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Internal Medicine > All Questions 1-200 > Flashcards

All Questions 1-200 Flashcards

1
Q

2yo M with recurrent infections and eczema. Workup reveals thrombocytopenia.

A

Wiscott Aldrich. X-linked.

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2
Q

70yo white M with easy bruising, visual disturbance, and elevated IgM

A

Waldenstrom’s macroglobulinemia

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3
Q

12yo M with bleeding, elevated PTT, and reduced quantitative factor VIII level. Platelets do no aggregate with ristocetin test.

A

von Willebrand’s disease

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4
Q

23yo HIV positive F recently started SMX-TMP with rash, confusion, fever, anemia, thrombocytopenia, tachycardia.

A

TTP

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5
Q

6yo F with itching, joint pain, skin rash who received penicillin six days previously for strep infection.

A

Serum sickness (Type III hypersens.)

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6
Q

62yo Jewish M with pruritus, melena, epistaxis, and history of DVTs.

A

Polycythemia vera (itching, epistaxis) Treat with phlebotomy, hydroxyurea for myelosuppression, aspirin for DVT prophy. Risk = develop CML, AML, myelofibrosis.

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7
Q

12yo M with bony-hard swelling above knee.

A

Osteosarcoma

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8
Q

53yo M with painless lumps in neck, fever, weight loss.

A

Non-Hodgkin’s lymphoma

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9
Q

54yo M with fatigue, splenomegaly, anemia, and ‘dry tap’ on bone marrow biopsy

A

Myelofibrosis with myeloid dysplasia

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10
Q

64yo black M with bone pain, fatigue, and recurrent URIs

A

Multiple myeloma

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11
Q

24yo M with painless lump in neck and CXR with hilar masses.

A

Hodgkin’s.

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12
Q

8yo M with palpable rash, hematuria, and joint pain. CBC reveals normal platelet count.

A

Henoch-Schonlein Purpura. Small vessel vasculits. IgA deposits. Hemmorhagic urticaria with fever, arthralgias, GI and renal involvement. Associated with URIs.

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13
Q

21yo F with sudden onset bruisability, edema, and rash following diarrheal illness. Low platelet count.

A

HUS

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14
Q

61yo M with mycobacterium avium infection, splenomegaly, and leukocytes with cytoplasmic projections seen on CBC.

A

Hairy cell leukemia (B cell)

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15
Q

45yo M with fever, rash, diarrhea, and jaundice. Elevated IgE level and history of leukemia.

A

Graft-versus-host

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16
Q

45yo M with frank rigors 1hr following blood transfusion.

A

Febrile nonhemolytic transfusion rxn

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17
Q

25yo F with continued bleeding following delivery.

A

DIC

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18
Q

55yo M with no complaints, found on physical exam to have splenomegaly and leukocytosis.

A

CML

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19
Q

65yo M with lymphadenopathy, hepatosplenomegaly, and leukocytosis with smudge cells.

A

CLL

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20
Q

66yo M with CLL has urine that gets darker during the day.

A

autoimmune hemolytic anemia

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21
Q

18yo M with pallor, petechiae, and recurrent URIs

A

aplastic anemia

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22
Q

25yo F with recent infection, gingival hyperplasia, and leukocytosis with bone marrow expansion.

A

AML

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23
Q

43yo M with epigastric pain and diarrhea refractory to medical management.

A

ZE syndrome

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24
Q

40yo F with intellectual impairment, jaundice, and choreiform movements.

A

Wilson’s

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25
Q

37yo M with acute pain in anorectal area and BRBPR for 4 months.

A

thrombosed ext. hemorrhoid

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26
Q

45yo F with pruritus, fatigue, and jaundice.

A

PBC

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27
Q

33yo M with four months epigastric pain radiating to back relieved by eating and leaning forward.

A

posterior duodenal ulcer

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28
Q

36yo F with difficulty swallowing and craving for ice. Physical exam reveals angular stomatitis and glossitis.

A

Plummer-Vinson syndrome.

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29
Q

24yo F with crampy abdominal pain and dark spots on lips.

A

Peutz-Jehghers. Multiple polyposis of small intestine, pigmented melanin macules on oral mucosa. Associated with gynecological cancers, but actually a low to moderate colon CA risk.

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30
Q

51yo M with 4 months pruritus, jaundice, and abdominal pain. Recent 15 pound wt loss.

A

pancreatic CA (CEA, CA19-9)

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31
Q

65yo M with abdominal pain, nausea, vomiting, and diarrhea. Has been suffering abd. Pain 30 min after eating.

A

ischemic bowel

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32
Q

50yo M with EtOH cirrhosis develops oliguria and abdominal distenstion.

A

hepatorenal

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33
Q

65yo M alcoholic with RUQ pain, jaundice, anorexia, and distention worsening over two months.

A

hepatocellular carcinoma

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34
Q

40yo M with increased pigmentation. PE reveals cardiomegaly. UA reveals glycosuria.

A

hemochromatosis (cirrhosis, bronze diabetes, heart failure)

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35
Q

24yo F found on dental checkup to have supernumerary teeth. Has father with history of colon polyps and

A

Gardener’s syndrome.

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36
Q

44yo M with hematemesis and melena. Has had recurrent painless hematemesis for several years.

A

gastric leiomyoma (#1 benign tumor of stomach)

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37
Q

83yo M with epigastric pain, anorexia, and frequent vomiting. Guaic positive stools. Palpable mass over L shoulder.

A

gastric CA (atrophic gastritis, pernicious anemia, ulcers, type A blood = risk; Krukenberg tumor = retro peritoneal spread to ovaries.

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38
Q

68yo F smoker with dysphagia.

A

esophageal CA (squamous > adeno in distal third)

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39
Q

54yo F with colicky LLQ pain and bloody stools that have returned intermittently over several months.

A

diverticulitis

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40
Q

45yo M with recurrent epigastric pain that radiates to back and foul-smelling stools.

A

chronic pancreatitis (alcoholism, cystic fibrosis)

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41
Q

25yo F with diarrhea, foul smelling stools, pruritus, dry skin, and bruising.

A

celiac disease (anti-gliadin Ab, nutrient malabsorption)

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42
Q

67yo F with several months fatigue, weight loss, intermittent diarrhea with palpable RLQ mass.

A

cecal CA (anemia and + guaic test + virchow’s node)

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43
Q

52yo M with diarrhea and facial flush.

A

carcinoid = primary GI tumors arise from neuroendocrine cells “Kulchitsky cells” and secrete 5-HT, histamine, gastrin, and prostaglandins. Malignant or benign.

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44
Q

45yo M with AIDS now with painful swallowing.

A

candida esophagitis (candida, rx with oral fluconazole)

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45
Q

34yo M with mediepigastric pain, periumbilical/flank bruising, and hypotension.

A

acute pancreatitis (Cullen’s / Grey Turner’s sign, assoc. with gallstones and alcohol)

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46
Q

33yo F with substernal pain and difficulty swallowing. Sometimes regurgitates food.

A

achalasia (loss of ganglion cells in Auerbach’s plexus). Esophageal CA risk. Can arise from Chagas disease (also with cardiomyopathy).

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47
Q

50yo F with cold nodule in the neck. Normal TSH, T3 and T4.

