You've Got Cooties
What causes Babesia and in what States of the USA is it most commonly found?
Can you name 3 of the most common symptoms the patient would present with?
What would you notice on a blood stain to help confirm your diagnosis?
What should you give to treat this?
What is the ixodes tick.
What is any of the following states: Connecticut, New York, Massachusetts, Rhode Island, New Jersey, Minnesota, and Wisconsin.
Flu like symptoms, fever, chills, fatigue, myalgias, headache, nausea, vomiting, abdominal pain, petechiae, bruising, jaundice, spleenomegaly.
A maltese cross is noted on the blood stain.
Treatment includes; clindamycin and quinine.
A 25 year old male patient is admitted for the management of a severe asthma attack. He has associated symptoms of nausea/vomiting diarrhea. He has been admitted multiple times for asthma and was intubated once 5 years ago. He has been SOB for 2 days. He tried home albuterol, ipratropium nebs and cromolyn therapy but nothing has helped. His peak flow rates are 50% of his norm. Which of the following should be added to his therapy?
A- inhaled beclomethasone
B- Disodium cromoglycate
C- IV hydrocortisone
D- Theophylline
What is IV hydrocortisone.
46 year old female is admitted with complaints of paralysis. During exam her paralysis begins to clear and completely disappears 1 hour later. She reports previous episodes of transient weakness but this was the first time she was unable to move. On exam BP is 165/95, Blood work shows; NA of 155, K+ of 2.7 and decreased serum renin. What is her most likely diagnosis?
A- Conn Syndrome
B- Cushing syndrome
C- Mallory-Weiss syndrome
D- May White syndrome
E- McClure-Albright syndrome
Please describe the incorrect answer syndromes.
What is Conn Syndrome (A)
B- Cushing syndrome is the result of increased gluocorticoid production (cortisol)
C- Mallory- Weiss syndrome is the laceration of the lower esophagus induced by vomiting and associated with ETOH abuse
D- May White syndrome is a form of familial progressive myoclonus epilepsy with lipomas deafness and ataxia
E- McClure Albright syndrome is a form of fibrous dysplasia with pigmented skin patches and endocrine dysfunction.
52 year old male is hospitalized for ganciclovir-resistant cytomegalovirus encephalitis, therapy with foscarnet is initiated, he has advanced aids and does not take antiretroviral meds. He is lethargic and only oriented to person. 100.0F, 102, 14, 136/56. BMI is 17. Sodium increased from 143 to 156 during the first week of hospitalization (he has been receiving NS IV.)
Labs show: BUN 10 to 15, Creat 0.6 to 1.2, glucose 88 to 75, sodium 143-156, urine osmolality 186-190 (normal is 300-900)
After desmopressin urine osmo increases to 614
What is his likely diagnosis>?
A- Central diabetes insipidous
B- Cerebral salt wasting
C- Nephrogenic diabetes insipidous
D- osmotic diuresis
What is A- central diabetes insipidous
32 year old women who is overweight presents with persistent right knee pain, she denies trauma, swelling, fever, rash and general unwellness. She has no medical hx. She leads an active but stressful life as the owner of a women's clothing store. Her knees are symmetrical with no redness or warmth. Distal femur is tender with palpation. ROM is decreased on the right. On the XR there is a lucent lytic lesion over the disease femur. Which is likely her dx?
A- osteoarthritis
B- osteogenic sarcoma
C- erwing's sarcoma
D- Giant cell tumor of bone
E- Chondrosarcoma
What is D.
What is the common name of Strongyoides stercoralis?
Which two states in the USA and which other continent have higher prevalence?
What symptoms would your patient present with?
How is this disease diagnosed?
What is the treatment? If the patient is taking ____ medication, it should be discontinued.
FUN FACT: IF LEFT UNTREATED THE HELMINTHIC ORGANISM THAT CAN REPLICATE IN THE BODY CAN ENTER THE BRAIN AND LUNGS CAUSING PULMONARY DISEASE AND NEUROLOGICAL SYMPTOMS
Roundworm.
