Vignettes - Micro, Path and Pharm -sidebyside

Question 1

An alcoholic vomits gastric contents and has foul smelling sputum. What organisms are most likely?

Answer 1

Anaerobes

Question 2

Middle-age man has acute monoarticular joint pain and bilateral Bell’s palsy. What disease and how?

Answer 2

Lyme, Ixodes tick

Question 3

Pt with Mycoplasma pneumoniae, cryoagglutinins. What Ig types?

Answer 3

IgM

Question 4

U/A with WBC casts. Dx?

Answer 4

Pyelonephritis

Question 5

Young child with tetany, candidiasis, hypocalcemia, and immunosuppression.
What cell is deficient?

Answer 5

Tcell (DiGeorge)

Question 6

Pt with “rose gardener’s” (thorn prick, ulcers along lymph drainage). What bug?

Answer 6

Sporothrix schenckii

Question 7

25yr old med student has “burning” gut after meals. Gram negative rods in Bx. What organism?

Answer 7

H. pylori

Question 8

32yr old man w/ “caulifl ower” skin lesions. Bx shows broad-based budding yeasts.
Organism?

Answer 8

Blastomyces

Question 9

Breast feeding woman w/ redness & swelling of right breast. Fluctuant mass. Dx?

Answer 9

Mastitis by S. aureus

Question 10

Young child w/ recurrent lung infxns & granulomatous lesions. What defect in
neutrophils?

Answer 10

NADPH oxidase (chronic granulomatous disease)

Question 11

20yr old college student w/ lymphadenopathy, fever, hepatosplenomegaly. Serum agglutinates sheep RBCs. What cell infected?

Answer 11

B-cell (EBV; infectious mononucleosis)

Question 12

1hr after eating custard at a picnic, whole family vomits. After 10hrs all better. Organism?

Answer 12

S. aureus(produces preformed enterotoxin)

Question 13

Infant eats honey -> flaccid. Organism? Mechanism?

Answer 13

Clostridium botulinum; inhibited release of Ach

Question 14

Man w/ squamous cell carcinoma, penis. what virus?

Answer 14

HPV

Question 15

Pt w/ endocarditis 3wks after prosthetic heart valve. Organism?

Answer 15

S. aureus or S. epidermis

Question 16

Woman w/ previous C-section has scar in lower uterus close to opening of the os. Risk for what?

Answer 16

Placenta previa

Question 17

35yr old man w/ hi BP in arms. Low in legs. Dx?

Answer 17

Coarctation of Aorta

Question 18

Woman w/ diffuse goiter and hyperthyroidism. Values of TSH and thyroid hormones?

Answer 18

Low TSH, and high thyroid hormones

Question 19

Pt w/ extended expiratory phase. Disease process?

Answer 19

Obstructive Lung Disease

Question 20

Woman w/ headache, visual disturbance, galactorrhea, amenorrhea. Dx?

Answer 20

Prolactinoma

Question 21

Baby has foul smelling stool and recurrent pulmonary infxns. Dx? Test to confirm?

Answer 21

Cystic fi brosis. Chloride sweat test.

Question 22

mua~!

Answer 22

^3^

Question 23

Obese woman w/ hirsutism and high serum testosterone.

Dx?

Answer 23

Polycyctic ovarian syndrome

Question 24

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?

Answer 24

Gouty arthritis

Question 25

48yr old female w/ progressive lethargy and | extreme sensitivity to cold temp. Dx?

Answer 25

Hypothyroidism

Question 26

Pt w/ elevated serum cortisol levels undergoes dexamethasone supp. test. 1mg doesn't lower cortisol. 8mgs does. Dx?

Answer 26

Pituitary tumor.

Question 27

During a football game, player collapses/dies | immediately. Likely Cardiac disease?

Answer 27

Hypertrophic cardiomyopathy

Question 28

Child anemic since birth. Splenectomy -> increased Hct in what disease.

Answer 28

Spherocytosis

Question 29

43yr old man experiences dizziness/tinnitus. CT shows enlarged internal acoustic meatus. Dx?

Answer 29

Schwannoma

Question 30

Child exhibits weakness and enlarges calves. Disease? How inherited?

Answer 30

Duchenne's muscular dystrophy, X-linked | recessive.

Question 31

25yr old female w/ sudden uniocular vision loss and slightly slurred speech. Hx of weakness and pareshesias that have resolved. Dx?

Answer 31

Multiple Sclerosis

Question 32

Teenager w/ nephritic syndrome & hearing loss. Dx?

Answer 32

Alport's syndrome

Question 33

Tall thin male teenager w/ abrupt-onset dyspnea & left-sided chest pain. Hyperresonant percussion on the a !ected side & diminished breath sounds. Dx?

Answer 33

Pneumothorax

Question 34

Young man concerned about wife's URIs and inability to conceive. Also dextrocardia. What protein?