A

thyroid CA (risk = ionizing rad - papillary CA c best prognosis, also follicular, mixed, and medullary assoc c MENIIa and IIb) psammoma bodies on FNA.

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48
Q

30yo F with weight loss, 2yrs amenorrhea following delivery of healthy baby.

A

Sheehan’s (postpartum pituitary infarction) decreased levels of all trophic hormones, can occur in males and nonpregnant females following trauma, SS anemia, DIC, and stroke)

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49
Q

33yo F with menstrual irregularity and milky nipple discharge.

A

prolactinoma (most common pituitary adenoma; GnRH suppressed by excessive prolactin, reduces LH and estradiol. In males = HA, impotence, visual disturbance.

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50
Q

56yo F with flank pain, confusion, constipation, thirst and polyuria.

A

hyperparathyroidism (symptoms of hypercalcemia, bank keratopathy, cystic bone lesions = osteitis fibrosa cystica, adenoma = 1 gland, hyperplasia = 4 gland, renal stones, elevated serum Ca and AP with lowPO4.

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51
Q

42yo F with hypertension, weakness, and decreased urinary volume.

A

Conn’s (hypokalemia, hypernatremia, hypertension, increased urinary aldosterone, low plasma renin). Usually adrenal cortex adenoma, sometimes adrenal cortical hyperplasia.

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52
Q

53yo F with fatigue, insomnia, depresison. Thinning of skin, hirsutism, vaginal atrophy.

A

menopause (hot flashes, vaginal atrophy, osteoporosis). Post-menopausal bleeding gets biopsy to r/o endometrial cancer.

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53
Q

48yo F with weakness, lethargy, cold intolerance.

A

hypothyroidism (weight gain, constipation, coarsening of facial features, hair loss, hoarseness, depression, loss of outer third of eyebrows, delayed recovery phase of achilles. Most common = Hashimoto’s

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54
Q

46yo M with impotence, fatigue and decreased peripheral vision. Is also hypotensive.

A

hypopituitarism: Low FSH, LH, TSH, ACTH. Most common cause adenoma compressing anterior pituitary.

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55
Q

29yo F with seizure. Has history of thyroid surgery two years ago.

A

hypoparathyroidism (circumoral and foot numbness, fasciculations, chvostek’s sign, trousseau’s sign, brittle nails, low serum calcium, elevated PO4, low Mg, low PTH. Most commonly d/t thyroidectomy, symptoms d/t hypocalcemia.

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56
Q

24yo F with weight loss despite good appetite, anxiety, menstrual irregularity, and tremors.

A

hyperthyroidism = diarrhea, heat intolerance, palpitations, tremors, increased T4, decr. TSH. Hot nodule with decreased uptake in surrounding tissue and other lobe d/t atrophy of remainder of gland. Rx with propranolol, PTU, methimazole.

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57
Q

45yo F with anterior neck fatigue, history of RA, and cold intolerance.

A

Hashimoto’s (anti-thyroglobulin and antimicrosomal Abs, often assoc with other autoimmune dx including SLE, pernicious anemia, Sjogren’s, hepatitis, HLA-DR5/3. May see thyrotoxicosis early during disease course.

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58
Q

55yo M with obesity, thirst, and excessive appetite.

A

DM2. Can develop nonketotic hyperosmoler coma but not DKA.

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59
Q

44yo F with irritability, easy bruising, weight gain, and glucosuria.

A

Cushing’s (truncal obesity, moon facies, buffalo hump, hirsutism. Elevated plasma cortisol with high ACTH, hypokalemia, leukopenia, osteoporosis, adrenocortical hyperplasia and pituitary adenoma.

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60
Q

60yo M with rash composed of red plaques with scaling and nodules. Has not responded to steroid rx.

A

Mycosis fungoides. Malignant cutaneous helper T-cell lymphoma; disseminated disease with exfoliative dermatitis and lymphadenopathy = Sezary syndrome. “Red man’s disease”. CBC shows lymphocytosis.

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61
Q

68yo outdoor construction worker, raised bleeding lesion over upper lip.

A

basal cell carcinoma. Most common skin cancer. Light-skinned people. Sun-exposed areas, slow growing, metastatic disease rare. Increased incidence in xeroderma pigmentosum.

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62
Q

60yo farmer with skin lesions on forehead, upper lip, dorsum of hands. Scaly rough plaques.

A

actinic keratosis. Most common precancerous dermatosis –> squamous cell CA. Signs that preceed malignancy include elevation, ulceration, inflammation, and enlargement >1 cm.

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63
Q

35yo M with cramping in calves with walking, smokes 3 ppd. PE reveals pallor and cyanosis of distal extremities.

A

thromboangiitis obliterans = occluded small and medium arteries, no atherosclerosis, inflammation of all layers of arterial wall. Smoking cessation critical. Amputation may become necessary of fingers/toes.

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64
Q

79yo F with unilateral HA, jaw pain, visual disturbance in ipsilateral eye.

A

temporal arteritis. Most common vasculitis in US. Often coexists with polymyalgia rheumatica. Ophthalmic artery occlusion –> blindness. Biopsy positive 60%, so treat on clinical picture with steroids before biopsy.

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65
Q

50yo M with palpitations and CP. Has had multiple sexual partners. Has diastolic murmur.

A

Syphilitic aortitis. Signs include collapsing pulse, wide pulse pressure, LVH with strain, mid-diastolic murmur at apex = Austin-Flint, VDRL / FTA-ABS positive. “Tree bark” calcification of arch and ascending aorta on CXR, tertiary stage syphillis.

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66
Q

30yo F with HTN and elevated plasma renin.

A

Renovascular hypertension. “String-of-pearls” pattern seen on renal angio. +/- renal artery bruit. Mostly fibromuscular dysplasia (young female), atherosclerosis (older male), <5% of all HTN. Rx with ACE-I but contraindicated in bilateral RAS.

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67
Q

34yo F in 27th week of pregnancy with dyspnea and orthopnea. History of recurrent strep pharyngitis as child.

A

Mitral stenosis. Opening snap and mid-diastolic murmur at apex. +/- LVH and a-fib.

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68
Q

37yo M with fatigue and dyspnea with exertion. Pansystolic murmur at the apex with radiation to the axilla.

A

Mitral insufficiency. Common causes: mitral valve prolapase, ischemic papillary muscle, endocarditis, rheumatic. S3 may be present.

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69
Q

42yo M with CP, headache and confusion. Has history of HTN.

A

malignant HTN. Severe diastolic hypertension, papilledema, hematuria, proteinuria, small scarred kidneys. Rx with sodium nitroprusside or IV beta-blockers to prevent end-organ damage due.

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70
Q

21yo M with DOE and an episode of syncope while playing tennis.

A

HCM. Signs = S4, SEM incr by valsalva, decr by squatting. EKG shows LVH. Echo: asymmetrical septal hypertrophy, ant. motion of mitral valve. Rx with beta-blockers, avoid sports, amiodarone may prevent fatal arrythymia, surgical myomectomy.

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71
Q

29yo F recently delivered baby, now with dyspnea and pedal edema.

