All Questions 1-200 Flashcards
(200 cards)
1
Q
2yo M with recurrent infections and eczema. Workup reveals thrombocytopenia.
A
Wiscott Aldrich. X-linked.
2
Q
70yo white M with easy bruising, visual disturbance, and elevated IgM
A
Waldenstrom’s macroglobulinemia
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
4
Q
23yo HIV positive F recently started SMX-TMP with rash, confusion, fever, anemia, thrombocytopenia, tachycardia.
A
TTP
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.)
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.
7
Q
12yo M with bony-hard swelling above knee.
A
Osteosarcoma
8
Q
53yo M with painless lumps in neck, fever, weight loss.
A
Non-Hodgkin’s lymphoma
9
Q
54yo M with fatigue, splenomegaly, anemia, and ‘dry tap’ on bone marrow biopsy
A
Myelofibrosis with myeloid dysplasia
10
Q
64yo black M with bone pain, fatigue, and recurrent URIs
A
Multiple myeloma
11
Q
24yo M with painless lump in neck and CXR with hilar masses.
A
Hodgkin’s.
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.
13
Q
21yo F with sudden onset bruisability, edema, and rash following diarrheal illness. Low platelet count.
A
HUS
14
Q
61yo M with mycobacterium avium infection, splenomegaly, and leukocytes with cytoplasmic projections seen on CBC.
A
Hairy cell leukemia (B cell)
15
Q
45yo M with fever, rash, diarrhea, and jaundice. Elevated IgE level and history of leukemia.
A
Graft-versus-host
16
Q
45yo M with frank rigors 1hr following blood transfusion.
A
Febrile nonhemolytic transfusion rxn
17
Q
25yo F with continued bleeding following delivery.
A
DIC
18
Q
55yo M with no complaints, found on physical exam to have splenomegaly and leukocytosis.
A
CML
19
Q
65yo M with lymphadenopathy, hepatosplenomegaly, and leukocytosis with smudge cells.
A
CLL
20
Q
66yo M with CLL has urine that gets darker during the day.
A
autoimmune hemolytic anemia
21
Q
18yo M with pallor, petechiae, and recurrent URIs
A
aplastic anemia
22
Q
25yo F with recent infection, gingival hyperplasia, and leukocytosis with bone marrow expansion.
A
AML
23
Q
43yo M with epigastric pain and diarrhea refractory to medical management.
A
ZE syndrome
24
Q
40yo F with intellectual impairment, jaundice, and choreiform movements.
A
Wilson’s
25
37yo M with acute pain in anorectal area and BRBPR for 4 months.
thrombosed ext. hemorrhoid
26
45yo F with pruritus, fatigue, and jaundice.
PBC
27
33yo M with four months epigastric pain radiating to back relieved by eating and leaning forward.
posterior duodenal ulcer
28
36yo F with difficulty swallowing and craving for ice. Physical exam reveals angular stomatitis and glossitis.
Plummer-Vinson syndrome.
29
24yo F with crampy abdominal pain and dark spots on lips.
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.
30
51yo M with 4 months pruritus, jaundice, and abdominal pain. Recent 15 pound wt loss.
pancreatic CA (CEA, CA19-9)
31
65yo M with abdominal pain, nausea, vomiting, and diarrhea. Has been suffering abd. Pain 30 min after eating.
ischemic bowel
32
50yo M with EtOH cirrhosis develops oliguria and abdominal distenstion.
hepatorenal
33
65yo M alcoholic with RUQ pain, jaundice, anorexia, and distention worsening over two months.
hepatocellular carcinoma
34
40yo M with increased pigmentation. PE reveals cardiomegaly. UA reveals glycosuria.
hemochromatosis (cirrhosis, bronze diabetes, heart failure)
35
24yo F found on dental checkup to have supernumerary teeth. Has father with history of colon polyps and
Gardener's syndrome.
