Vignettes - Micro, Path and Pharm -sidebyside Flashcards
Microbiology Vignettes
p174
An alcoholic vomits gastric
contents and has foul
smelling sputum. What
organisms are most likely?
Anaerobes
Middle-age man has acute
monoarticular joint pain and
bilateral Bell’s palsy. What
disease and how?
Lyme, Ixodes tick
Pt with Mycoplasma
pneumoniae, cryoagglutinins.
What Ig types?
IgM
U/A with WBC casts. Dx?
Pyelonephritis
Young child with tetany,
candidiasis, hypocalcemia,
and immunosuppression.
What cell is deficient?
Tcell (DiGeorge)
Pt with “rose
gardener’s” (thorn prick,
ulcers along lymph drainage).
What bug?
Sporothrix schenckii
25yr old med student has
“burning” gut after meals.
Gram negative rods in Bx.
What organism?
H. pylori
32yr old man w/ “caulifl ower”
skin lesions. Bx shows broad-
based budding yeasts.
Organism?
Blastomyces
Breast feeding woman w/
redness & swelling of right
breast. Fluctuant mass. Dx?
Mastitis by S. aureus
Young child w/ recurrent lung
infxns & granulomatous
lesions. What defect in
neutrophils?
NADPH oxidase (chronic granulomatous disease)
20yr old college student w/ lymphadenopathy, fever, hepatosplenomegaly. Serum agglutinates sheep RBCs. What cell infected?
B-cell (EBV; infectious
mononucleosis)
Microbiology Vignettes
p175
1hr after eating custard at a
picnic, whole family vomits.
After 10hrs all better.
Organism?
S. aureus(produces
preformed enterotoxin)
Infant eats honey -> flaccid.
Organism? Mechanism?
Clostridium botulinum;
inhibited release of Ach
Man w/ squamous cell
carcinoma, penis. what virus?
HPV
Pt w/ endocarditis 3wks after
prosthetic heart valve.
Organism?
S. aureus or S. epidermis
Pathology Vignettes
p220
Woman w/ previous C-
section has scar in lower
uterus close to opening of the
os. Risk for what?
Placenta previa
35yr old man w/ hi BP in
arms. Low in legs. Dx?
Coarctation of Aorta
Woman w/ di! use goiter and
hyperthyroidism. Values of
TSH and thyroid hormones?
Low TSH, and high thyroid
hormones
Pt w/ extended expiratory
phase. Disease process?
Obstructive Lung Disease
Woman w/ headache, visual
disturbance, galactorrhea,
amenorrhea. Dx?
Prolactinoma
Baby has foul smelling stool
and recurrent pulmonary
infxns. Dx? Test to confi rm?
Cystic fi brosis. Chloride sweat
test.
mua~!
^3^
Obese woman w/ hirsutism
and hi serum testosterone.
Dx?
Polycyctic ovarian syndrome
Man w/ pain and swelling in knees, subcutaneous nodules around the joints and Achilles, exquisite pain in the metatarsophalangeal join of right big toe. Bx shows needle-like crystals. Dx?
Gouty arthritis
48yr old female w/
progressive lethargy and
extreme sensitivity to cold
temp. Dx?
Hypothyroidism
Pt w/ elevated serum cortisol levels undergoes dexamethasone supp. test. 1mg doesn't lower cortisol. 8mgs does. Dx?
Pituitary tumor.
During a football game,
player collapses/dies
immediately. Likely Cardiac
disease?
Hypertrophic cardiomyopathy
Pathology Vignettes
p221
Child anemic since birth.
Splenectomy -> increased
Hct in what disease.
Spherocytosis
43yr old man experiences
dizziness/tinnitus. CT shows
enlarged internal acoustic
meatus. Dx?
Schwannoma
Child exhibits weakness and
enlarges calves. Disease? How
inherited?
Duchenne’s muscular
dystrophy, X-linked
recessive.
25yr old female w/ sudden uniocular vision loss and slightly slurred speech. Hx of weakness and pareshesias that have resolved. Dx?
Multiple Sclerosis
Teenager w/ nephritic
syndrome & hearing loss. Dx?
Alport’s syndrome
Tall thin male teenager w/ abrupt-onset dyspnea & left- sided chest pain. Hyperresonant percussion on the a !ected side & diminished breath sounds. Dx?
