Exam 2 Case Studies

Question 1

25 year old man comes in a primary clinic complaining of fever, chills, and HA. He presents with a sore throat and non-productive cough. He has a history of renal failure. What diagnostic test would you run? How would you treat him?

Answer 1

Rapid influenza diagnostic test (RIDTs)
Zanamivir (Relenza)

Question 2

A 16 year old female comes with in with vesicles on her lips and inside the mouth. She complains of pain whenever she eats. Her physical shows that she has a swollen lymph nodes. What labs would you order to help confirm the diagnosis? How would you treat it?

Answer 2

HSV1
Culture, PCR, Tzank smear
Oral antiviral(any of the 3), Zovirax, Docosanol

Question 3

A 54year old male comes in complaining about getting blurring vision. His symptoms started 5 days ago. He has a history of HIV and alcohol use. A physical exam reveals lesions on the side of his eye and nose as well as macules and papules spreading along the back of his right leg. How would you treat him? Is there something that could help prevent further complications?

Answer 3

Shingles
IV acyclovir + topical steroids
Zoster vaccine(RZV or shingrix)

Mainly to prevent post-herpetic neuralgia

Question 4

A 55 year old man with multiple complications returns to the clinic after getting treatment for a bacterial infection for endocarditis. He currently is complaining about a rash after the last visit. He presents with a fever, sore throat, and tonsillar enlargement. After a physical exam, he has palatal petechiae has a raised tender bump on the back of his neck. What could be causing his symptoms and how do you treat it?

Answer 4

EBV, rash developed after taking ampicillin for endocarditis.
Fluids and antipyretics

Question 5

A sick mother gives birth to a baby girl. The baby girl’s skin appears yellow and have trouble hearing. The mother has a history of HIV and is antivax. The mother has trouble seeing and has shortness of breath. What could be the mother and newborn be sick with? How do we treat the mother?

Answer 5

CMV

Ganciclovir, valganciclovir, foscarnet

Question 6

A 18 year old male comes in with burning and itching on his butt. On further examinations, you notice raised pearly lesions. He complains that because of lesions, he has a hard time finding people to sleep with. How could you remove the lesions? Is there any education you can provide him?

Answer 6

Chemical destruction(podophyllin/podofilox or imiquimod), cryotherapy, Interferon treatment, laser/surgical surgery

He has contracted HPV and could spread it to others. So he should wear protection for sexual acts to prevent transmission. He should also get the Gardasil vaccine because it can still protect from other strains.

Question 7

A 30 year old female gets rushed to the emergency room. Her mother comes along and tells the staff that she was sick with the flu for the past 3 days, and is now going crazy and hallucinating. She was out in the woods trying to catch coyotes and returned home after getting bit. What do you tell the mother?
What could have you have given under ideal circumstances?

Answer 7

RIP she dead. Jk be more empathetic than that.

If her daughter came right after getting bit, you would have given 1 dose of Ig, and 4 doses of rabies vaccine over 14days. Given on day 0, 3, 7, 14. She may have lived.

Question 8

A 28 year old man to the clinic. He has not been eating well lately and has complains about pain in the mouth when eating. On inspection, he has white plaques in them and a beefy red mucosa. You can scrap off the plaques. How could you treat him?

Answer 8

OC
Nystatin
Clotrimazole
Miconazole

Fluconazole

Gentian violet

Question 9

A patient comes in complaints of painful swallowing and nausea. He is currently take immunosuppressant drugs because he recently had a bone marrow transplant. On examination, it is revealed to have oral thrush spreading to this throat. What exam could you give to confirm your diagnosis? What could you give him he does not want to swallow any pills?

Answer 9

EC
Endoscopy
Fluconazole (IV)
If resistant, Voriconazole, posaconazole, or echinocandin

Question 10

A 28 year old pregnant women comes in with burning in the vaginal area. You notice there is a “cottage cheese” discharge. She tells you this happened before and had a bad allergic reactions to the ointments given to her before. What could you give to treat her? How could you prevent her from getting it again?

Answer 10

VC
Ibrexafungerp, Gentian violet, boric acid

Probiotics(but questionable benefit)

Question 11

You enter a nursing home and a patient complains of a rash on his groin area. He is obese and incontinent. On PE, there you notice macercated lesions. What could you prescribe him to treat the symptoms?

Answer 11

Candidal Intertrigo
Topical azoles or nystatin

Question 12

A patient comes into the clinic and says he’s having a hard time breathing. He tells you, that he is a birdwatcher and started having symptoms after one of his trips. You notice he has bilateral swelling on his neck and edema on his arm and face, with distension of neck veins. What would show up on a chest X-ray? How would you treat him?

Answer 12

Histoplasmosis
CXR: mediastinal lan and fibrosis of the mediastinum

Itrazconazole + rituximab + corticosteroids
Surgical intervention

Question 13

A 65 year old male travel to Mexico to celebrate his retirement for two week. After his trip, he developed fever, chills, fatigue, HA, cough, and swelling in his knees and ankles as well as a rash around his shin. His blood work came in and has elevated WBC and eosinophils. What lab would you order to confirm the diagnosis? What would be the best treatment for him?