36
44yo M with hematemesis and melena. Has had recurrent painless hematemesis for several years.
gastric leiomyoma (#1 benign tumor of stomach)
37
83yo M with epigastric pain, anorexia, and frequent vomiting. Guaic positive stools. Palpable mass over L shoulder.
gastric CA (atrophic gastritis, pernicious anemia, ulcers, type A blood = risk; Krukenberg tumor = retro peritoneal spread to ovaries.
38
68yo F smoker with dysphagia.
esophageal CA (squamous > adeno in distal third)
39
54yo F with colicky LLQ pain and bloody stools that have returned intermittently over several months.
diverticulitis
40
45yo M with recurrent epigastric pain that radiates to back and foul-smelling stools.
chronic pancreatitis (alcoholism, cystic fibrosis)
41
25yo F with diarrhea, foul smelling stools, pruritus, dry skin, and bruising.
celiac disease (anti-gliadin Ab, nutrient malabsorption)
42
67yo F with several months fatigue, weight loss, intermittent diarrhea with palpable RLQ mass.
cecal CA (anemia and + guaic test + virchow's node)
43
52yo M with diarrhea and facial flush.
carcinoid = primary GI tumors arise from neuroendocrine cells "Kulchitsky cells" and secrete 5-HT, histamine, gastrin, and prostaglandins. Malignant or benign.
44
45yo M with AIDS now with painful swallowing.
candida esophagitis (candida, rx with oral fluconazole)
45
34yo M with mediepigastric pain, periumbilical/flank bruising, and hypotension.
acute pancreatitis (Cullen's / Grey Turner's sign, assoc. with gallstones and alcohol)
46
33yo F with substernal pain and difficulty swallowing. Sometimes regurgitates food.
achalasia (loss of ganglion cells in Auerbach's plexus). Esophageal CA risk. Can arise from Chagas disease (also with cardiomyopathy).
47
50yo F with cold nodule in the neck. Normal TSH, T3 and T4.
thyroid CA (risk = ionizing rad - papillary CA c best prognosis, also follicular, mixed, and medullary assoc c MENIIa and IIb) psammoma bodies on FNA.
48
30yo F with weight loss, 2yrs amenorrhea following delivery of healthy baby.
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)
49
33yo F with menstrual irregularity and milky nipple discharge.
prolactinoma (most common pituitary adenoma; GnRH suppressed by excessive prolactin, reduces LH and estradiol. In males = HA, impotence, visual disturbance.
50
56yo F with flank pain, confusion, constipation, thirst and polyuria.
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.
51
42yo F with hypertension, weakness, and decreased urinary volume.
Conn's (hypokalemia, hypernatremia, hypertension, increased urinary aldosterone, low plasma renin). Usually adrenal cortex adenoma, sometimes adrenal cortical hyperplasia.
52
53yo F with fatigue, insomnia, depresison. Thinning of skin, hirsutism, vaginal atrophy.
menopause (hot flashes, vaginal atrophy, osteoporosis). Post-menopausal bleeding gets biopsy to r/o endometrial cancer.
53
48yo F with weakness, lethargy, cold intolerance.
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
54
46yo M with impotence, fatigue and decreased peripheral vision. Is also hypotensive.
hypopituitarism: Low FSH, LH, TSH, ACTH. Most common cause adenoma compressing anterior pituitary.
55
29yo F with seizure. Has history of thyroid surgery two years ago.
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.
56
24yo F with weight loss despite good appetite, anxiety, menstrual irregularity, and tremors.
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.
57
45yo F with anterior neck fatigue, history of RA, and cold intolerance.
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.
58
55yo M with obesity, thirst, and excessive appetite.
DM2. Can develop nonketotic hyperosmoler coma but not DKA.
59
44yo F with irritability, easy bruising, weight gain, and glucosuria.
Cushing's (truncal obesity, moon facies, buffalo hump, hirsutism. Elevated plasma cortisol with high ACTH, hypokalemia, leukopenia, osteoporosis, adrenocortical hyperplasia and pituitary adenoma.
