Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer.
So if you're ready, let's jump right in.
Margaret Fizgerald: Sonya is a 15-year-old teen who plays varsity basketball and is generally well and up-to-date with health maintenance. She presents today for an urgent care visit with a six hour history of sudden onset nausea with multiple episodes of vomiting, abdominal cramping, and two episodes of diarrhea. Stool is described as having a light to dark brown color without visible blood.
Her vital signs are within normal limits, and mucous membranes are slightly dry. She has slightly hyperactive bowel sounds and mild tenderness to abdominal palpation without rebound. When considering a diagnosis of staph food poisoning, what would be most likely reported by Sonya? A: One after another the people on my basketball team have been getting sick like this during the past week.
B: My basketball team stopped at a restaurant today to get something to eat on our way home from the game. Practically all of us who bought turkey sandwiches are sick like this. C: I had an ear infection a couple of weeks ago and I took about five days of an antibiotic. D: I have really bad cramps with my period and I take a lot of ibuprofen to help out.
And the correct answer here is, B: My basketball team stopped at a restaurant today to get something to eat on our way home from the game. Practically all of us who ate turkey sandwiches got sick like this. So, where do you start? First, figure out what kind of a question this is. Given we're being asked about a specific diagnosis.
In this case, we're being told this is a staph food poisoning. And what we would most likely hear during the health history or history of present illness in this condition. Then this is an assessment question, part of information gathering, as we've done with all the other Q&A in this series. Let's do some background information first. staph food poisoning is caused from an acute intoxication that develops after ingestion of food contaminated with an enterotoxin produced by Staph aureus.
The organism must be present on a food, and then that food is stored at an incorrect temperature that allows for growth of the pathogen and the enterotoxin production. The source of the organism can be from a food handler who's a Staph aureus carrier, actually quite common in the general population, or from other unsafe food handling practices.
In particular, since poultry is mentioned here and that pretty much everybody who got sick on the basketball team had eaten a turkey sandwich, this might be an issue that the poultry was undercooked or as mentioned, handled incorrectly. The most common food products implicated in food poisoning include poultry and other cooked meat products, as well as milk, milk products, and even sometimes in bakery products.
On occasion, canned foods are implicated as well. Invariably, the history is, as mentioned here, where a group of people all ate the same food and they all got sick within hours, maybe even minutes of one another. This is one reason why a careful history of present illness is critical and always asking this way with an episodic illness that appears to be infectious in origin.
And the reason why I said infectious in origin is because a number of people on her team have similarly become ill. Clinical presentation of staph food poisoning is classically what's described in this scenario. In other words, within one half, to upwards to eight hours, of the ingestion of the problematic food, there's a sudden onset of nausea, vomiting, abdominal cramping, and diarrhea.
Usually vomiting is more frequent than the stooling. Fever might or might not be present. And sometimes the abdominal cramping is very significant. One of the few good things that you could say about staph food poisoning is that invariably the signs and symptoms are gone within a day or two. This is a clinical diagnosis, and unless symptoms persist, no particular testing is needed.
Treatment is largely supportive. Perhaps an antiemetic such as a 5-HT3 agonist like Zofran, sometimes I've even prescribed over-the-counter Dramamine, which could be very helpful in calming the stomach; and clear liquids progressing to a diet as tolerated. Of course, people with underlying chronic health problems can get much sicker than what we're seeing here with a young, otherwise well, female.
With that in mind, let's take a look at the question and work our way through the different choices. Sonya is a 15-year-old teen who plays varsity basketball and is generally well and up-to-date with health maintenance. She presents for an urgent care visit with a six hour history of sudden onset of nausea, with multiple episodes of vomiting, abdominal cramping, and two episodes of diarrhea, with stool being described as light to dark brown in color without visible blood.
Her vital signs are within normal limits and her mucous membranes are slightly dry. She has slightly hyperactive bowel sounds and mild abdominal tenderness without rebound. And considering the diagnosis of staph food poisoning, which would be most likely reported by Sonya? A: One after another, the people on my basketball team have been getting sick like this during the past week.
Well, this is incorrect and really sounds more like viral gastroenteritis. When one member of the team transmitted the virus to the other. So, you might get a couple of people who get sick on one day. Then a day or two later, more people get sick. And then after that, two days later, you get more people who will get sick.
I always think of this as like dominoes falling over, where the first domino picks this up and then spreads to everyone else. I will grant you the clinical presentation of viral gastroenteritis can look very similar to staph food poisoning, but the history will be what is most helpful. And one more time I've said this in other podcasts. Timing, timing, timing.
Get an exact timing from the patient as to what happened and when it happened. B: Which obviously is the correct answer. My basketball team stopped at a restaurant today to get something to eat on our way home from a game. Practically all of us who got turkey sandwiches are sick like this. First of all, in this age of electronic communication, you bet,
The members of the basketball team have no doubt been furiously texting one another about getting sick. And part of this that leans towards staph food poisoning is there's an identification of one particular food source that seems to be a culprit. Interestingly, sometimes in staph food poisoning, you'll actually see a dose-dependent response. And by that, I mean somebody who wasn't terribly hungry and only ate about a quarter of the sandwich is only mildly ill, where the person who ate the entire sandwich became quite ill.
I do advise you, when you have a scenario like this, check with your local Department of Public Health and see if they would like a report on this. Obviously, if there is a restaurant or some food service area in a given location, the Department of Public Health will be quite interested in stemming the tide of staph food poisoning going throughout the community.
Now, let's take a look at C: I had an ear infection a couple of weeks ago and I took an antibiotic. In this scenario with a history of recent antibiotic use you might actually have antibiotic-associated diarrhea and far less commonly that dreaded C. diff disease. With either one of those though you would get more stooling and not the severe, sudden onset of upper GI symptoms.
Option D, of course not correct. I have really bad cramps during my period and I take a lot of ibuprofen to help out. That scenario would result in an NSAID-induced gastropathy or gastritis and even in an otherwise well teen like this, however, the report would be some mild stomach burning. In other words, more mild upper GI symptoms, maybe even a wee bit of nausea, but not the severe, sudden onset of symptoms that she is having.
By the way, and I just have to say this because I've been fortunate throughout my clinical career that I see a lot of sick visits, but I do this within the purview of primary care, so I can ensure people have a really good follow-up after their acute care visit. But we have so many really good options to help a young woman like this with significant dysmenorrhea.
And please make sure you are informed on this and you can help this young woman out. Key takeaway: your history of present illness will be your best diagnostic tool. Keep this in mind in your clinical practice will be greatly enhanced.
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