A 4-year-old male presented to the emergency room with a 2 hour history of vomiting, diarrhea, fever, irritability, and lethargy. The child had gone to sleep on the living room couch at 8:00 p.m., and his mother found him on the floor at 10:00 p.m. covered with feces. In the ER, he was febrile, had two episodes of vomiting, and was dehydrated. A stool specimen contained bloody streaks and also had WBCs in the feces. A cerebrospinal fluid sample was normal; a peripheral WBC was 13,200/ul; a blood culture was negative; a stool exam for ova and parasites was negative. His history was significant for him attending a day care center. 61. Why were WBCs present in his stool? a. a result of the fever b. WBCs are usually elevated in children c. diarrhea is caused by invasive bacteria or protozoans d. multiple episodes of vomiting c. spill over from blood into feces 62. What is the most likely bacterial pathogen in this patient? a. Enterococcus b. Staph aureus c. Clostridium difficile d. Shigella e. Citrobacter 63. What is the most logical explanation for the negative blood cultures? a. organism does not penetrate beyond lamina propria b. organism is killed outside of intestinal "niche" c. culture needs to incubate another 48 hours to see growth d. blood contains natural inhibitors to this organism's growth e. poor handling of specimen 64. Aside from the possible use of antibiotics, what would be an appropriate primary (first) approach to this child's diarrhea? a. withhold all food and drink b. rehydration (fluid and electrolyte replacement) c. loperamide (Imodium) treatment d. protection from sunlight e. no action necessary 65. What was the significance of being in a day care facility? a. they are good at collecting and transporting samples b. food handlers are not licensed c. rapid spread in close quarters due to low numbers of organism needed to infect d. children are usually immunocompromised e. there is no significant difference between day care and home care