A 30-year-old man returns to the hospital 3 weeks after open reduction and internal fixation of left tibia and fibula fractures from a motor vehicle accident. The patient complains that his surgical site has been draining pus for a few days, and his visiting nurse told him to go to the emergency room after he had a fever this morning. On exam, his temperature is 103.0°F (39.4°C), blood pressure is 85/50 mmHg, pulse is 115/min, and respirations are 14/min. The ED physician further documents that the patient is also starting to develop a diffuse, macular rash. The patient is started on broad spectrum antibiotics, and Gram stain demonstrates purple cocci in clusters. Which of the following toxins is likely to be the cause of this patient's condition?
APyogenic exotoxin A
BAlpha toxin
CEndotoxin
DExfoliative toxin
EToxic shock syndrome toxin 1
A 62-year-old woman presents to the emergency department for evaluation of a spreading skin infection that began from an ulcer on her foot. The patient has type 2 diabetes mellitus that is poorly controlled. On examination, there is redness and erythema to the lower limb with skin breakdown along an extensive portion of the leg. The patient’s tissues separate readily from the fascial plane, prompting a diagnosis of necrotizing fasciitis. What is the exotoxin most likely associated with this patient’s presentation?
AStreptococcal pyogenic exotoxin A
BTSST-1
CDiphtheria toxin
DExfoliative toxin
EStreptococcal pyogenic exotoxin B
A 27-year-old man presents to the emergency department with unrelenting muscle spasms for the past several hours. The patient’s girlfriend states that he started having jaw spasms and soreness last night but now his neck, back, and arms are spasming. She also states that he stepped on a nail about 1 week ago. Past medical history is noncontributory. The patient's vaccination status is unknown at this time. Today, the vital signs include temperature 39.1°C (102.4°F), heart rate 115/min, blood pressure 145/110 mm Hg, and respiratory rate 10/min. On exam, the patient is in obvious discomfort, with a clenched jaw and extended neck. Labs are drawn and a basic metabolic panel comes back normal and the white blood cell (WBC) count is moderately elevated. Which of the following is the most likely etiology of this patient’s symptoms?
AAn exotoxin that causes ADP-ribosylation of EF-2
BAn edema factor that functions as adenylate cyclase
CA heat-labile toxin that inhibits ACh release at the NMJ
DAn exotoxin that cleaves SNARE proteins
EA toxin that disables the G-protein coupled receptor
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