Answer 13

Coccidioidomycosis
Bronchoscopy with biopsy and culture

Fluconazole or itrazonazole
Voriconazole or posiocnazole if refractory

Question 14

A man comes back from a hiking trip in Canada. He complains of his testicles hurting as well as bladder irritation. He also mentions of bone pain especially on his spine. He has a fever and has been coughing purulent sputum. What initial lab would you order? What would show up on it? How would you treat him?

Answer 14

Blastomycosis
CBC: elevated WBCs and anemic values

Amphotericin B

Question 15

You go to New York with your boyfriend and realized theres too many pigeons everywhere you go. He starts developing a fever and does not seem like himself. You go to the hospital because you worry like the good girlfriend you are. The doctor takes a CSF sample and is positive for the cryptococcal antigen. You’re a smart PA knows what treatment the doctor will prescribe. What is it?

Answer 15

Cryptococcosis
IV amphotericin B + flucytosine for 2 weeks
then 8 weeks of fluconazole
LP or CSF shunting to relieve CSF pressure

Question 16

A patient comes in with from a sudden onset of fever and a non-productive cough. He has a hx of HIV. A blood culture is taken but nothing shows up. A CXR is taken and is shown to have diffuse interstitial infiltrate with some nodules and cavitations. What is the treatment?

Answer 16

Pneumocystosis
Bactrim 14-21 days

(But google says you can culture it now)

Question 17

A 4 year old girl comes in with a 104 F fever and sore throat. She has erythematous skin from the back of her ears trailing down to her feet. What can you give to treat her?

Answer 17

Rubeola/measles

Post-exposure vaccination if within 72hours

Increased fluid intake
Acetaminophen (NO ASA)
Abx for complications of bacterial infection

Question 18

A 13 year old boy comes in presenting with a swollen jaw. He complains of a headache and being tired. The doctor told him there is no treatment. His 7 year old brother traumatized with his swollen face, wants to know how to prevent it from happening to him. What should the doctor tell him?

Answer 18

To get the mumps vaccine (2 dose 88%, 1 dose 78% effective)
Wash hands
Dont share food/drinks
Clean regularly touched areas
Cough and sneeze etiquette

Question 19

A pregnant woman from Haiti enters a primary care clinic and complains of joint pain, congestion, fever, and HA. She specifies that the joints that hurt are the fingers, wrists, and knees. PE determines a symmterical posterior cervical and occipital LAN, as well as a rash. She also mentions she gets slightly disoriented from time to time. What do you diagnose her with? What could you give her to reduce her symptoms? What do you tell her about her child?

Answer 19

Rubella
Hyperimmune Globulin
The child can develop microcephaly, cataracts, and cardiac defects.

Question 20

A 7-year old boy presents with a mild fever, HA, and facial erythema looking like “slapped cheeks”. The parents assure you that they did not slap him. What would show up on a blood test for the boy?

Answer 20

5th disease/Erythema Infectiosum
IgM specific antibodies to parvovirus B19

Question 21

You’re working in Peds. You examine a 2 year after being admitted for having high fever. Other than the fever he is completely normal. When his fever starts going down, and you’re about to discharge him, he developed a rash on the neck and trunk. What complications do you worry for the boy if you still decide to discharge him?

Answer 21

Roseola

Could develop meningitis, encephalitis, leukopenia, thrombocytopenia, hepatitis

Question 22

A 10 year old girl comes in saying “my skin be looking like dewdrops on a rose petal”. The mother telling her to stop saying that, asks what she should do to help her daughter?

Answer 22

Varicella

Calamine lotion/oatmeal baths
Trim nails
Acetaminophen

Question 23

A 8 year old boy comes in with a fever, LAN, and sore throat. You examine him and he has a rash on his palms and foot. In his mouth, you see blister-like lesions on his tongue, gyms, and buccal mucosa. How could you treat him?

Answer 23

HFMD
No treatment only supportive
Topical oral anesthetic
OTC pain meds

Question 24

A 27 year old man came back from a trip to Indonesia. He complains about bright red diarrhea. On PE you determined abdominal distention and tenderness, and hepatomegaly. What treatment regime should he be on?

Answer 24

Entamoeba histolytica

Metronidazole(10days) or Tinidazole(3days)
then Paramomycin for 7 days

Question 25

After a trip from Jamaica, a 28 year old man has been having foul smelling diarrhea. He has signs of dehydration and does not have fever or vomiting. What would show up on a stool microscopy? How do you treat this patient?

Answer 25

Giardiasis

Stool microscopy: Cysts and trophozoites

Tinidazole
Nitazonxanide(1-3yo recommended)
Metronidazole(<1yo recommended)

Question 26

A 15 year old boy complains of a watery diarrhea. He mentions he was a a pool party a week ago. He has N/V, abdominal pain and cramps. His temperature is 99.3F. What does he have? How do you treat it?

Answer 26

Cryptosporidiosis

Nitazoxanide, paromomycin

Question 27

A 26 year old female comes in with a chief complaint of watery diarrhea for 16 days. She has a hx of HIV. She also tells you she has been eating some imported Mangos from Peru. She has fatigue and malaise. She has lost a lot of weight since then. What do you treat her with?