Kentucky, Tennessee and Africa
GI symptoms and rash
Stool samples (BAL and CSF)
Ivermectin, Thiabendazole. Immunosupressive medication.
A 66 year old man with a 59 pack/year smoking history comes to ER with worsening SOB and cough. He has also had hemoptysis and his son states he has had increased hoarseness of this voice over the past 3 weeks. There are dense rhonchi to the right mid lung field and scattered soft rhonchi in the other fields. CXR shows 6 cm irregular mass in the right middle lobe with lobar consolidation. Which of the following would suggest that the patient has surgically incurable lung CA?
A- The change in pattern of cough
B- Hemoptysis
C- Increased hoarseness
D- Post obstructive PN
E- Worsening dyspnea
What is increased hoarseness.
63 year old man with hx of IDDM and newly dx CHF is brought into his PMD's office with generalized weakness, sweating and shaking, his finger stick glucose is 48, he improves with glucose administration. What medication did this patient most likely recently start?
A- spironolactone
B- eplerenone
C- losartan
D- atenolol
What is D- atenolol.
66 year old man is evaluated for a 3 year hx of CKD. Med hx is gout and HTN. He is a retired industrial worker in a battery factory. His weight is stable, appetite is good. No hx of drug abuse or smoking. He takes HCTZ, norvasc and allopurinol and no over the counter remedies. VS: 98.4, 128/72, 82, 13, BMI 30. No rashes, no joint swelling or pitting edema.
Bicarb 21
BUN 18
Calcium 6.9
Creat 1.9
Glucose 95
Lead 16 (normal <25)
Phos 3.4
Uric acid 5.8
UA- PH 5.5, trace protein, + glucose, 0 eryth, 1-3 leuks, no ketones, urine protein 0.4
Which of the following is the most appropriate diagnostic test to perform next?
A- Chelation mobilization testing
B- Erythrocyte protoporphyrin measurement
C- Long bone radiography
D- Peripheral blood smear
A- Chelation Mobilization testing
This is used to find and treat arsenic, gold, and mercury poisoning in combo with calcium disodium to treat lead poisoning.
46 yr old female presents for followup after hospitalization for an AMI, she underwent emergency coronary percutaneous intervention which showed 99% occluded LAD coronary artery and 35-40% left vent EF. She received a single stent. Today she feels well, she quit smoking to improve her health. She is sexually active again with her husband and uses contraception occasionally. Vs WNL. Exam is WNL. Which of the following medications is ABSOLUTELY CONTRAINDICATED in women who may become pregnant and why?
A- Clopidogrel
B- Buproprion
C- ASA
D- Metoprolol
E- Lisinopril
What is E- lisonpril
ACE inhibitors are known teratogens linked to renal dysplasia, oligohydramnios, interuterine growth restriction and other CNS/Cardiac malformations.
Identify which mask should be worn in the following cases; influenza vs TB
What is; standard surgical mask vs. N95
50 year old man with a hx of HTN, seizures and ETOH abuse, presents in the ED with a few weeks of productive cough, difficulty breathing, fever and chills. VS; 102.5F, 110 HR, RR 20, 02 sat 90% on RA, BP 110/72. CXR shows cavitary infiltrate with airfluid level in the RUL. What is the diagnosis and what is the treatment?
A- Non-small cell lung CA
B- Aspiration PN
C- Lung absess
D- P.E.
E- Primary Ghon complex
What is C- lung abscess.
The treatment is abx therapy with clindamycin
47 year old man started experiencing fatigue, malaise, followed by 7 lb weight loss over 2 months. He reports watery diarrhea and nausea but no dysphagia or vomiting, vitals WNL, lab work shows; calcium 11.7, phos 2.2, mag 1.6, albumin 3.9, protein 7.4, tsh 3.4 prolactin 262. Fasting glucose 65. CT shows lesion on the head of the pancreas. Blood levels of which of the following hormone are most likely to be DECREASED?
A- Gastrin
B- Insulin
C- PTH
D- Testosterone
E- Vasoactive intestinal peptide
What is D- testosterone.
