the needle and perform a second venipuncture in the other arm Answers to Questions 12–17 Blood bank/Select course of action/Collection/3 12. Who is the best candidate for a predeposit blood flow does not resume after repositioning, then autologous donation? A 45-year-old man who is having elective surgery Do not perform a second venipuncture on the donor. A The 45-year-old man with alloanti-k is the best hemoglobin of 10 g/dL candidate for predeposit autologous donation C. A 12-year-old boy who has hemophilia because compatible blood will be hard to find if he D. The other candidates may not be good choices for donation because the Blood bank/Select course of action/Donor processing/ process may prove harmful to them. B In acute normovolemic hemodilution, one or more surgery units of blood are removed from the donor and C. Yes, he or she can donate, but only a half a unit replaced with crystalloid or colloid. No, he or she cannot donate within 5 days of stored at room temp for up to 8 hours or at 1°C–6°C surgery for up to 24 hours. Which of the following is an acceptable time in are for autologous transfusion only. Units removed may be stored in the operating room at room temperature for 8 hours C. Units removed may be stored in the operating room at room temperature for 24 hours D. Unused units can be added to the general donor blood inventory Blood bank/Apply knowledge of standard operating procedures/Autologous donation/2 4. An autologous unit of whole blood was collected Answers to Questions 18–20 on a 33-year-old woman in preparation for a knee replacement procedure in 3 weeks. D This is a common scenario with women who have blood unit had her hyphenated last name, first recently married, and have not changed their license name, and last four digits of her social security or other form of identification given to the collection number for identification. Checking that other demographic information system, however, only had her married name and matches is sufficient if approved by the medical first name, medical record number, and social director, because an autologous unit is very difficult security number. C Vaccines developed by recombinant technology admissions make the correction in the carry no deferral period. Ensure that social security numbers match, confirm the name with donor and have admissions make the correction in the computer system with the medical director’s approval, then make the unit available for transfusion Blood bank/Standard operating procedures/Autologous donation/3 19. Perform an elution on the cord cells the cells of an Rh-positive baby Blood bank/Select course of action/Hemolytic disease of D. A fetal screen yielded negative results on a mother baby’s red cells if they did not contain the K antigen; who is O negative and infant who is O positive. B If the fetal screen or rosette test is negative, indicating the fetal maternal blood is negligible in a possible B. Issue one full dose of RhIg RhIg candidate, standard practice is to issue one dose C. Perform an antibody screen on the mother Blood bank/Select course of action/Hemolytic disease of 3. A The identification of the antibody is very important the newborn/Rosette test/3 at this stage of the pregnancy. What should be done when a woman who is may determine the strength of the antibody and 24 weeks pregnant has a positive antibody screen? No need to do anything until 30 weeks gestation who already has an antibody might cause a C. Administer Rh immune globulin (RhIg) transfusion reaction and/or evoke an even stronger D. Adsorb the antibody onto antigen-positive cells antibody response, possibly causing more harm to the fetus. Blood bank/Apply knowledge of standard operating procedures/Hemolytic disease of the newborn/Antibody 5.

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