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A 35-year-old woman presented to the oral surgeon with an extremely painful molar tooth and a swollen gum. She reports that the area "tastes bad." She has a fever, and the area is tender to the touch.

The surgeon drained the area of several milliliters of foul-smelling pus which was sent to the lab for aerobic and anaerobic culture and Gram stain.

1. Which of the following represents the expected Gram stain report?

A . WBCs and gram-positive cocci
B . WBCs and gram-negative rods
C . WBCs and a mixture of organisms
D . No WBCs seen, no organisms seen

2 . Which of the following represents the expected culture report?

A . Pure culture of Staphylococcus aureus
B . Pure culture of Streptococcus pyogenes
C . Mixed organisms representing normal oral microbiota
D . Mixed aerobic and anaerobic organisms

3. What is the usual treatment for this type of infection?

A . Surgical debridement and broad-spectrum antibiotics
B . Penicillin
C . Amoxicillin
D . None is required for normal organisms

4 . For what organism may the surgeon be particularly concerned if the infection appeared to be spreading through "sinus tracts"?

A . Actinomyces israelii
B . Streptococcus pyogenes
C . Escherichia coli
D . Bacteroides fragilis

5 . Why is this organism (#4) of concern?

A . It is notoriously resistant to antibiotics
B . It requires prolonged antibiotic therapy
C . It is highly contagious
D . It is pigmented

User Swervo
by
4.8k points

2 Answers

7 votes

Final Answers:

B. WBCs and gram-negative rods

D. Mixed aerobic and anaerobic organisms

A. Surgical debridement and broad-spectrum antibiotics

A. Actinomyces israelii

A. It is notoriously resistant to antibiotics

Step-by-step explanation:

1. Gram stain: The presence of white blood cells (WBCs) indicates inflammation, and gram-negative rods are commonly associated with dental abscesses. Therefore, option B is the most likely result.

2. Culture: While pure cultures are possible, mixed aerobic and anaerobic organisms are more common in oral infections due to the diverse microbiota present. Hence, option D is most likely.

3. Treatment: Surgical debridement to drain pus and broad-spectrum antibiotics to target potential bacterial diversity are standard management for abscesses. So, option A is the appropriate choice.

4. Sinus tracts: Actinomyces israelii, an anaerobic bacteria, can form branching sinus tracts within tissues. This characteristic makes it a concern in cases where the infection seems to be spreading through these pathways. Therefore, option A is the most relevant organism.

5. Resistance: Actinomyces israelii is known for its resistance to various antibiotics, making it a challenging organism to treat. Hence, option A accurately explains the concern with this specific bacterium.

These answers consider the clinical context of the scenario, emphasizing the typical findings and management strategies for dental abscesses while highlighting the specific concerns associated with Actinomyces israelii infections.

Disclaimer: This information is intended for educational purposes only and should not be interpreted as medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.

User Robooneus
by
5.7k points
3 votes

Answer:

1. A

2. B

3. A

4. B

5. B

Step-by-step explanation:

User Crou
by
5.3k points