75 year old female is evaluated during a PMD visit for HTN. She has a 54 pack per year hx of smoking. She quit 5 years ago after having a TIA. She is adherent to her medications which consist of a beta blocker, calcium channel blocker and diuretic. Six months ago BP was 148/82, three months ago 158/90 and now 174/96. HR is 60. BM is 20. Patient has bilateral carotid bruits and epigastric bruits. S4 gallop is noted. Trace pedal edema is present. Creat is 1.7 GFR is 29.
Which is the most appropriate next step in management?
A- add ace inhibitor
B- increased beta blocker dose
C- obtain doppler of renal arteries
D- obtain kidney angiography
What is C- obtain doppler of renal arteries
25 yr old female is referred to GI practice. Her med hx reveals that her mother at the age of 48 was dx with colon CA, she also has an aunt with endometrial CA. Her 29 yr old brother has hx of polyps. When you speak with her, you encounter a young woman reluctant to devote time to appropriate colon CA screening despite risk factors for Lynch syndrome, which of the following might improve her compliance and what is Lynch syndrome?
A- Education regarding lifetime colon cancer risk
B- minimum of 7 clinic visits per yr
C- Having you, her GI MD assume responsibility for all of her healthcare
D- Genetic testing
E- Further education on Lynch syndrome
What is D.
Lynch syndrome is hereditary non-polyposis colorectal CA linked to an autosomal dominant genetic condition with associated high risk as well for endometrial CA, ovary, stomach, small intestine, hepatobiliary, brain, upper urinary tract and skin due to mutations that impair DNA mismatch repair.
What is the most common bacteria which causes bacterial meningitis?
Which bacteria most commonly causes meningitis in elderly, alcoholic or immosuppressed patients?
What symptoms are noted in patients with meningitis?
What are the two antibiotics that should be initiated to treat meningitis? Which third antibiotic should be added if your patient is over 60?
Streptococcus pneumoniae.
Listeria monocytogenes
Fever, headache, nuchal rugidity, photosensitivity.
Ceftriaxone, Vancomycin and Ampicillin.
FUN FACT: Ceftriaxone is used for good CSF penetration.
32 year old female is admitted for ARDS, she is intubated and mechanically vented, Her vent settings are; Vt 360, RR 24, FIO2 100%, PEEP 18. ABG shows; PH 7.45, pCO2 34, pa02 of 75. Xray shows stable bilateral aveolar infiltrates. Vent pressures show peak inspiration pressure of 44mm Hg. What maneuver is most likely to improve her survival?
A- Decrease peep to 12
B- add inhaled nitric oxide
C- Decrease Vt
D- add bronchodilators
E- Attempt recruitment maneuver
What is C- decrease Vt
45 year old female presents to PMD with weight gain and abnormal menstrual cycles. She is depressed and reports fagiue. Lab work shows normal TSH and thyroid hormone levels but elevated cortisol levels. Which of the following will likely be present since this patient has adrenal dysfunction?
A- Enhanced glucose uptake
B- Hirsutism
C- Hypocalciuria
D- Hypoglycemia
E- Hypotension
What is B- Hirtuism
Chemotherapy agents such as ifosfamide and cisplatin treating your patient's testicular CA can cause hypophosphatemia, his level is 2, the fractional excretion of phosphate is noted to be increased at 20% which indicates renal wasting. Which is the most likely cause of this patient's hhypophosphatemia?
A- malnutrition
B- oncogenic osteomalacia
C- primary hyperparathyroidism
D- proximal type 2 renal tubular acidosis
Proximal type 2 renal tubular acidosis occurs when the kidney's don't properly remove acids from the blood into the urine. This occurs when bicarbonate is not properly reabsorbed by the kidney's filtering system.