Answer 34

Dynein (Kartagener's)

Question 35

55yr old man who smokes & drinks has cough & flu-like Sx. Gram stain shows nothing. Silver shows gram-neg rods. Dx?

Answer 35

Legionellapneumonia

Question 36

Pt has stoke after incurring multiple long bone fractures in trauma stemming from MVA. Cause?

Answer 36

Fat emboli.

Question 37

25yr old woman w/ a low grade fever, rash across nose from sun, widespread edema. Should be concerned about what disease?

Answer 37

SLE

Question 38

50yr old man w/ diarrhea, PE reveals plethoric face and heart murmur. Dx?

Answer 38

Carcinoid syndrome

Question 39

Elderly woman w/ a headache and jaw pain. Elevated ESR. Dx?

Answer 39

Temporal arteritis.

Question 40

Pregnant woman @16wks w/ an atypically large abdomen. Blood test abnormality? Disorder?

Answer 40

High hCG, hydatidiform mole

Question 41

80yr old man w/ a systolic crescendo-decrescendo murmur. Most likely cause?

Answer 41

Aortic stenosis

Question 42

Woman of short stature w/ short 4th and 5th | metacarpals. Endocrine disorder?

Answer 42

Albright's hereditary osteodystrophy or | pseudohypoparathyroidism

Question 43

After stressful event, 30yr old man w/ diarrhea and blood per rectum. Intestinal bx shows transmural inflamm. Dx?

Answer 43

Crohn's

Question 44

Young man w' mental deterioration and tremors. Brown pigmentation in a ring around periphery of cornea and altered LFTs. Tx?

Answer 44

Penicillamine for Wilson's disease.

Question 45

Pt w/ fatigue, blood tests show macrocytic, | megaloblastic anemia. Why danger to give folate alone?

Answer 45

Masks signs of neural damage w/ vitamin B12 | deficiency

Question 46

I~~~

Answer 46

LOVE u~~~!!

Question 47

10yr old "spaces out" in class (stops talking midsentence and then continues as if nothing had happened). During spells, quivering of lips. Dx?

Answer 47

Absence seizure.

Question 48

85yr old man w/ knee pain and swelling. X-ray shows increased joint space w/o erosion. Dx? What does aspirate show?

Answer 48

Pseudogout. Rhomboid calcium pyrophosphate crystals.

Question 49

X-ray shows bilateral hilar lymphadenopathy. Dx?

Answer 49

Sarcoidosis.

Question 50

5yr old boy w/ systolic murmur and a wide, fixed split S2. Dx?

Answer 50

ASD

Question 51

28yr old chemist w/ MPTP exposure. Neurotransmitter depleted?

Answer 51

Dopamine

Question 52

Woman taking tetracycline is photosensitive. Clinical manifestations?

Answer 52

Rash on sun-exposed regions of body

Question 53

Non-diabetic pt has hypoglycemia but low C- | peptide. Dx?

Answer 53

Surreptitious insulin injection

Question 54

African-american man who goes to Africa develops a hemolytic anemia after taking malarial prophylaxis. Enzyme deficiency?

Answer 54

Glucose-6-Phosphate Dehydrogenase

Question 55

27yr old female w/ hx of psych illness now has urinary retention due to a neuroleptic. Tx?

Answer 55

Bethanechol

Question 56

Farmer presents w/ dyspnea, salivation, miosis, diarrhea, cramping, blurry vision. Cause & mechanism?

Answer 56

Insecticide poisioning; inhibition of AChE

Question 57

Pt w/ recent kidney transplant is on cyclosporine for immunosuppression. Requires antifungal agent for candidiasis. What antifungal -> cyclosporine toxicity?

Answer 57

Ketoconazole

Question 58

Man on several meds including antidepressants and antihypertensives, has mydriasis and becomes constipated. Cause?

Answer 58

TCA

Question 59

55yr old postmenopausal woman is on tamoxifen therapy. Risk?

Answer 59

Endometrial carcinoma

Question 60

Woman on MAO inh has hypertensive crisis after a meal. What did she eat?

Answer 60

Tyramine (wine/cheese)

Question 61

After taking clindamycin, pt dev toxic megacolon and diarrhea. Mechanism?

Answer 61

Clostridium diffcile overgrowth

Question 62

hug~~

Answer 62

kiss~~~

Question 63

Man starts meds for hyperlipidemia. Then rash, pruritus, and upset GI. Drug?

Answer 63

Niacin

Question 64

Pt on carbamazepine. What routine workup should always be done?

Answer 64

LFTs

Question 65

23yr old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?

Answer 65

Rifampin augments estrogen metabolism in the liver, rendering it less effective.

Question 66

Pt develops cough and must discontinue captopril. What is a good replacement? Why not same side effects?

Answer 66

Losartan, an angiotensin II receptor antagonist, does not increase bradykinin as captopril does.