Exam 2 Case Studies Flashcards
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?
Rapid influenza diagnostic test (RIDTs)
Zanamivir (Relenza)
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?
HSV1
Culture, PCR, Tzank smear
Oral antiviral(any of the 3), Zovirax, Docosanol
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?
Shingles
IV acyclovir + topical steroids
Zoster vaccine(RZV or shingrix)
Mainly to prevent post-herpetic neuralgia
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?
EBV, rash developed after taking ampicillin for endocarditis.
Fluids and antipyretics
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?
CMV
Ganciclovir, valganciclovir, foscarnet
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?
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.
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?
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.
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?
OC
Nystatin
Clotrimazole
Miconazole
Fluconazole
Gentian violet
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?
EC
Endoscopy
Fluconazole (IV)
If resistant, Voriconazole, posaconazole, or echinocandin
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?
VC
Ibrexafungerp, Gentian violet, boric acid
Probiotics(but questionable benefit)
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?
Candidal Intertrigo
Topical azoles or nystatin
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?
Histoplasmosis
CXR: mediastinal lan and fibrosis of the mediastinum
Itrazconazole + rituximab + corticosteroids
Surgical intervention
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?
Coccidioidomycosis
Bronchoscopy with biopsy and culture
Fluconazole or itrazonazole
Voriconazole or posiocnazole if refractory
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?
Blastomycosis
CBC: elevated WBCs and anemic values
Amphotericin B
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?
Cryptococcosis
IV amphotericin B + flucytosine for 2 weeks
then 8 weeks of fluconazole
LP or CSF shunting to relieve CSF pressure
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?
Pneumocystosis
Bactrim 14-21 days
(But google says you can culture it now)
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?
Rubeola/measles
Post-exposure vaccination if within 72hours
Increased fluid intake
Acetaminophen (NO ASA)
Abx for complications of bacterial infection
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?
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
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?
Rubella
Hyperimmune Globulin
The child can develop microcephaly, cataracts, and cardiac defects.
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?
5th disease/Erythema Infectiosum
IgM specific antibodies to parvovirus B19
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?
Roseola
Could develop meningitis, encephalitis, leukopenia, thrombocytopenia, hepatitis
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?
Varicella
Calamine lotion/oatmeal baths
Trim nails
Acetaminophen
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?
HFMD
No treatment only supportive
Topical oral anesthetic
OTC pain meds
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?
Entamoeba histolytica
Metronidazole(10days) or Tinidazole(3days)
then Paramomycin for 7 days