60
60yo M with rash composed of red plaques with scaling and nodules. Has not responded to steroid rx.
Mycosis fungoides. Malignant cutaneous helper T-cell lymphoma; disseminated disease with exfoliative dermatitis and lymphadenopathy = Sezary syndrome. "Red man's disease". CBC shows lymphocytosis.
61
68yo outdoor construction worker, raised bleeding lesion over upper lip.
basal cell carcinoma. Most common skin cancer. Light-skinned people. Sun-exposed areas, slow growing, metastatic disease rare. Increased incidence in xeroderma pigmentosum.
62
60yo farmer with skin lesions on forehead, upper lip, dorsum of hands. Scaly rough plaques.
actinic keratosis. Most common precancerous dermatosis --> squamous cell CA. Signs that preceed malignancy include elevation, ulceration, inflammation, and enlargement >1 cm.
63
35yo M with cramping in calves with walking, smokes 3 ppd. PE reveals pallor and cyanosis of distal extremities.
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.
64
79yo F with unilateral HA, jaw pain, visual disturbance in ipsilateral eye.
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.
65
50yo M with palpitations and CP. Has had multiple sexual partners. Has diastolic murmur.
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.
66
30yo F with HTN and elevated plasma renin.
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.
67
34yo F in 27th week of pregnancy with dyspnea and orthopnea. History of recurrent strep pharyngitis as child.
Mitral stenosis. Opening snap and mid-diastolic murmur at apex. +/- LVH and a-fib.
68
37yo M with fatigue and dyspnea with exertion. Pansystolic murmur at the apex with radiation to the axilla.
Mitral insufficiency. Common causes: mitral valve prolapase, ischemic papillary muscle, endocarditis, rheumatic. S3 may be present.
69
42yo M with CP, headache and confusion. Has history of HTN.
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.
70
21yo M with DOE and an episode of syncope while playing tennis.
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.
71
29yo F recently delivered baby, now with dyspnea and pedal edema.
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.
72
60yo M with COPD with severe dyspnea at rest, bulging neck veins, and peripheral edema.
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.
73
24yo M with angina, DOE, occasional fainting, and systolic ejection murmur to right of sternum.
aortic stenosis. Crescendo-decrescendo SEM, paradoxical splitting. Causes include congenital bicuspid valve, degenerative calcification, rheumatic.
74
31yo M with ankylosing spondylitis develops severe SOB.
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.
75
35yo M with nonproductive cough and chest pain worse with inspiration, relieved by sitting up.
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.
76
25yo F with myalgias and low-grade fevers starting one week after a dental extraction.
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.
77
25yo M with SOB and ankle edema following severe URI.
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.
78
35yo M develops pruritus and blistering rash over shins following camping trip.
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.
79
5yo M with yellow crusty lesions behind the ear and around the mouth.
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.
80
30yo homosexual M with skin eruption on upper limbs, trunk, anogenital areas.
molluscum contagiousum. Poxvirus. Opportunistic AIDS infection. Painless, pearly-white, dome-shaped, waxy, umbilicated nodules, 2-5mm, palms and soles not affected.
81
16yo M with headache, fever, and rash on the palms and soles. Recent camping in North Carolina. UA demonstrates proteinuria and hematuria.
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
24yo F with extensive denuding of skin and recent skin infection.
Scalded skin syndrome. Vesicle fluid is sterile. S. aureus on blood culture. Rx IV methicillin or oxacillin. Phage group 2 staph exotoxin.
83
30yo M with bilateral circular red eruption in the groin.
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
28yo M treated for UTI develops raised, red, pruritic rash over trunk and limbs.
urticaria. wheal and flare rxn, "hives". Rx: stop causative agent, H1/2 blockers, calamine lotion, corticosteroids.
85
11yo M with jaundice, dark urine, and recent shellfish ingestion.
