Clinical Medicine 3

Question 1

Cause of anthrax

Answer 1

Bacillus anthracis. Endospore forming gram + rod. Comes from undercooked meats or from infected animals. Can be either skin, inhalation, or ingested

Question 2

Clinical presentation of cutaneous anthrax

Answer 2

Most common form. Small sore that becomes a blister and eventually ulcerates with a black center. Death rare

Question 3

Clinical presentation of inhalation anthrax (aka wool sorters disease)

Answer 3

Most severe and lethal form (bioterrorism)
1. SX occur 7days-6wks
2. common cold/flu like sx
3. Will be followed by wheezing, cyanosis, shock, severe edema
DEATH MAY OCCUR RAPIDLY IF NOT TX’D
4. CXR shows mediastinal widening with pleural effusions/infiltrates

Question 4

Management of anthrax

Answer 4

1. ABX
2. Vaccination available for high risk occupations
3. Post exposure prophylaxis with cipro or doxy, especially in airborne verson

Question 5

Clinical presentation of GI anthrax

Answer 5

Very uncommon. NVD, abdominal px
GI ulcerations lead to hematemesis or melena
(coffee ground stools)

Question 6

Leading cause of death in the tropics and subtropics due to mosquito bites

Answer 6

Dengue (self-limited biphasic febrile illness)

Question 7

Clinical presentation of dengue

Answer 7

1. Sudden fever - “breakbone fever”
2. Severe px of muscle and joint
3. Measles-like skin rash
4. Mosquito bite s/sx begin 4-7 days after. Typically last 3-10 days

Question 8

Management of dengue

Answer 8

Supportive over the course of illness. Pain management

Question 9

Complications of dengue

Answer 9

Hemorrhagic fever and shock syndrome. This is when there is an increased capillary permeability and disordered blood clot which causes significant internal bleeding

Question 10

Cause of cat scratch fever “subacute regional lymphadenitis”

Answer 10

Bartonella henselae a gram - rod. Transmitted by scratch or bite from a cat

Question 11

Clinical presentation of cat scratch fever

Answer 11

1. Initial - papule at the site of inoculation
2. Then a solitary lymphadenopathy appears
3. Fever, headache, malaise

Question 12

Management of cat scratch

Answer 12

It is a self limited bug, so no tx is required unless it moves. DO NOT CONFUSE with pasteurella multicoida

Question 13

Cause of tularemia

Answer 13

Francisella tularensis. Acquired by humans with contact of animal tissues ( or insect bit or drinking contaminated water

Question 14

Clinical presentation of tularemia

Answer 14

1. Papule at site of inoculation which is most often in skin or eye
2. GI issues if ingested
3. Potential pneumonia like sx if inhaled
   1-14 day incubation

Question 15

Management of tularemia

Answer 15

ABX - streptomycin or tetracycline family

Question 16

Causes of plague

Answer 16

Yersinia pestis, gram - rod. Comes from wild rodent (mice, rats) who were bitten by a flea

Question 17

2 types of plague

Answer 17

1. Bubonic

2. Pneumonic - spread person to person

Question 18

Clinical presentation of bubonic plague

Answer 18

Buboes - lymphadenitis (massive swollen lymph nodes)

Question 19

Clinical presentation of pneumonic plague

Answer 19

Headache
Hemoptysis
Hematemesis
Weakness

Question 20

Complications of plague

Answer 20

1. Septicemic plague - bacteria enters bloodstream via lymphatics
2. Meningeal plague - bacteria crosses the BBB resulting in meningitits

Question 21

Cause of toxoplasmosis

Answer 21

Toxoplasma gondii. Transmitted via cat feces (and sometimes birds), or ingestion of raw or undercooked meats, or contaminated water. Crosses placenta!

Question 22

Clinical presentation of primary toxoplasmosis

Answer 22

1. May be completely asymptomatic (mild mono-like symptoms)
2. Fever
3. Nontender cervical adenopathy
4. May have hepatosplenomegaly

Question 23

Clinical presentation of latent toxoplasmosis

Answer 23

After primary infection, latency occurs in mostly immunocompromised patients.

1. Ring enhancing lesion in the brain
2. Altered mental status
3. Focal brain lesion seen on MRI (seen in AIDS pts)

Question 24

Causes of malaria

Answer 24

4 different species of mosquitos. Most severe is caused by Plasmodium - P falciforum. Transmitted by mosquito bites!!

Question 25

Clinical presentation of malaria

Answer 25

1. Incubation of 7-30 days - no symptoms
2. Cold stage - RIGORS!
3. Hot stage - fevers, headaches, sweating
4. Episodic 6-10 between hot and cold

Question 26

Complications of malaria

Answer 26

1. Hemolytic anemia
2. Organ failure
3. Acute respiratory distress
4. Altered coagulation

Malaria starts to attack the RBC in the body

Question 27

Management of malaria

Answer 27

Antimalarial drugs to fight the erythrocyte stage. Multi drug regimen

Question 28

DX of malaria

Answer 28

Thick and thin blood smear - looking for evidence of parasites