Vignettes, some micro too
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Full-term neonate of uneventful delivery becomes MR and hyperactive and has musty odor | PKU
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| Stressed executive consumes 7-8 martinis quickly before dinner and becomes hypoglycemic, why? | NADH increase prevents gluconeogenesis by shunting pyruvate and oxaloacetate to lactate and malate
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| 2yo girl has inc abdominal girth, FTT, skin and hair depigmentation | kwashiorkor
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| alcoholic with rash, diarrhea, altered mental status, what is vitamin deficiency? | B3, pellagra
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| 20yo male with idiopathic hyperbilirubinemia; what is mcc? | Gilbert's disease
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| 51yo male w/black spots in sclera has noted urine turns black when standing | alkaptonuria
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| 25yo male with severe chest pain and xanthomas of Achilles tendon, what is dz and where is defect? | Familial hypercholesterolemia; LDL receptor
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| Baby vomits milk when fed and has gastric air bubble | blind esophagus with lower segment of esophagus attached to trachea (tracheoesophageal fistula)
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| 20yo dancer reports dec plantar flexion and dec sensation over back of thigh, calf, lateral half of foot; what spinal nerve is involved? | tibial (L4-S3)
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| Pt with dec pain and temp sensation over lateral aspects of both arms; what is lesion? | syringomyelia
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| penlight in pt's R eye produces bilateral pupillary constriction. when moved to L, there is paradoxical bilateral pupillary dilatation. what is defect? | atrophy of left optic nerve
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| pt has dec prick sensation on lateral aspect of leg and foot, what deficit in muscular action should be expcted? | dorsiflexion and eversion of foot (common peroneal nerve)
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| elderly woman w/arthritis and tingling over lateral digits of R hand | carpal tunnel syndrome; median nerve compression
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| car accident; cannot turn head to left and has R shoulder droop; which structure is damaged? | right CNXI (runs thru jugular foramen w/CNIX and X), innervating SCM and trapezius mm
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| man presents with one wild flailing arm, where is lesion? | contralateral subthalamic nucleus (hemiballismus)
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| pregnant woman in 3rd trimester has normal BP when standing and sitting. when supine it drops to 90/50; what is dx? | compression of IVC
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| soccer player was kicked in L leg and suffered a damaged medial meniscus; what else is likely to be damaged? | anterior cruciate ligament (part of "unhappy triad"
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| gymnast dislocates shoulder anteriorly; what nerve is damaged? | axillary nerve (C5-C6)
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| pt w/cortical lesion doesn't know he has a dz; where is lesion? | R parietal lobe
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| child w/cleft lip; which embryologic process failed? | fusion of maxillary and medial nasal processes
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| pt cannot protrude tongue toward left side and has a R sided spastic paralysis; where is lesion? | left medulla, CNXII
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| teen falls while rollerblading and hurts elbow. he can't feel medial part of arm, which nerve is injured? | ulnar nerve d/t broken medial condyle
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| 24yo male develops testicular cancer; metastatic spread occurs by what route? | para-aortic lymph nodes (recall the descent of testes during development AND the existance of blood-testes barrier)
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| field hockey player falls at practice; xray shows midshaft break of humerus; which nerve and artery are most likely damaged? | radial nerve and deep brachial artery, they run together
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| pt cannot blink R eye or seal his lips and has mild ptosis on R side; what is dx and which nerve is affected? | Bell's Palsy; CNVII
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| pt has pain, numbness, tingling with wasting of thenar eminance; what is dx? | Carpal tunnel syndrome; median nerve is compressed
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| Woman w/previous c-section has scar in lower uterus near os; what is she at risk for? | placenta previa
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| 35yo male, HTN in arms and low pressure in legs | coarctation of aorta
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| woman w/diffuse goiter and hyperthyroidism; what are expected TSH and thyroid levels? | low TSH and high thyroid hormones
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| pt w/extended expiratory phase | obstructive lung dz
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| woman w/HA, visual disturbance, galactorrhea, amenorrhea | prolactinoma
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| baby w/foul smelling stool and recurrent pulmonary infxns | cystic fibrosis, do chloride sweat test
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| obese woman w/hirsutism and inc testosterone | polycystic ovarian syndrome