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
25yo M with jaundice following needle stick two months ago.
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
30yo M intermittent jaundice for two years following a motorcycle accident.
HCV. Percutaneous transmission = 90% of cases. >50% progress to chronic, leading to cirrhosis in 20%. PCR test.
88
50yo alcoholic with fever, abdominal pain, and progressive distention of abdomen.
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
56yo M with diarrhea for 2 months, arthritis, and weight loss.
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
19yo F with recurrent episodes of periorbital swelling and dyspnea lasting up to 24hrs.
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
3yo M with albinism and recurrent infections with recurrent staph and strep infections.
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
2yo M with recurrent fungal and staph furunculosis and neutrophilic leukocytosis.
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
25yo F with recurrent sinusitis, multiple allergies, watery diarrhea, and hypopigmented skin lesions.
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
7 month M recurrent URIs, skin infections, and asymetric arthritis of the kness. No tonsillar tissue on exam.
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
15yo M with thick yellow discharge that prevents eye-opening in the morning.
Conjunctivitis. Rx topical AB drops. Usually viral = adenovirus. Self-limiting. Secondary staph/strep may result.
96
8yo F with rash, diffuse joint pain, fever, and sore throat two weeks ago.
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
35yo F with pain in upper teeth and face, nasal congestion and discharge.
sinusitis. boggy nasal mucosa. Common pathogens = S. pneumo, other streptococci, H. flu, Moraxella. Rx amoxicillin or TMP-SMX, decongestants.
98
48yo missionary returns from West Africa with lethargy, nuchal rigidity, HA, drowsiness.
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
45yo M Peace Corps in Mexico with spiking fever, RUQ pain, and bloody diarrhea with mucus. Tender hepatomegaly on exam.
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
30yo sheep farmer with dyspnea, nonproductive cough, and black skin lesions.
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
38yo M on chemotherapy with pleuritic chest pain, fever, and productive cough.
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
25yo M c sudden onset double vision, dry mouth, weakness, dysarthria, and dysphagia. Ate some home-canned peaches the night before.
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
28yo M with hip pain, undulating fever for two months, and pain in testicle. Drinks unpasteurized milk.
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
49yo obese, diabetic F with pruritus underneath her breasts.
candidiasis. Denuded, beefy red areas with whitish curd-like material. Budding cells with short hyphae on KOH prep. Rx clotrimazole, keep area dry.
105
24yo F with fever and swelling over eye after trip to Brazil.
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
30yo M with profuse watery diarrhea, vomiting, and abdominal pain following trip to India.
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
19yo Arizona migrant worker with cough, pleuritic CP, fever and tender nodules over the both shins.
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
30yo M with AIDS presents with profuse, nonbloody diarrhea.
Cryptosporidium parvum. Dehydration. Acid-fast stain --> oocyts in fresh stool. Rx is supportive only. Self-limiting in immunocompetent pts.
109
13yo F s/p BMT on immunosuppresion now with fever, dyspnea, dry cough.
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
5yo M with fever, cervical lymphadenopathy, and grey membrane on tonsils.
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
56yo veterinarian with sudden high fever, jaundice, and RUQ pain.
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
36yo woman with AIDS and pneumonia develops spiking fever, chills, and delirium.
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
28yo Guatamalan refugee with severe headache, fever, and rash on trunk and extremities; palms and soles spared. Spent time in refugee camp.
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
21 yo F with low-grade fever, pain and swelling over left knee, and dysuria.
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
19yo M with burning urination and greenish-yellow purulent discharge.
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
25yo M with painful skin rash in the perianal area.
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
27yo F with two months fever, mouth ulcers, fatigue, and weight loss. Started new job on farm in Ohio.
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
37yo M black male from the Caribbean with swollen glands in armpits and groin, feeling of heavyness in abdomen.
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
20yo M with sore throat, lymphadenopathy, and malaise.