A

dilated cardiomyopathy. Systolic dysfunction, decr ejection fraction Peripartum period (3 mo.), alcoholism, hypothyroidism, Freidreich’s ataxia, previous myocarditis coxsackie B, adriamycin, tricyclic antidepressants, lithium, cyclophosphamide.

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72
Q

60yo M with COPD with severe dyspnea at rest, bulging neck veins, and peripheral edema.

A

cor pulmonale. Right heart failure d/t pulmonary cause, usually COPD. Other causes include pulmonary fibrosis, pneumoconioses, recurrent PE, PPHTN, obesity with sleep apnea, kyposcoliosis.

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73
Q

24yo M with angina, DOE, occasional fainting, and systolic ejection murmur to right of sternum.

A

aortic stenosis. Crescendo-decrescendo SEM, paradoxical splitting. Causes include congenital bicuspid valve, degenerative calcification, rheumatic.

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74
Q

31yo M with ankylosing spondylitis develops severe SOB.

A

aortic insufficiency. Signs include bounding pulse, wide pulse pressure, diastolic decrescendo murmur at left sternal border. Causes include rheumatic, ankylosing spondylitis, marfan’s, reiter’s, tertiary syphillis.

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75
Q

35yo M with nonproductive cough and chest pain worse with inspiration, relieved by sitting up.

A

pericarditis. +/- friction rub, incr JVP (c inspir = Kussmaul’s sx), elevated ESR, CPK-MB nl, diffuse ST elev., pericardial effusion. Coxsackie A/B, TB, staph/strep, amebiasis, actinomycoses, CRF, SLE, scleroderma, RA, CA, MI, trauma.

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76
Q

25yo F with myalgias and low-grade fevers starting one week after a dental extraction.

A

subacute bact. endocarditis. Ass. c rheumatic dx, mvp, etc. AB prophy prevents. Janeway = periph hemmorhage, Osler’s = painful, Splinter hem. = subungal linear, Roth’s spots = oval retinal. Strep viridans = most common subacute.

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77
Q

25yo M with SOB and ankle edema following severe URI.

A

viral myocarditis. Cocksackie B > Borrelia burdorferi (Lyme), trypanosome cruzi (Chagas), hypersensitivity rxn in SLE or drug rxn, radiation, sarcoidosis. Echo: dilatation c low EF. ASO titers not elevated. ESR elevated.

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78
Q

35yo M develops pruritus and blistering rash over shins following camping trip.

A

Contact dermatitis = type IV hypersensitivity rxn. Papulovesicular rash c oozing and crusting. Rx c topical and systemic corticosteroids. Also occurs with various irritants, diaper rash.

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79
Q

5yo M with yellow crusty lesions behind the ear and around the mouth.

A

impetigo. “honey-colored” lesions. Group A strep. Rx with cephalosporin, pcn, or erythromycin. ASO titer negative. Highly communicable. Staph. aureus superinfection may cause bullous impetigo. Group B strep impetigo in newborns.

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80
Q

30yo homosexual M with skin eruption on upper limbs, trunk, anogenital areas.

A

molluscum contagiousum. Poxvirus. Opportunistic AIDS infection. Painless, pearly-white, dome-shaped, waxy, umbilicated nodules, 2-5mm, palms and soles not affected.

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81
Q

16yo M with headache, fever, and rash on the palms and soles. Recent camping in North Carolina. UA demonstrates proteinuria and hematuria.

A

RMSF. Rash periph. to central, palms/soles, petechial, thrombocytopenia, + Hess’ test = Rumpel-Leede phenomena, + Proteus OX19 / OX2 Weil-Felix rxn. Rickettsia rickettsii. Rx tetracycline. Dermacentor wood tick. East coast of US.

82
Q

24yo F with extensive denuding of skin and recent skin infection.

A

Scalded skin syndrome. Vesicle fluid is sterile. S. aureus on blood culture. Rx IV methicillin or oxacillin. Phage group 2 staph exotoxin.

83
Q

30yo M with bilateral circular red eruption in the groin.

A

tinea corporis = ringworm. Circular papulosquamous eruption. Hyphae on KOH skin scrapings. Rx clotrimazole, miconazole, ketoconazole cream. Also systemic griseofulvin, keto/itraconazole prn. Tinea capitis = children.

84
Q

28yo M treated for UTI develops raised, red, pruritic rash over trunk and limbs.

A

urticaria. wheal and flare rxn, “hives”. Rx: stop causative agent, H1/2 blockers, calamine lotion, corticosteroids.

85
Q

11yo M with jaundice, dark urine, and recent shellfish ingestion.

A

Hep A. Hyperbilirubinemia, ALT>AST, +/- AP, incr PT, incr. urine urobilinogen and bili, + IgM Ab to HepA. No infectivity in 3wks. Fecal/oral, bad water. Not chronic. HAV = naked, ssRNA, picorna. Prevent with killed vaccine and immune globulins.

86
Q

25yo M with jaundice following needle stick two months ago.

A

HBV. Hyperbili, ALT>AST, +/- AP, HBsAg +, IgM anti-HBc + (window period). Liver biopsy = Councilman bodies. 5% progress to chronic c risk cirrhosis and HCC. Long incubation = 3 months. Enveloped DNA hepadna. HBsAg = chronicity.

87
Q

30yo M intermittent jaundice for two years following a motorcycle accident.

A

HCV. Percutaneous transmission = 90% of cases. >50% progress to chronic, leading to cirrhosis in 20%. PCR test.

88
Q

50yo alcoholic with fever, abdominal pain, and progressive distention of abdomen.

A

SBP. Ascites fluid leukocyte count >500/cc; PMNs >250 = diagnostic, low protein and glucose, ascites culture may be negative. Rx empirically, then organism-specific if possible. E. coli = most common.

89
Q

56yo M with diarrhea for 2 months, arthritis, and weight loss.

A

Whipple’s disease. Increased fecal fat. Macrocytic, hypochromic anemia. Small bowel biopsy c PAS + macrophages. Gram + actinomycete bacilli in macs. Rx with bactrim or ceftriaxone for 1 year. Tropheryma whippellii. Vitamin malabsorption.

90
Q

19yo F with recurrent episodes of periorbital swelling and dyspnea lasting up to 24hrs.

A

C1 esterase inhibitor deficiency. Autosomal dominant. Decreased C4= best screening test. Decreased C1 inhibitor (confirmatory test). Decr. C2, but normalC3, normal IgE. Also called hereditary angioedema.

91
Q

3yo M with albinism and recurrent infections with recurrent staph and strep infections.

A

Chediak-Higashi. Also nystagmus, photophobia. Decreased neutrophil count. Normal platelet count. Large cytoplasmic granules (Giant Lysosomes) in WBCs. Autosomal recessive, defect in microtubule polymerization in leukocytes. Defective chemotaxis.

92
Q

2yo M with recurrent fungal and staph furunculosis and neutrophilic leukocytosis.

A

Chronic granulomatous disease. X-linked disorder of neutrophils, deficient NADPH oxidase . Normal chemotaxis, degranulation, and phagocytosis. Deficient killing d/t myeloperoxidase system. Recurrent staph infections. Rx SMP-TMP prophy.

93
Q

25yo F with recurrent sinusitis, multiple allergies, watery diarrhea, and hypopigmented skin lesions.