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| xray w/ bilateral hilar lymphadenopathy | sarcoidosis
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| 5yo boy w/systolic murmur and wide fixed split S2 | ASD
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| 48yo female w/progressive lethargy, extreme sensitivity to cold | hypothyroidism
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| pt w/elevated serum cortisol; 1mg of dexamethasone suppression test does not decrease cortisol levels, but 8mg does; what is dx? | pituitary tumor
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| young athlete collapses and dies during a game | hypertrophic cardiomyopathy; idopathic hypertrophic subaortic stenosis
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| anemic child since birth; splenectomy would inc the hematocrit in what disease? | hereditary spherocytosis
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| 43yo male w/dizziness and tinnitus; CT shows enlarged acoustic meatus, what is dx? | schwannoma
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| child w/weakness and enlarged calves | duchenne's muscular dystrophy; x-linked recessive
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| 25yo female w/sudden uniocular vision loss and slurred speech; h/o weakness and paresthesias that have resolved | Multiple sclerosis
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| teenager w/nephritic syndrome and hearing loss | Alport's syndrome
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| tall, thin teen male w/abrupt onset dyspnea and L-sided chest pain; hyperresonant percussion on affected side and diminished breath sounds | spontaneous pneumothorax
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| young man concerned about wife's inability to conceieve and her recurrent URI; she has dextrocardia; what is defective? | dynein (Kartagener's) = immotile cilia
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| 55yo male smoker/drinker w/new cough and flu-like symptoms; gram stain shows no bugs, but silver stain shows G(-) rods | Legionella pneumonia
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| pt has stroke after multiple long bone fxs; what caused infarct? | fat emboli
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| 25yo woman w/low-grade fever, rash across nose that gets worse in sun, and widespread edema (anasarca) | worry about SLE
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| 50yo male w/diarrhea; face is plethoric and heart murmur is detected | Carcinoid syndrome
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| eldely woman w/HA and jaw pain; labs show elevated ESR | temporal arteritis
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| pregnant woman at 16wks w/atypically large abdomen and high hCG | hydatiform mole
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| 80yo man w/systolic crescendo-descrescendo murmur | aortic stenosis
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| woman w/ short 4th and 5th metacarpals; what associated endocrine disorder? | Albright's hereditary osteodystrophy OR Pseudohypoparathyroidism
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| aftere a stressful life event, 30yo man has diarrhea and blood per rectum; transmural inflammation on biopsy | Crohn's dz
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| young man w/mental detrioration and tremors; brown pigmentation in ring around periphery of cornea and altered LFTs; what treatment should he receive? | Penicillamine for Wilson's disease
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| pt w/fatigue, macrocytic megaloblastic anemia; what is danger of giving folate alone? | masks neuronal damage with vitamin b12 deficiency
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| 10yo child spaces out inclass; during spells there is a lip quiver | absence seizures
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| 85yo man w/acute knee pain and swwelling; xray show inc joint space without erosion; what is dz and what should you find on aspiration? | Pseudogout; rhomboid calcium pyrophosphate crystals
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| alcoholic vomits gastric contents; foul-smelling sputum | anaerobes
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| middle-aged man w/acute onset monoarticular joint pain and bilateral Bell's palsy | Lyme disease; bite from Ixodes tick
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| Pt w/M. pneumoniae exhibits cryoagglutinins during recovery phase; what types of Ig are reacting? | IgM
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| UA of pt shows WBC casts | pyelonephritis
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| child with tetany and candidiasis; hypocalcemia and immunosuppression are found | T cell deficiency; DiGeorge
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| Pt with "rose gardener's" rash (thorn prick w/lymph drainage) | Sporothrix schenckii
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| 25yo med student w/burning feeling in gut after meals; biopsy of gastric mucosa shows G(-) rods | H. pylori
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| 32yo male w/"cauliflower" skin lesions; tissue biopsy shows broad based budding yeast | Blastomyces
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| Breast feeding woman develops redness and swelling of breast; on exam it is a flucutant mass | mastitis d/t S. aureus
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| Young child has lung infxns and granulomatous lesions; what is defect in neutrophils | NADPH oxidase = chronic granulomatous dz
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| 20yo student w/lymphadeopathy, fever, hepatosplenomegaly; serum agglutinates sheep RBCs; what cell is infected? | B cells w/EBV, infectious mononucleosis