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
40yo M smoker with high fever, nonproductive cough, pleuritic CP, and coworkers with similar symptoms.
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
30yo Pakistani immigrant with history of red papule on arm following insect bite; now with chronic fever, skin darkening, and massive splenomegaly.
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
26yo M from India with hypopigmented anesthetic skin patch on face and swelling in elbow in area of ulner nerve.
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
12yo M with fatigue, joint pain, and rash.
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
25yo with tender masses and painful groin ulcers after unprotected sex.
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
30yo missionary with high fever, chills, and severe HA after returning from Africa 1 wk ago.
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
12yo F with fever, severe HA, and stiff neck who fainted at school.
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
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.
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
20yo M college student with productive cough, malaise, and fever. Cough started out nonproductive.
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
45yo M undergoing chemotherapy for Hodgkin's now with SOB/cyanosis; has had greenish sputum for 3 months.
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
56yo F with visual acuity change, generalized itching after showering, and recent travel to tropics.
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
28yo diabetic with immobility of knee, swelling, tenderness, and elevated ESR.
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
18 month F with irritability and ear discharge. Recurrent URIs.
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
25yo M bitten by a cat with shiny, edematous tender hand draining purulent fluid.
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
14yo M bitten by younger sister with shiny, edematous, tender hand draining fluid.
Eikenella corrodens. Rx: PCN + I&D.
135
44yo archaeologist returns from dig site in Arizona with high fever, severe myalgia, and painful inguinal swelling.
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
11yo M with blood-tinged, mucoid sputum and pleuritic chest pain.
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
32yo HIV + M with progressive dyspnea over 3 wks.
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
14yo M Russian immigrant with weight loss, fever, night sweats and bloody sputum.
TB. Primary = lower lobes / subpleural. Secondary = cavity lesions in upper lobes. Rx: RIPE therapy = rifampin, isoniazid, pyrazinamide, ethambucil.
139
28yo M with numbness of R arm following bat bite. Refuses to drink water.
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
27yo Peace Corps volunteer in Africa with fever, sweats, abdominal pain. Had an itchy rash after swimming several weeks ago.
Schistosomiasis. CBC: eosinophilia. Rx: praziquantel. Snail-infested ponds/lakes. Hepatosplenomegaly d/t portal hypertension d/t granulomas = periportal fibrosis.
141
36yo M executive with sudden nausea, vomiting, and diarrhea with blood and mucus after business trip to South America.
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
37yo with ulcerated nodule on hand after trauma while doing yardwork.
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
9yo M with odynophagia and erythematous tonsils with white exudate.
Strep pharyngitis. Rx: oral penicillin V. Streptococcus pyogenes. Complications include glomerulonephritis and rheumatic fever.
144
38yo diplomat in Nigeria with diarrhea, fever, dry cough, and dyspnea. Frequently walks barefoot through his neighborhood.
Strongyloidiasis. Eosinophilia with motile rhabditiform larvae. Rx: thiabendazole or ivermectin. Results from poor hygeine in tropics. CXR: bilateral transient migratory infiltrates.
145
54yo F with spiking fever, loss of appetite, and RUQ pain who underwent emergency cholecystectomy 10d ago.
Subdiaphragmatic abscess. Rx: percutaneous drainage. Findings include pain on percussion, left-shift, fluid collection below diaphragm. Occurs typically >1wk after abdominal surgery.
146
18yo M with painless ulcer on penis.
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
23yo F with nonpruritic skin rash, hair loss, and copper-colored maculopapular rash on palms and soles.
Secondary syphilis = generalized tender lymphadenopathy, rash on palms/soles, coalescent papules/plaques in groin = condyloma lata, hair loss = alopecia. Rx: IV benzathine PCN.
148
12yo M with dysphagia. Stepped on a nail about a week ago.
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
40yo HIV + M with severe HA. Has 2 cats at home.