A

IgA deficiency. No blood or plasma transfusions! #1 congenital immunodeficiency. Diarrhea usually G. lamblia, sinopulmonary infection with S. pneumo, H. flu, or S. aureus. Assoc with allergies/autoimmune dx. May be d/t isotype switching defect.

94
Q

7 month M recurrent URIs, skin infections, and asymetric arthritis of the kness. No tonsillar tissue on exam.

A

X-linked hypogammaglobulinemia. Selective B-cell defect. Recurrent bacterial infections. a.k.a. Bruton’s disease. Tyrosine kinase receptor defect, impaired maturation of antibodies. Labs = panhypoglobulinemia: very low IgG; IgA and IgM not detectable.

95
Q

15yo M with thick yellow discharge that prevents eye-opening in the morning.

A

Conjunctivitis. Rx topical AB drops. Usually viral = adenovirus. Self-limiting. Secondary staph/strep may result.

96
Q

8yo F with rash, diffuse joint pain, fever, and sore throat two weeks ago.

A

Acute rheumatic fever. Erythema marginatum = blanching ring-shaped over trunk and extremities. Elevated ASO titer, incr ESR, incr C-reactive protein. Blood culture negative. Endo/myo/pericarditis. Rx aspirin/corticosteroids, pcn/erythromycin.

97
Q

35yo F with pain in upper teeth and face, nasal congestion and discharge.

A

sinusitis. boggy nasal mucosa. Common pathogens = S. pneumo, other streptococci, H. flu, Moraxella. Rx amoxicillin or TMP-SMX, decongestants.

98
Q

48yo missionary returns from West Africa with lethargy, nuchal rigidity, HA, drowsiness.

A

African trypanosomiasis. Tsetse fly. Painless lymphadenopathy in posterior neck & supraclavicular = Winterbottom’s sign. Does not respond to antibiotic rx. Chancre with induration at bite site. AKA African sleeping sickness. Rx suramin / pentamidine.

99
Q

45yo M Peace Corps in Mexico with spiking fever, RUQ pain, and bloody diarrhea with mucus. Tender hepatomegaly on exam.

A

Amebic liver disease. Entamoeba histolytica. Cavitating liver lesion with chocolate-colored pus that is sterile, ameba obtained from periphery of lesion. Rx includes metronidazole and abscess drainage.

100
Q

30yo sheep farmer with dyspnea, nonproductive cough, and black skin lesions.

A

Anthrax. CXR c mediastinal widening = hemorrhagic mediastinits. Vesicular papules covered by “black eschar”. Bacillus anthracis. Rx IV penicillin G. Isolation precautions. Cell-free anthrax vaccine for high risk groups.

101
Q

38yo M on chemotherapy with pleuritic chest pain, fever, and productive cough.

A

Aspergillosis. Multiple nodular infiltrates. Branched hyphae c silver stain, vascular invasion –> thrombi. Rx Amphotericin B c flucytosine. Lobectomy for fungus ball. Invasive dx: AIDS, neutropenia, chronic granulomatous dx, steroid rx, transplant pts.

102
Q

25yo M c sudden onset double vision, dry mouth, weakness, dysarthria, and dysphagia. Ate some home-canned peaches the night before.

A

Botulism. Flaccid paralysis. Rx antitoxin, resp. support. Botox cleaves synaptic docking/fusion machinery. Disease d/t ingestion of toxin produced by C. botulinum. Often seen in infants after honey.

103
Q

28yo M with hip pain, undulating fever for two months, and pain in testicle. Drinks unpasteurized milk.

A

Brucellosis. Blood culture demonstrates B. abortus, transmitted from milk or direct contact with animal tissues. Rx combination of doxycycline/SMX-TMP plus rifampin/streptomycin.

104
Q

49yo obese, diabetic F with pruritus underneath her breasts.

A

candidiasis. Denuded, beefy red areas with whitish curd-like material. Budding cells with short hyphae on KOH prep. Rx clotrimazole, keep area dry.

105
Q

24yo F with fever and swelling over eye after trip to Brazil.

A

Chagas dx. Eye swollen shut = Romana’s sign. Encapsulated, nodular area at bite site = Chagoma. Ipsilateral retroauricular & cervical nodes. Trypanosoma cruzi, reduviid bug injects feces. Complications = dilated cardiomyopathy, megaesophagus/colon.

106
Q

30yo M with profuse watery diarrhea, vomiting, and abdominal pain following trip to India.

A

Cholera. Vibrio cholerae. Severe dehydration, rice-water stools gram - rods c darting motility, O1 antigen, decreased serum chloride with increased serum sodium. Heat-labile exotoxin, stimulates Gs via ADP ribosylation incr cAMP –> secretory diarrhea.

107
Q

19yo Arizona migrant worker with cough, pleuritic CP, fever and tender nodules over the both shins.

A

Coccidioidomycosis. Erythematous skin rash, erythema nodosum, positive skin test with coccidioidin, dimorhphic fungi, eosinophilia, caseating granulomas. Rx amphotericin B. Endemic in southwestern US. Inhalation of spores.

108
Q

30yo M with AIDS presents with profuse, nonbloody diarrhea.

A

Cryptosporidium parvum. Dehydration. Acid-fast stain –> oocyts in fresh stool. Rx is supportive only. Self-limiting in immunocompetent pts.

109
Q

13yo F s/p BMT on immunosuppresion now with fever, dyspnea, dry cough.

A

CMV pneumonitis. Insterstitial pneumonitis, intranuclear inclusions with surrounding halo (owl’s eye). Rx ganciclovi ). #1 pneumonia and death in BMT patients. Common in AIDS. Enveloped dsDNA herpesvirus.

110
Q

5yo M with fever, cervical lymphadenopathy, and grey membrane on tonsils.

A

Diptheria. Cornybacterium diphtheriae growth on Loffler’s blood agar. Heat-labile exotoxin –> myocarditis and neuritis (blocks EF-2 via ADP ribosylation –> decr ribosomal fnctn & protein synth. Rx: PCN or erythromycin, antitoxin.

111
Q

56yo veterinarian with sudden high fever, jaundice, and RUQ pain.

A

Echinococcosis. Hepatomegaly, + immunoblot test : echinococcal antigens, large septated liver cysts. +/- lungs/kidneys/bone/brain. Scoleces c inner germinal & outer laminated layer, fibrotic rxn. Rx: surgical cyst removal, albendazole.

112
Q

36yo woman with AIDS and pneumonia develops spiking fever, chills, and delirium.

A

Endotoxic shock/gram neg. sepsis. E. coli on urine & blood culture. CXR with fluffy infiltrates (ARDS). Sequelae: ATN, DIC, multiorgan failure. Rx: fluid, IV ABs, manage ARDS c O2 and PEEP. Usually d/t gram negative endotoxins &gram positive exotoxins.

113
Q

28yo Guatamalan refugee with severe headache, fever, and rash on trunk and extremities; palms and soles spared. Spent time in refugee camp.

A

Epidemic typhus. Rickettsia prowazekii. Cerebral edema/myocarditis/pneumonia, peripheral spreading rash. + Weil-Felix rxn. Path: Zencker’s degeneration of striated musc. Rx: tetracycline, chloramphenicol. Intracellular. Lice vector. war/famine/crowding.