Answer 27

Cyclosporiasis

Bactrim
Ciprofloxacin
Niazoxanide

Question 28

A 34 year old females comes complaining about a yellow green vaginal discharge. She has painful urination and upon PE a “strawberry cervix”. How do you treat this?

Answer 28

Trichomoniasis

Tinidazole or Secnidazole
Metronidazole

Question 29

A 42 year old man comes in with a fever, HA, and sore throat. He came from a bbq party with a questionable grillmaster making the food.Upon PE, you notice LAN and HSM. He does not have any medical history. How do you treat him?

Answer 29

Toxoplasmosis
No treatment necessary for acute disease

Question 30

After a trip to Africa, a 36 year old man is complaining about having seizures when he did not before, he also presents with a high fever, chills, and sweats. You take a blood test and it shows deceased hgb, hct, and HgA1C is below normal. Their blood pH is 7.2 (normal 7.4). How do you treat him?

Answer 30

Malaria
IV artesunate
IV quinidine/IV quinine (but these aren’t in the US)

Question 31

A 22 year old female coming in with diarrhea and abdominal pain. You tell her to come back with a stool sample, and she returns the next day with the stool. Upon examination, you the stool has proglottids. Where does this organisms live in the body? How would you treat her?

Answer 31

Tapeworms(Taeniasis)

Lives in intestines

Praziquantel(Biltricide)

Question 32

A 39year old man comes in with a rash. It presents with a squiggly line from the plantar side of his foot to towards the ankle. You take a blood test and shows signs of anemia as well. How would you treat him? Are there any special instructions in the treatment?

Answer 32

Hookworms

Albendazole, should be taken with a high-fat meal or snack
Mebendazole

Question 33

A 12 year old boy comes in with problems sleeping. He tells you that his butthole is itchy at night. On PE, you see excoriations on the perianal skin. You take a stool sample, but you do not see anything in the feces. What test could you order to further determine the diagnosis? How medication would you give to treat the child?

Answer 33

Pinworms(Enterobiasis)

Scotch tape test/paddle test
Albendazole
Mebendazole

Question 34

A farmer comes in abdominal pain and blood in the eyes. He has a HA, cough, dyspnea, and rash. He tells you this started when he went hunting and caught a wild boar to eat. How would you treat him?

Answer 34

Trichinosis
Albendazole, mebendazole

Supportive
Analgesics, antipyretics, bed rest, steroids

Question 35

A 11 year old girl comes in presenting with a dry cough and hives. She also has dyspnea and chest pain. The mother is worried that she caught something from their pet dog as they always play together. How could you treat the girl?

Answer 35

Round worms (ascariasis)

Albendazole
Mebendazole

Question 36

A 26 year old farmer comes in complaining about a weird black spot on his arm. You notice is an eschar, and when you culture it, it shows Gram + rod. How would you treat him? What would you give him to prevent further infections?

Answer 36

Anthrax(skin)

Antitoxin, Cipro, Clinda

Vaccination, Cipro, Doxy, Amox

Question 37

A man is rushed to the ER with diplopia, dry mouth, ptosis, and descending flaccid paralysis. What do you suspect he is infected by? How could you treat him?

Answer 37

Botulism

Equine antitoxin
Intubation, mechanical ventilation, parenteral nutrition

Question 38

You go back in time to Europe 1420s because its Rick and Morty adventure time. Morty starts feeling sick and is developing a fever and starts coughing up blood. Rick tells Morty to not worry as he has a 16% chance of living but 100% with him around. Rick gives him pills to swallow as well as injection to help prevent future infections. What did RIck give him?

Answer 38

Plague(Yersinia Pestis)

Genta, Strepto, Doxy, Chloramphenicol

Doxy, Levo (prophylaxis)

Question 39

Some antivaxxers begin to worry when their healing crystals were not curing their sick child. They bring him to the ER in a panic. The child has a fever, HA, N/V, and a rash spreading from the face, extremities, and trunk. There are scabs all over the child’s body. The parents said at first it was a fluid-filled sac then pus filled before turning into scabs. What do you do to treat the child?

Answer 39

Small pox
Isolate the child
Supportive measures

Question 40

You’re on a hiking trip and you get bitten by a tick. You’re tell yourself oh “Oh shit Lyme disease, LOL”. However, the next day, you develop pharyngitis and conjunctivitis. You feel your airways inflamed and no bull’s eye mark on your body. You remember another disease that can be cause from tick bites from your PA studies. What is it? What can treat it?

Answer 40

Tularemia

Strepto, Doxy, Genta, Chloramphenicol, Cipro

Question 41

A 41 year old female comes in with a fever or 103F. She tells you that she has been having it for 2 weeks. She tells you that she has been getting nose bleeds, coughing up blood, as well as bloody stool. She worries about dying. What would show up on a CBC and PT? What is the treatment?

Answer 41

Viral hemorrhagic fevers/Ebola

Decreased PLTs, Increased PT
No approved treatment, but experimental antibody cocktails and ribavirin