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
50yo M with generalized myalgia and low-grade fever. Had severe abdominal pain and diarrhea several weeks ago after eating at a pigroast.
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
20yo M with ulcer on wrist, lymphadenopthy in ispilateral axilla with suppuration. Recently trapped and disposed of rabbit on his property.
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
27yo M with increasing fever, constipation, and faint erythematous macules over the trunk. Visited Southeast Asia three weeks ago.
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
5yo M with pruritic rash on scalp, face and trunk.
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
45yo HIV+ M with painful, burning skin rash on left side of chest.
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
24yo South American male develops high fever. He develops yellow eyes, and coffee-ground emesis four days later.
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
50yo M with sudden fever, chills, neck stiffness.
Bacterial meningitis. S. pneumoniae = most common adult. Photophobia, obtundation. Tap = high pressure, cloudy, high protein, very low glucose, high cells mostly WBCs.
157
33yo HIV+ M with persistent HA.
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
30yo HIV+ M with rapidly progressive visual loss.
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
45yo hog farmer with visual loss, severe HA, and projectile vomiting.
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
54yo man with ataxia, MS changes, deformed ankles, and shooting pain in extremities.
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
25yo F with dysuria, frequency, and hematuria after her honeymoon.
Acute cystitis. E. coli > Proteus, Klebsiella, Staph. saprophyticus, and Enterococcus. Hemorrhagic cystitis may also result from adenovirusinfection.
162
28yo F in 27th week of pregnancy with R flank pain, fever, and dysuria.
Acute pyelonephritis. UA: proteinuria, WBC casts, >100,000 cfu E. coli. Rx by sensitivity, ampicillin empirically. E. coli, Klebsiella, Proteus, and Enterobacter.
163
19yo M with painful urination and yellow-green urethral discharge. No bacteria seen on Gram stain.
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
15yo M with painful bilateral parotid swelling and left-sided scrotal pain.
Orchitis. Mumps, E.coli, enterobacteria, chlamydia, gonnorhea, mycobacterium tuberculosis. May cause sterility if bilateral. Rx: scrotal support, ice packs, steroids. CBC: lymphocytosis, hyperamylasemia.
165
25yo F with burning on urination.
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
34yo M with multiple myeloma develops reticular skin infarction, necrosis, and ulceration.
Cryoglobulinaemia. Associated with paraproteinemias, RA, SLE, mononucleosis, lymphoma, PBC, and HCV. Small vessel vasculitis that may involve kidneys = renal failure. Rx: plasmapheresis.
167
54yo F with RA develops Bence Jones proteinuria.
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
78yo M with fever, anemia, fatigue, petechiae and recent lacunar stroke.
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
55yo M with anemia, leukopenia, thrombocytopenia and bone pain.
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
19yo M with recurrent DVTs for one year.
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
24yo M with recurrent DVTs. Family history of DVTs affecting mother and sister.
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
23yo M bitten by snake now with purpuric skin lesions.
DIC. Causes include meningococcal, snakebite, staph septicemia, obstetric, malignancy (bronchus, pancreas, ovary, prostate, leukemias), shock, massive transfusion, vasculitis (HUS/TTP), bypass, cavernous hemangiomas.
173
16yo M with massive hematomas and no history of trauma.
Differential includes: Christmas dx, von Willebrand's, hemophilia, or uncontrolled anticoagulation.
174
15yo M with acute hot, red, swollen knee and easy bruising.
Hemophilia. Prolonged aPTT, normal PT. Rx: factor VIII replacement. X-linked recessive.
175
13yo M with recurrent bleeding episodes and normal factor VIII levels and activity assay.
Christmas disease. Factor IX deficiency. Complications of both include: chronic degenerative joint dx, compression neuropathy, renal pelvic / ureteral obstruction, intestinal obstruction.
176
53yo homeless man with bleeding gums, purpura, and perifollicular bleeding.
Scurvy = vitamin C deficiency.