114
Q

21 yo F with low-grade fever, pain and swelling over left knee, and dysuria.

A

gonnococcal arthritis. Intracellular diplococci bean-shaped. Migratory polyarthralgias. Incr WBCs c urethral smear & synovial fluid. Rx: IV ceftriaxone. Rapidly destroys cartilage. Associated with skin rash over affected joint, complement deficiencies.

115
Q

19yo M with burning urination and greenish-yellow purulent discharge.

A

gonorrhea. Intracellular gram negative diplococci, confirmed c Thayer-Martin medium culture. Rx: Ceftriaxone + doxycycline/erythromycin for Chlamydia coverage. Gonorrhea can involve throat, anus, rectum, epididymis, cervix, fallopian, prostate, joints.

116
Q

25yo M with painful skin rash in the perianal area.

A

Herpes simplex 2. Vesicular in clusters with clear fluid over erythematous base. Giant cells on Pap-stained scraping. Rx: acyclovir. dsDNA virus. Transmitted to fetus through birth canal.

117
Q

27yo F with two months fever, mouth ulcers, fatigue, and weight loss. Started new job on farm in Ohio.

A

histoplasmosis. Histoplasma capsulatum.Rx: itraconazole or amphotericin B. Intracellular budding fungus in reticuloendothelial cells. Hilar adenopathy. Associated with bird or bat feces. Transmitted by inhalation of mold spores.

118
Q

37yo M black male from the Caribbean with swollen glands in armpits and groin, feeling of heavyness in abdomen.

A

Human T-cell leukemia virus type 1 (HTLV-1). Lymphadenopathy & splenomegaly. Skin biopsy –> leukemic CD4+. Type C is assoc. c adult T-cell leukemia/lymphoma –> high incidence blacks in Carribean/SE US, Subsaharan Africa/Japan.

119
Q

20yo M with sore throat, lymphadenopathy, and malaise.

A

IM (EBV). Lymphocytosis c atypical lymphs. Incr ALT/AST/bili. Positive heterophil Ab test (Monospot / Paul-Bunnell test). IgM antibodies to viral capsid = monospot positive.

120
Q

40yo M smoker with high fever, nonproductive cough, pleuritic CP, and coworkers with similar symptoms.

A

Legionella pneumonia. Gram stain shows no organisms. Direct immunofluorescence confirms indirect fluorescent antibody titer. CXR: ill-defined nodules. Rx: erythromycin. Outbreaks d/t drinking water, humidifiers.

121
Q

30yo Pakistani immigrant with history of red papule on arm following insect bite; now with chronic fever, skin darkening, and massive splenomegaly.

A

Leishmaniasis / “kala azar”. Leshmania donovani zoonosis. Transmitted by Phlebotomussandfly. Labs = anemia, leukopenia, thrombocytopenia. Amastigotesin buffy layer. Rx: pentavalent antimony = Na stibogluconate; amph. B, or pentamidine.

122
Q

26yo M from India with hypopigmented anesthetic skin patch on face and swelling in elbow in area of ulner nerve.

A

Leprosy: Mycobacterium leprae. Acid-fast bacillus. Thermolabile, divides slowly –> long course. Tuberculoid = skin with limited nerve /involvement (ulner/peroneal). Lepromatous = diffuse skin involvement/eyes/nerves/disfigurement (leonine facies).

123
Q

12yo M with fatigue, joint pain, and rash.

A

Lyme. Borrelia burgdorferii, spirochete. IgM ELISA, confirm c WB. Rx: doxy or amox. 3 stages; 1= erythema chronicum migrans + constitutional si/sx. 2= cardiac & neuro. 3= persistent migratory arthritis/synovitis/acrodermatitis chronicum atrophicans.

124
Q

25yo with tender masses and painful groin ulcers after unprotected sex.

A

Lymphogranuloma venerum. Inguinal adenitis, buboes. + complement fixation and IF tests. Ulcerated nodule –> secondary = inguinal bubo (enlarged node +/- fistula/balanitis/phimosis/rectal involvement. Rx: doxycycline. An STD d/t C. trachomatis (L1/2/3).

125
Q

30yo missionary with high fever, chills, and severe HA after returning from Africa 1 wk ago.

A

Malaria. peripheral smear = plasmodia in erythrocytes. Rx: chloroquine, quinine for cerebral malaria, tetracycline for resistant areas. Anophelesmosquito. Plasmodium falciparum may be lethal –> cerebral malaria.

126
Q

12yo F with fever, severe HA, and stiff neck who fainted at school.

A

Meningococcemia. +/- petechial rash. Kernig’s / Brudzinski’s. CSF = incr prot, low gluc. Hypoglycemia, hypo-Na, hyper-K = Waterhouse-Friedrichsen’s = adrenal necrosis –> death. Rx: steroids, IV fluid, DA, PCN-G. Prophylactic rifampin for contacts.

127
Q

24yo F in hospital for DKA develops periorbital swelling and purulent postnasal discharge that fails to respond to ABs. PE reveals black ulceration of nasal mucosa.

A

Mucormycosis. Irregular nonseptate hyphae branching at wide angles. Mucor and Rhizopus molds. Conjunctival swelling = chemosis, black ulceration of nasal mucosa, CNIII palsy, necrotic destruction. !Suspect if AB-resistant sinusitis in DM/lymph/leukemia!

128
Q

20yo M college student with productive cough, malaise, and fever. Cough started out nonproductive.

A

Mycoplasma pneumonia. CBC: normal leukocyte count. Elevated cold agglutinin titer >1:128. CXR: patchy infiltrates appear worse than clinical picture. Rx: erythromycin. #1 atypical pneumonia. Rapid spread in close quarters.

129
Q

45yo M undergoing chemotherapy for Hodgkin’s now with SOB/cyanosis; has had greenish sputum for 3 months.

A

Nocardiosis. Gram + filamentous, partially acid-fast bacteria. Nocardia asteroides. Chronic infection: DM/leukemia/lymphoma/IC’d pts. Usually lungs, +/- brain/SC tissue. Rx: SMX-TMP 6mo.

130
Q

56yo F with visual acuity change, generalized itching after showering, and recent travel to tropics.

A

River blindness. Hypopigmentation, nodules, keratitis, chorioretinal lesions.Diethylcarbamazapine –> pruritus, rash, fever, conjuctivitis = Massotti reaction. Rx: ivermectin. Blackfly –> Onchocerca volvulus. Larvae in SC tx and lymphatics.

131
Q

28yo diabetic with immobility of knee, swelling, tenderness, and elevated ESR.

A

Osteomyelitis. Periosteal thickening. New bone = involucrum traps necrotic bone = sequestrum. Rx IV ABs, surg. #1 =Staph > strep > enterobacteria. SC = E. coli > Salmonella. DM/puncture = Pseudomonas. IC’d = Sporothrix.Human bite = anaerobes.

132
Q

18 month F with irritability and ear discharge. Recurrent URIs.

A

Otitis media. E. coli,staph, Klebsiella (neonates); S. pneumo, H. flu, Morexella, group A strep (kids). Rx amoxicillin-clavulanate. Complications = ingrowth of epithelium of middle ear = cholesteatoma. Hearing loss, mastoiditis, CNS abscess.