40 yr old female comes into ED for evaluation of fever, nausea, vomiting and painfulness to her lower abdomen and groin. She started feeling ill overnight and noticed a macular rash extending from her groin and lower abdomen after having hair removed in that area as she usually does. She is a smoker, no significant med hx, no vaginal discharge, urinary frequency or dysuria. She has a 5 and 2 year old and husband at home. She appears restless and in pain. VS: 104.1, 110, 28, 104/68, 90% on RA. She is centrally obese, cardiac is WNL, Neck WNL, lungs- bilat rales, Lower abdomen shows 10 cm by 20 cm area of raised erythema with pustules to the groin region. Lab studies show multiorgan failure with coagulopathy, cultures are sent. UA shows proteinuria and hematuria. CXR shows bilateral widespread infiltrates. What is the most common diagnosis and what is the treatment?
A- ARDS
B- Clostridium perfringens infection
C- Streptococcal toxic shock syndrome
D- Meningococcal septicemia
E- Erythema multiforme
Streptococcal toxic shock syndrome is a lifethreatening illness associated with group A streptococcal infection but commonly caused from a cutaneous lesion.
Treatment is debridement and PCN, clindamycin, vancomycin
What is the most common bacteria associated with osteomyelitis in a patient who has had a prosthetic joint operation?
A patient with this medical history may present with Salmonella associated osteomyelitis?
Which tests should you consider ordering to diagnose osteomyelitis?
How long is typical antibiotic treatment for osteomyelitis?
Which surgical procedure may be necessary to assist in treating osteomyelitis?
Staphlococcus (coagulase negative)
Sickle cell disease
Wound culture, MRI, CT scan
6 weeks
Debridement of the wound
58 year old man reports to PMD with complaints of sob, doe and wheezing, he smokes 3 packs of cigs a day for the last 42 years. He has never been intubated but has been admitted several times for COPD. Phys exam shows poor air movement, Chest CT shows flattening diaphragm and an increased anterior-posterior chest diameter. When he goes for pulm function testing which patterns should be seen?
A- Decreased residual volume and total lung volume capacity
B- Decreased RV
C- Normal forced expiratory volume in 1 second forced vital capacity
D- Reduced FEV1/FVC
E- Reduced VC and TLC
What is D reduced FEV1/FVC
A 35 year old female presents to an endocrinologist with complaints of fatigue, dry skin, weight gain, and hair loss. She also reports being very uncomfortable when the weather is cold. Her serum level of T4 is 0.6mg/dl. TSH is 34 and physical exam reveals uniform enlargement of the gland. Lymphadenopathy is also noted in the neck. Which is the most likely to be present in this patient?
A- Elevated anti-thyroid peroxidase antibody
B- elevated calcitonin
C- exopthalmus
D- Psammoma bodies
E- Flulike illness symptoms
A 32 year old man is evaluated for a recent diagnosis of autosomal dominant polycystic kidney disease by renal ultrasound. His mother had PKD, HTN and renal failure requiring HD, she died from a CVA. The patient himself has HTN managed by losartan and metoprolol. BP is currently 132/82 and HR is 64, exam is unremarkable. Creat is 1.2, urine-protein creatinine ratio is 0.15, UA reveals 5-10 erythrocytes. Which of the following is the most appropriate next step in managing this patient?
A- 24 hour urine for protein
B- Cerebral artery MR angiography
C- Genotype testing for ADPKD subtype
D- Non-contrast abdominal CT
What is B, cerebral artery angiography.
Patients with CKD have an increased incidence of cardiovascular events and mortality compared with those with similar comorbid conditions. This test should be used to screen for intracranial cerebral aneurysms in a patient with autosomal dominant polycystic kidney disease.
60 yr old male is evaluated for a 1 yr history of generalized fatigue and lack of energy. He has had ED for 9 months, chronic lower back pain and hypertension. Ccurrent meds are metoprolol, HCTZ, hydrocodone, and naproxen. VS are WNL. Cardiac, lung and thyroid exams are all normal. Lab studies show morning total serum testosterone level of 180 all other lab results are WNL. Which of the following is most appropriate for the next step in this patient's management?
A- Discontinue hydrocodone
B- Discontinue metoprolol
C- Recheck testosterone levels
D- Start testosterone replacement therapy
What is A Opioids, high dose corticosteroids and hormonal therapies can lower serum testosterone levels.
FUN FACT: Normal testosterone level is 250-1050 with the average at 680.