Pneumothorax
Young man concerned about
wife’s URIs and inability to
conceive. Also dextrocardia.
What protein?
Dynein (Kartagener’s)
55yr old man who smokes & drinks has cough & flu-like Sx. Gram stain shows nothing. Silver shows gram- neg rods. Dx?
Legionellapneumonia
Pt has stoke after incurring
multiple long bone fractures
in trauma stemming from
MVA. Cause?
Fat emboli.
25yr old woman w/ a low grade fever, rash across nose from sun, widespread edema. Should be concerned about what disease?
SLE
Pathology Vignettes
p222
50yr old man w/ diarrhea, PE
reveals plethoric face and
heart murmur. Dx?
Carcinoid syndrome
Elderly woman w/ a headache
and jaw pain. Elevated ESR.
Dx?
Temporal arteritis.
Pregnant woman @16wks w/
an atypically large abdomen.
Blood test abnormality?
Disorder?
High hCG, hydatidiform mole
80yr old man w/ a systolic
crescendo-decrescendo
murmur. Most likely cause?
Aortic stenosis
Woman of short stature w/
short 4th and 5th
metacarpals. Endocrine
disorder?
Albright’s hereditary
osteodystrophy or
pseudohypoparathyroidism
After stressful event, 30yr old man w/ diarrhea and blood per rectum. Intestinal bx shows transmural inflamm. Dx?
Crohn’s
Young man w' mental deterioration and tremors. Brown pigmentation in a ring around periphery of cornea and altered LFTs. Tx?
Penicillamine for Wilson’s
disease.
Pt w/ fatigue, blood tests
show macrocytic,
megaloblastic anemia. Why
danger to give folate alone?
Masks signs of neural
damage w/ vitamin B12
defi ciency
I~~~
LOVE u~~~!!
10yr old "spaces out" in class (stops talking midsentence and then continues as if nothing had happened). During spells, quivering of lips. Dx?
Absence seizure.
85yr old man w/ knee pain and swelling. X-ray shows increased joint space w/o erosion. Dx? What does aspirate show?
Pseudogout. Rhomboid
calcium pyrophosphate
crystals.
Pathology Vignettes
p223
X-ray shows bilateral hilar
lymphadenopathy. Dx?
Sarcoidosis.
5yr old boy w/ systolic
murmur and a wide, fixed
split S2. Dx?
ASD
Pharmacology Vignettes
p286
28yr old chemist w/ MPTP
exposure. Neurotransmitter
depleted?
Dopamine
Woman taking tetracycline is
photosensitive. Clinical
manifestations?
Rash on sun-exposed regions
of body
Non-diabetic pt has
hypoglycemia but low C-
peptide. Dx?
Surreptitious insulin injection
African-american man who goes to Africa develops a hemolytic anemia after taking malarial prophylaxis. Enzyme defi ciency?
Glucose-6-Phosphate
Dehydrogenase
27yr old female w/ hx of
psych illness now has urinary
retention due to a
neuroleptic. Tx?
Bethanechol
Farmer presents w/ dyspnea,
salivation, miosis, diarrhea,
cramping, blurry vision.
Cause & mechanism?
Insecticide poisioning;
inhibition of AChE
Pt w/ recent kidney transplant is on cyclosporine for immunosuppression. Requires antifungal agent for candidiasis. What antifungal - > cyclosporine toxicity?
Ketoconazole
Man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. Cause?
TCA
55yr old postmenopausal
woman is on tamoxifen
therapy. Risk?
Endometrial carcinoma
Woman on MAO inh has
hypertensive crisis after a
meal. What did she eat?
Tyramine (wine/cheese)
After taking clindamycin, pt
dev toxic megacolon and
diarrhea. Mechanism?
Clostridium
diffcileovergrowth
hug~~
kiss~~~
Pharmacology Vignettes
p287
Man starts meds for
hyperlipidemia. Then rash,
pruritus, and upset GI. Drug?
Niacin
Pt on carbamazepine. What
routine workup should always
be done?
LFTs
23yr old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?
Rifampin augments estrogen
metabolism in the liver,
rendering it less e ! ective.
Pt develops cough and must
discontinue captopril. What is
a good replacement? Why not
same side e ! ects?
Losartan, an angiotensin II
receptor antagonist, does not
increase bradykinin as
captopril does.