133
Q

25yo M bitten by a cat with shiny, edematous tender hand draining purulent fluid.

A

Pasturella multicoda. Gram neg rod with bipolar staining. Catalase and oxidase positive. Rx: Incision and drainage + amoxicillin/clavulanate, tetracycline, or penicillin. Can progress to osteomyelitis.

134
Q

14yo M bitten by younger sister with shiny, edematous, tender hand draining fluid.

A

Eikenella corrodens. Rx: PCN + I&D.

135
Q

44yo archaeologist returns from dig site in Arizona with high fever, severe myalgia, and painful inguinal swelling.

A

Plague. Yersinia pestis. Enlarged inguinal nodes = buboes. No genital lesions. Gram negative bacilli c safety pin appearance in aspirates from buboes. Rx: streptomycin / tetracycline. Rodents and fleas in Southwestern US. Death rapid if untreated.

136
Q

11yo M with blood-tinged, mucoid sputum and pleuritic chest pain.

A

Pneumococcal pneumonia. Incr fremitus & dullness over afffected lobe. Gram positive diplococci in sputum, alpha-hemolytic colonies. CXR = homogenous opacification of affected lobe +/- pleural effusion. Rx: IV PCN. #1 community acquired pneumonia.

137
Q

32yo HIV + M with progressive dyspnea over 3 wks.

A

PCP. dry cough, fatigue, hypoxemia out of proportion to clinical findings. Rx: SMX-TMP. Interstitial pneumonia in IC’d pts. Bactrim prophylaxis for HIV pts if CD4 <200. Labs: serum LDH elevated.

138
Q

14yo M Russian immigrant with weight loss, fever, night sweats and bloody sputum.

A

TB. Primary = lower lobes / subpleural. Secondary = cavity lesions in upper lobes. Rx: RIPE therapy = rifampin, isoniazid, pyrazinamide, ethambucil.

139
Q

28yo M with numbness of R arm following bat bite. Refuses to drink water.

A

Rabies. Hydrophobia, neuropathy. Long incubation period 3-8wks, prevent occurrence with vaccine. Negri bodies = cytoplasmic inclusions in Ammon’s horn. Positive rabies antigen on corneal scraping.

140
Q

27yo Peace Corps volunteer in Africa with fever, sweats, abdominal pain. Had an itchy rash after swimming several weeks ago.

A

Schistosomiasis. CBC: eosinophilia. Rx: praziquantel. Snail-infested ponds/lakes. Hepatosplenomegaly d/t portal hypertension d/t granulomas = periportal fibrosis.

141
Q

36yo M executive with sudden nausea, vomiting, and diarrhea with blood and mucus after business trip to South America.

A

Shigellosis. + fecal leukocytes. Shigella on stool culture. Not motile. Outbreaks c overcrowding, fecal-oral. Can be complicated by Reiter’s syndrome = arthritis, conjunctivitis, urethritis (HLA-B27 individuals). Rx: ampicillin or SMX-TMP.

142
Q

37yo with ulcerated nodule on hand after trauma while doing yardwork.

A

Sporotrichosis. Sporothrix schenckii. Nonpainful, soft, ulcerated nodule at inoculation site = sporotrichotic chancre. Rx: itraconazole. (Sporothrix is a dimorphic fungus = cigar shaped budding cells). May cause bone/joint infection.

143
Q

9yo M with odynophagia and erythematous tonsils with white exudate.

A

Strep pharyngitis. Rx: oral penicillin V. Streptococcus pyogenes. Complications include glomerulonephritis and rheumatic fever.

144
Q

38yo diplomat in Nigeria with diarrhea, fever, dry cough, and dyspnea. Frequently walks barefoot through his neighborhood.

A

Strongyloidiasis. Eosinophilia with motile rhabditiform larvae. Rx: thiabendazole or ivermectin. Results from poor hygeine in tropics. CXR: bilateral transient migratory infiltrates.

145
Q

54yo F with spiking fever, loss of appetite, and RUQ pain who underwent emergency cholecystectomy 10d ago.

A

Subdiaphragmatic abscess. Rx: percutaneous drainage. Findings include pain on percussion, left-shift, fluid collection below diaphragm. Occurs typically >1wk after abdominal surgery.

146
Q

18yo M with painless ulcer on penis.

A

Syphillis. Dark-field exam of exudate = treponemes. VDRL and FTA-ABS positive. Rx: Benzathine PCN IM, 2.4U single dose. STD d/t Treponema pallidum.

147
Q

23yo F with nonpruritic skin rash, hair loss, and copper-colored maculopapular rash on palms and soles.

A

Secondary syphilis = generalized tender lymphadenopathy, rash on palms/soles, coalescent papules/plaques in groin = condyloma lata, hair loss = alopecia. Rx: IV benzathine PCN.

148
Q

12yo M with dysphagia. Stepped on a nail about a week ago.

A

Tetanus. Clostridium tetani. Trismus = jaw m rigid, Risus sardonicus = facial m spasm; dysphagia, neck rigidity, painful facial spasms, opisthotonos. Rx: debride wound, tetanus immune globulin IM or intrathecally, diazepam; tetanus toxoid; IV PCN.

149
Q

40yo HIV + M with severe HA. Has 2 cats at home.

A

Toxoplasmosis. Toxoplasma gondii. Host = cats. Rx: pyrimethamine or sulfadiazine. PE reveals generalized lymphadenopathy, papilledema. CT/MRI-head reveals mass lesions with ring or nodular enhancement. Compl include seizure, brain abscess.

150
Q

50yo M with generalized myalgia and low-grade fever. Had severe abdominal pain and diarrhea several weeks ago after eating at a pigroast.

A

Trichinosis. Labs: elevated CPK, LDH, and AST. Normal ESR. Eosinophilia. Raw/undercooked pork. Trichinella spiralis. Affects facial, neck, lower back, and diaphragm. Biopsy of SCM reveals organism.

151
Q

20yo M with ulcer on wrist, lymphadenopthy in ispilateral axilla with suppuration. Recently trapped and disposed of rabbit on his property.

A

Tularemia. Francisella tularensis. Rabbits, squirrels, rodents, ticks. E levated ESR. Lymph nodes with suppuration + necrosis. Direct fluorescentantibody staining. May be tonsillar, oculoglandular, pneumonitic, typhoidal. Rx: streptomycin + tetracycline.

152
Q

27yo M with increasing fever, constipation, and faint erythematous macules over the trunk. Visited Southeast Asia three weeks ago.

A

Typhoid fever. Salmonella typhi. Rx: ciprofloxacin. Infection of Peyer’s patches c subsequent mucosal necrosis. Fever c stepladder pattern. Macules = “Rose spots” Infection from contaminated food or water. Typhoid vaccine available.

153
Q

5yo M with pruritic rash on scalp, face and trunk.

A

Varicella zoster. Lesions appear in crops q3-5d. Macules, papules, vesicles, pustules, and scabs all present at same time. Leukopenia. Tzank smear = inclusion bodies (Lipschutz bodies) + MNG cells. DNA herpesvirus.