177
6yo F with generalized skin rash following mild URI. Rash became purpuric after one day.
HSP. Drugs, food, insect bites, infections. Purpura +/- glomerulonephritis. Immune complex deposition. Children > adults. Glomerulonephritis in 33%.
178
14yo with recurrent epistaxis and multiple small red lesions on lips, mouth, tongue. Mother and uncle have similar condition.
Hereditary hemorrhagic telangiectasias = Osler-Weber-Rendu. Autosomal dominant. Mucosal bleeding. Association with pulmonary AV fistula.
179
9yo F with recurrent URIs, diarrhea, and failure to thrive.`
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
23yo M with chronic productive cough and wife with difficulty becoming pregnant. Apical impulse not present on L side.
Kartagener's syndrome. Sperm immotility, bronchiectasis. Dynein defect leads to immotile cilia. Autosomal recessive. Dextrocardia.
181
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.
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
26yo M with flat nose, and single palmar crease. Had silver spots on iris at birth.
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
7yo boy with diminished visual acuity and long arms, legs, and fingers.
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
17yo F with amenorrhea, lack of breast development, and harsh systolic murmur.
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
5yo Asian F with sudden eye pain and loss of vision after watching a film. Reports seeing halos around lights at night.
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
49yo M with progressive weakness, difficulty speaking, and fasciculations.
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
40yo M, now unresponsive, found in bathroom at work projectile vomiting. Said he was "seeing double".
Cerebral aneurysm. Papilledema, CNIII palsy. Congenital Berry aneurysms associated with polycystic kidney disease, AV malformation. Cause subarachnoid hemmorhage. ACOMM > PCOMM > POST CEREBRAL.
188
14yo M with short stature, history of polyuria, and peripheral vision loss.
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
62yo M with rapidly progressing decline in cognitive function, somnolence, and clonus on exam.
Creutzfeld-Jakob. Subacute spongiform encephalopathy. Risk = dura mater, corneal transplants, cadaveric growth hormone, neurosurgical contamination. Lithium OD may mimic presentation.
190
19yo F horseback rider was thrown off horse. Lost consciousness then recovered. Now with HA, confusion, and weakness of left side with projectile vomiting.
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
19yo M with wide-based gait, clubfoot, and lateral curvature of spine.
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
60yo M with HA worse in morning, nausea, and vomiting for six weeks.
Glioblastoma multiforme. CT = irregular enhancing left-sided mass with necrotic center; mass effect and surrounding edema.
193
38yo M with symmetric muscle weakness started in feet, now involving legs and shoulders. Had diarrhea and fever.
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
65yo M with sudden severe HA and hemiplegia. Now incontinent.
Hypertensive stroke.
195
59yo F with retro-orbital HA and diplopia. Diagnosed with lung cancer.
Metastatic dx. Intracranial mets from lung, breast, GI, GU, CA, and melanoma.
196
25yo with weakness, droopy eyelids, double vision, and dysphonia.
Myastenia gravis. Autoimmune c Abs to acetylcholine receptor subunits. Thymoma is present in 20% of cases.
197
46yo M with HAs in the morning, seizures, and CT showing nodular calcifications in a frontal lobe mass.
Oligodendroglioma. Usually low grade, but may be anaplastic. More sensitive to chemo than astrocytomas. Calcification in 90% of cases.
198
30yo M with anesthesia and weakness in both arms, occipital HAs, and stiff gait.
Syringomyelia. MR/CT --> cystic dilatation within central cervical cord. Hydromelia is lined by ependymal tissue, syringomyelia is not.
199
18yo M with wide-based gait and headaches. Father died of renal cell carcinoma at young age.
von Hippel-Lindau. Auto-dom, renal cell CA + renal, hepatic, pancreatic cysts + cerebellar ataxia.
200
49yo alcoholic with confusion, stupor, and nystagmus following 5% dextrose infusion.
Wernicke's encephalopathy. Due to thiamine deficiency.
