Cases- Steinauer Flashcards
A 63 year old male presented with intermittent fever, chills, sweats, and vague epigastric discomfort for 20 days. He lived in the San Francisco Bay area and other than a trip to France, had no travel history.
Two months previously, he picked and ate local watercress in rural Marin county (North of San Francisco)
Exam showed minimal epigastric discomfort and was otherwise unremarkable
Eosinophilia, which peaked at 4,410/ul
Treated with antibiotics for liver abscess.
No improvement
Which pathogen is most likely?
A. Histoplasma capsulatum
B. Fasciola hepatica
C. Clonorchis sinensis
D. Ascaris lumbricoides
E. Schistosoma mansoni
B. Fasciola hepatica Aquatic vegetation Livestock or cervids Migration of larvae through the intestinal wall, to liver, burrow through parenchyma and move to biliary ducts. 3-4 months. Acute fascioliasis: Mostly asymptomatic. Epigastric pain. Subcapsular hematoma of liver Chronic fascioliasis: Mimics gall bladder disease. Right upper quadrant pain and tenderness
A 30-year-old previously healthy American man working in Madagascar swam with a Malagasy colleague in a lake in the central highlands of Madagascar. Immediately upon exiting the water, they both experienced generalized itching for approximately 30 min, which they attributed to algae in the water.
Eight hours later, the patient noticed intensely puritic papules on his skin. The rash resolved completely after four days.
After returning home to the US, 4 weeks later, he developed malaise, myalgia, dry nocturnal cough and temperatures to 38.1 C (100.5 F). A rapid test for malaria was negative.
His laboratory investigations, however, were as follows: WBC count 8.1×109/L (eosinophils 30%; lymphocytes 35%; monocytes 7%; neutrophils 25%; and bands 3%).
Which pathogen is most likely?
A. Ascaris lumbricoides
B. Necator americanus
C. Schistosoma haematobium
D. Histoplasma capsulatum
E. Coccidiodes immitus
C. Schistosoma haematobium
Water contaminated with feces or urine
Snail vector
Direct penetration of skin with freshwater contact
Lung migration, develop in liver for several weeks, move to venules of intestine, bladder, or genital tract
If Schistosoma Haematobium is left untreated, which of the following would be most likely to develop? A. Bloody urine B. Iron deficiency anemia C. Liver abscess D. Myocarditis E. Seizures, neurological problems
A. Bloody urine
A 32-year-old female presents to her primary care physician 10 days after returning from a vacation in Mexico. She complains of foul-smelling diarrhea and watery diarrhea that floats on the toilet. Examination of a stool specimen reveals flagellated trophozoites. Which Pathogen do you Suspect? A. Entamoeba histolytica B. Cryptosporidium parvum C. Cyclospora sp. D. Giardia lamblia E. Trichuris trichiura What is the most likely source of infection? A. Bite of an Anopheles mosquito B. Raw pork C. Cat litter box D. Contaminated water E. Contaminated food
D. Giardia lamblia
What pathogen has this clinical presentation: Asymptomatic, diarrhea, Bloody diarrhea, invasive disease.
Entamoeba histolytica
What pathogen has this clinical presentation: Watery, greasy diarrhea. 2-6 weeks
Giardia lamblia
What pathogen has this clinical presentation: Self limited watery diarrhea 1-2 weeks, HIV—chronic diarrhea
Cryptosporidium sp.
What pathogen has this clinical presentation: Watery diarrhea intermittent , several weeks or months
Cyclospora sp.
A 22-year-old student from China presented with fatigue, paleness, and dizziness for one month. He estimates 12 kg of weight loss in the last three months. Lab work indicates iron deficiency anemia. Which pathogen is most likely? A. Ancylostoma duodenale B. Trichuris trichiura C. Ascaris lumbricoides D. Plasmodium falciparum E. Schistosoma mansoni
How was this person exposed to this pathogen? A. Contaminated water B. Contaminated food C. Ingested eggs in soil D. Larvae in soil penetrated skin E. Larvae in water penetrated skin
A. Ancylostoma duodenale
D. Larvae in soil penetrated skin
A florist presents with a red, hard, painless nodule on the forearm. Culture reveals what is shown in the photograph. What is the most likely pathogen? A. Histoplasma capsulatum B. Trichophyton sp. C. Leishmania major D. Wucheria bancrofti E. Sporothrix sp.
Which of the following wouldNOT be found in the cell wall or membrane of this organism? A. Mannoprotein B. Lipoteichoic acid C. Glucosyl polymers D. Chitin E. Ergosterols
E. Sporothrix sp.
B. Lipoteichoic acid
A 45 year old immigrant from Uganda presents with the following:Is this a chronic or acute infection? (Elephantiasis leg).
A. Acute
B. Chronic
What pathogen is most likely? A. Onchocerca volvulus B. Wucheria bancrofti C. Leishmania brasiliensis D. Leishmania donovani E. Trichophyton sp.
B. Chronic
B. Wucheria bancrofti
A 56 year old woman from central California was admitted to the hospital after 16 days of fever. On admission, temperature was 48.8 C (102F), and there were multiple, erythematous, blanching, irregular macules of the neck, thorax, abdomen and extremities, sparing the face, palms and soles. She had never left the country.
A blood smear showed the following:What pathogen is most likely?
A. Leishmania spp.
B. Schistosoma mansoni
C. Trypanosoma cruzi
D. Plasmodium falciparum
E. Coccidioides immitus
C. Trypanosoma cruzi
Chagas Disease:
Acute