154
Q

45yo HIV+ M with painful, burning skin rash on left side of chest.

A

Zoster (shingles). Vesicular rash on erythematous base. Dermatomal distribution. Exquisitely tender. Acantholytic cells on Tzanck smear from base of vesicles. Cowdry A = intranuclear eosinophilic inclusions surrounded by clear halo. Rx: acyclovir.

155
Q

24yo South American male develops high fever. He develops yellow eyes, and coffee-ground emesis four days later.

A

Yellow fever. Flavivirus transmitted by Aedes mosquito. Affects liver and kidneys: liver midzonal lobular necrosis, severe renal tubular damage. Rx: symptomatic only. Preventable by vaccine. 5-10% mortality, most cases mild.

156
Q

50yo M with sudden fever, chills, neck stiffness.

A

Bacterial meningitis. S. pneumoniae = most common adult. Photophobia, obtundation. Tap = high pressure, cloudy, high protein, very low glucose, high cells mostly WBCs.

157
Q

33yo HIV+ M with persistent HA.

A

Cryptococcal meningitis. Encapsulated spherical fungi on India ink prep. CT/MRI-brain multiple ring-enhancing lesions. Rx: amphotericin B + 5-flucytosine. Acquired from pigeon droppings, usually seenin IC’d pts.

158
Q

30yo HIV+ M with rapidly progressive visual loss.

A

CMV retinitis. Cotton-wool exudates, necrotizing retinitis, perivascular hemorrhages. Rx: ganciclovir; foscarnet. Occurs in 20% of AIDS pts. Blindness in HIV = toxoplasmosis, PML, and CMV.

159
Q

45yo hog farmer with visual loss, severe HA, and projectile vomiting.

A

Neurocysticercosis. Taenia solium. Papilledema, free-floating cysts in vitreous body of right eye. Ingestion of ova is fecal-oral. CT/MRI-brain: intracranial cysts or calcifications. Eosinophilia.

160
Q

54yo man with ataxia, MS changes, deformed ankles, and shooting pain in extremities.

A

Tertiary syphillis. Gummas = subcutaneous nodules. Dorsal column –> reduced position/vibration sense. Charcot’s neuropathic arthropathy. Broad-based gait. Romberg’s sign. Light reflex lost with retained accomadation = Argyll Robertson. “Tree-bark” aorta.

161
Q

25yo F with dysuria, frequency, and hematuria after her honeymoon.

A

Acute cystitis. E. coli > Proteus, Klebsiella, Staph. saprophyticus, and Enterococcus. Hemorrhagic cystitis may also result from adenovirusinfection.

162
Q

28yo F in 27th week of pregnancy with R flank pain, fever, and dysuria.

A

Acute pyelonephritis. UA: proteinuria, WBC casts, >100,000 cfu E. coli. Rx by sensitivity, ampicillin empirically. E. coli, Klebsiella, Proteus, and Enterobacter.

163
Q

19yo M with painful urination and yellow-green urethral discharge. No bacteria seen on Gram stain.

A

Nongonnococcal urethritis. Rx: doxycycline. Most common = C. trachomatis, also Ureaplasma urealyticum. Frequentl coinfection c gonnococcal urethritis. Direct immunofluorescence using monoclonal Ab to Chlamydia. No growth on culture.

164
Q

15yo M with painful bilateral parotid swelling and left-sided scrotal pain.

A

Orchitis. Mumps, E.coli, enterobacteria, chlamydia, gonnorhea, mycobacterium tuberculosis. May cause sterility if bilateral. Rx: scrotal support, ice packs, steroids. CBC: lymphocytosis, hyperamylasemia.

165
Q

25yo F with burning on urination.

A

UTI. E. coli, staph saprophyticus = #1 and 2 causes. Others include proteus, klebsiella, enterobacter, serratia, psuedomonas, enterococcus, chlamydia, neisseria. Risk = females, sex, pregnancy, obstruction, bladder dysfunction, reflux, catheters.

166
Q

34yo M with multiple myeloma develops reticular skin infarction, necrosis, and ulceration.

A

Cryoglobulinaemia. Associated with paraproteinemias, RA, SLE, mononucleosis, lymphoma, PBC, and HCV. Small vessel vasculitis that may involve kidneys = renal failure. Rx: plasmapheresis.

167
Q

54yo F with RA develops Bence Jones proteinuria.

A

Monoclonal gammopathy of uncertain significance (MGUS). Monoclonal paraprotein without B-cell tumor. Assoc c hepatitis, leptospirosis, autoimmune dx. Follow closely 10-20% develop myeloma. Rx: None necessary. Close f/u.

168
Q

78yo M with fever, anemia, fatigue, petechiae and recent lacunar stroke.

A

Waldenstrom’s macroglobulinemia. Old men 2:1. Normochromic normocytic anemia. Rouleaux RBCs. ESR elevated. Serum M protein, cryoglobulin, and cold-reacting Abs. Hyperviscosity –> stroke, MI, Raynaud’s, pyoderma gangrenosum.

169
Q

55yo M with anemia, leukopenia, thrombocytopenia and bone pain.

A

Multiple myeloma. Infections (70%), renal failure (50%), bone pain (100% with progression), bleeding (10%). Very high ESR, rouleaux RBCs. Diagnosis = 2 of following: Bence Jones, bone marrow plasma cells, punched-out bone lesions.

170
Q

19yo M with recurrent DVTs for one year.

A

Antithrombin III deficiency. Diagnosis = antithrombin level. Rx: coumadin. AT-III activity enhanced by binding heparin (don’t use heparin to treat AT-III deficiency). Inherited disorder, screen family. Onset in late teens typical.

171
Q

24yo M with recurrent DVTs. Family history of DVTs affecting mother and sister.

A

Factor V Leiden. #1 thrombophilia. 20-40% of pts c DVTs esp. young ages. Auto dom: homoz’s with 80x risk, hetero 7x risk. Incr risk in pregnancy & contraceptive use. Mutation eliminates protein C cut site. Rx: coumadin for homos, prophy for hetero’s.

172
Q

23yo M bitten by snake now with purpuric skin lesions.

A

DIC. Causes include meningococcal, snakebite, staph septicemia, obstetric, malignancy (bronchus, pancreas, ovary, prostate, leukemias), shock, massive transfusion, vasculitis (HUS/TTP), bypass, cavernous hemangiomas.

173
Q

16yo M with massive hematomas and no history of trauma.

A

Differential includes: Christmas dx, von Willebrand’s, hemophilia, or uncontrolled anticoagulation.

174
Q

15yo M with acute hot, red, swollen knee and easy bruising.

A

Hemophilia. Prolonged aPTT, normal PT. Rx: factor VIII replacement. X-linked recessive.

175
Q

13yo M with recurrent bleeding episodes and normal factor VIII levels and activity assay.

A

Christmas disease. Factor IX deficiency. Complications of both include: chronic degenerative joint dx, compression neuropathy, renal pelvic / ureteral obstruction, intestinal obstruction.

176
Q

53yo homeless man with bleeding gums, purpura, and perifollicular bleeding.

A

Scurvy = vitamin C deficiency.

177
Q

6yo F with generalized skin rash following mild URI. Rash became purpuric after one day.

A

HSP. Drugs, food, insect bites, infections. Purpura +/- glomerulonephritis. Immune complex deposition. Children > adults. Glomerulonephritis in 33%.

178
Q

14yo with recurrent epistaxis and multiple small red lesions on lips, mouth, tongue. Mother and uncle have similar condition.

A

Hereditary hemorrhagic telangiectasias = Osler-Weber-Rendu. Autosomal dominant. Mucosal bleeding. Association with pulmonary AV fistula.

179
Q

9yo F with recurrent URIs, diarrhea, and failure to thrive.`

A

CF. High Cl sweat test.CXR: brochiectasis. Pseudomonasand staph infections of the lung. Mucous plugging, small bowel obstruction = meconium ileus. Rx: pulmozyme (DNAse breaks up airway). Azithromycin. Inhaled tobramycin (Tobi). Male sterility.

180
Q

23yo M with chronic productive cough and wife with difficulty becoming pregnant. Apical impulse not present on L side.

A

Kartagener’s syndrome. Sperm immotility, bronchiectasis. Dynein defect leads to immotile cilia. Autosomal recessive. Dextrocardia.

181
Q

23yo M goes to family doctor for evaluation of sterility. Found to have height greater than arm span, crown-pubis length greater than pubis-floor.

A

Klinefelter’s. 47XXY. Male hypogonadism. High incidence of breast CA, COPD, DM, mild mental retardation. PE: small testes, gynecomastia, “eunuchoid” body proportions. Increased gonadotropin with reduced testosterone.

182
Q

26yo M with flat nose, and single palmar crease. Had silver spots on iris at birth.

A

Down’s. Epicanthal folds, Brushfield spots, Simian crease. Double bubble on KUB: dilated stomach proximal duodenum d/t duodenal atresia. Hypoplastic phalanges in 5th digits (acromicria). Usually nondisjunction; Robertsonian translocation or mosaicism.

183
Q

7yo boy with diminished visual acuity and long arms, legs, and fingers.

A

Marfan’s syndrome. Arm span > height, arachnodactyly, ectopia lentis, severe myopia, high-arched palate, flat feet = pes planus, aortic insufficiency, pectus excavatum. Rx: beta-blockers, endocarditis prophy. Auto-dom. fibrillin = elastin scaffold.

184
Q

17yo F with amenorrhea, lack of breast development, and harsh systolic murmur.

A

Turner’s. Short stature, webbed neck, shield-like chest with wide-spaced nipples. High serum FSH/LH; no Barr bodies on buccal smear. Get US pelvis –> streak ovaries. Karyotype 45, XO; sometimes mosaicism –> skeletal, CV, horshoe kidney.

185
Q

5yo Asian F with sudden eye pain and loss of vision after watching a film. Reports seeing halos around lights at night.

A

Acute glaucoma (angle closure). Hazy cornea, elevated intraocular pressure. Rock-hard eye. Rx: analgesics, IV acetazolamide, topical beta-blocker, steroids, pilocarpine, laser iridotomy. Precip’d by mydriatics and switch from dark to well lit areas.

186
Q

49yo M with progressive weakness, difficulty speaking, and fasciculations.

A

ALS. Bilateral hand wasting, DTRs absent in upper limbs, muscle weakness, + Babinski sign (upgoing great toe) = upper motor neuron sign. Involves both upper and lower motor neurons. CSF normal. CT/MRI-brain normal.

187
Q

40yo M, now unresponsive, found in bathroom at work projectile vomiting. Said he was “seeing double”.

A

Cerebral aneurysm. Papilledema, CNIII palsy. Congenital Berry aneurysms associated with polycystic kidney disease, AV malformation. Cause subarachnoid hemmorhage. ACOMM > PCOMM > POST CEREBRAL.

188
Q

14yo M with short stature, history of polyuria, and peripheral vision loss.

A

Craniopharyngioma. #1 supratentorial tumor in kids. Derived from Rathke’s pouch remnants. Common cause of growth retardation, diabetes insipidus, bitemporal hemianopia, and headache d/t obstructive hydrocephalus. Bimodal with peak in fifth decade.

189
Q

62yo M with rapidly progressing decline in cognitive function, somnolence, and clonus on exam.

A

Creutzfeld-Jakob. Subacute spongiform encephalopathy. Risk = dura mater, corneal transplants, cadaveric growth hormone, neurosurgical contamination. Lithium OD may mimic presentation.

190
Q

19yo F horseback rider was thrown off horse. Lost consciousness then recovered. Now with HA, confusion, and weakness of left side with projectile vomiting.

A

Epidural hematoma. “Lucid interval” is classic. Signs = bradycardia, papilledema, mydriasis and CNIII palsy on ipsilateral,extensor plantar response and weakness on contralateral. CT –> lens-shaped, convex extra-axial fluid collection btwn dura & skull.

191
Q

19yo M with wide-based gait, clubfoot, and lateral curvature of spine.

A

Friedreich’s ataxia. #1 hereditary ataxia. Auto-dom, chromosome 9. Degeneration of doral root ganglia –> prorioceptive loss, areflexia, ataxia, Babinski’s. Also causes visual loss, hypertrophic cardiomyopathy.

192
Q

60yo M with HA worse in morning, nausea, and vomiting for six weeks.

A

Glioblastoma multiforme. CT = irregular enhancing left-sided mass with necrotic center; mass effect and surrounding edema.

193
Q

38yo M with symmetric muscle weakness started in feet, now involving legs and shoulders. Had diarrhea and fever.

A

Guillain-Barre. Symmetrical proximalweakness / flaccidity. Increased CSF protein concentration without cellular increase. VDRL negative. Decreased nerve conduction velocity. Preceeded by GI/respiratory/EBV/Campylobacter/CMV +/- respiratory paralysis.

194
Q

65yo M with sudden severe HA and hemiplegia. Now incontinent.

A

Hypertensive stroke.

195
Q

59yo F with retro-orbital HA and diplopia. Diagnosed with lung cancer.

A

Metastatic dx. Intracranial mets from lung, breast, GI, GU, CA, and melanoma.

196
Q

25yo with weakness, droopy eyelids, double vision, and dysphonia.

A

Myastenia gravis. Autoimmune c Abs to acetylcholine receptor subunits. Thymoma is present in 20% of cases.

197
Q

46yo M with HAs in the morning, seizures, and CT showing nodular calcifications in a frontal lobe mass.

A

Oligodendroglioma. Usually low grade, but may be anaplastic. More sensitive to chemo than astrocytomas. Calcification in 90% of cases.

198
Q

30yo M with anesthesia and weakness in both arms, occipital HAs, and stiff gait.

A

Syringomyelia. MR/CT –> cystic dilatation within central cervical cord. Hydromelia is lined by ependymal tissue, syringomyelia is not.

199
Q

18yo M with wide-based gait and headaches. Father died of renal cell carcinoma at young age.

A

von Hippel-Lindau. Auto-dom, renal cell CA + renal, hepatic, pancreatic cysts + cerebellar ataxia.

200
Q

49yo alcoholic with confusion, stupor, and nystagmus following 5% dextrose infusion.

A

Wernicke’s encephalopathy. Due to thiamine deficiency.

Internal Medicine (4 decks)

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