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| 1hr after eating custard a family at a picnic begins to vomit; after 10hours they feel better | Staph aureus d/t preformed enterotoxin
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| Infant becomes flaccid after eating honey; what bug and what is MOA | Clostridium botulinum; inhibited release of ACh
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| Man presents with squamous cell carcinoma on penis, what was he exposed to? | HPV
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| Pt develops endocarditis 3wks after getting a prosthetic heart valve, what bug is suspected? | S. aureus or S. epidermidis
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| All DNA viruses are HHAPPPy viruses | Hepadna, Herpes, Adeno, Pox, Parvo, Papova
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| All DNA viruses are double stranded EXCEPT | Parvo "part of a virus" = single stranded
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| All DNA viruses are linear EXCEPT | Papovirus (circular, supercoiled) and Hepadna (circular, incomplete)
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| All DNA viruses are icosohedral EXCEPT | Pox (complex)
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| All DNA viruses replicate in the nucleus EXCEPT | Pox (carries own DNA-dependent RNA polymerase)
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| Naked DNA viruses are PAP (you need to be naked for a pap smear) | Parvo, Adeno, Papova
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| Enveloped DNA viruses are HPH | Hepadna, Pox, Herpes
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| Hepadnavirus | HBV, not a retrovirus, but has reverse transcriptase; acute or chronic hepatitis; vaccine available
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| Herpesviruses | HSV-1, HSV-2, VZV, EBV, CMV, HHV6, HHV8
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| HSV-1 | oral/genital lesions; keratoconjunctivitis; gC binds C3 and gE/gI binds Fc portion of Ab
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| EBV | mono, Burkitt's lymphoma
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| CMV | infxn in immunocompromised pts, especially trasnplant recipients; congenital infxns (liver/blood/vascular, silent - hearing loss)
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| HHV6 | roseola (xanthem subitum)
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| HHV8 | a/w Kaposi's sarcoma
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| Adenovirus | febrile pharyngitis (sore throat), pneumonia, conjunctivitis; fecal-oral (pools) causing watery diarrhea ~2wks
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| Parvovirus | smallest DNA virus; B19 = aplastic crisis in sickle cell pts, "slapped cheeks" rash (erythema infectiosum), hydrops fetalis
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| Papovavirus | HPV = warts, CIN, cervical cancer; JC = progressive multifocal leukoencephalopathy (PML) in HIV pts
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| Poxvirus | largest DNA virus; Smallpox = although eradicated, can be germ warfare; Vaccinia = cowpox; Molluscum contagiosum
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| All RNA viruses are single stranded EXCEPT | Reoviridae "repeato-virus"; double stranded
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| Helminth a/w brain cysts and seizures | Taenia solium; pork tapeworm/cestode; Tx = Praziquantel/niclosamide; Albendazole for cystericosis
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| Helminth a/w liver cysts | Echinococcus granulosus; eggs in dog feces; can cause anaphylaxis; Tx = Albendazole
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| Helminth a/w B12 deficiency | Diphyllobothrium latum
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| Helminth a/w biliary tract inflammation dz | Clonorchis sinensis trematode (fluke); undercooked fish; Tx = Praziquantel
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| Helminth a/w Hemoptysis lung inflammation | Paragonimus westermani trematode (fluke); undercooked crab; Tx = Praziquantel
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| Helminth a/w Portal hypertension | Schistosoma mansoni fluke (trematode); snail is host; cercariae enter skin - granulomas; Tx = Praziquantel
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| Helminth a/w Hematuria, bladder cancer | Schistosoma haematobium trematode (fluke); snail is host; Tx = Praziquantel
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| Helminth a/w perianal pruritis; eggs are flat on one side and round on other | Enterobius vermicularis nematode (roundworm); Pinworm; egg-contaminated food; Tx = Mebendazole/Pyrantel Pamoate
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| Larvae penetrate skin of feet; intestinal infection = anemia; thin-shelled multicell egg | Ancylostoma duodenale hookworm; Nematode (roundworm); Tx = Mebendazole/Pyrantel pamoate
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| Eggs are VISIBLE in feces as bumpy & thick shelled; intestinal infxn; migrates thru lung during maturation; causes type I hypersensitivity (allergen) | Ascaris lumbricoides (giant roundworm/nematode); Tx = Mebendazole/pyrantel pamoate
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| Larvae in soil penetrate skin; intestinal infxn; Rhabditiform larvae passed in stool | Strogyloides stercoralis (nematode/roundworm); Tx = Ivermectin/thiabendazole
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| Undercooked pork; Muscle inflammation, Periobital edema | Trichinella sporalis (nematode/roundworm); Tx = Thiabendazole
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| Present in drinking water; Skin ulcers and inflammation | Dracunculus medinensis; Tx = Niridazole
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| Transmitted by deer tick; skin swelling; crawls in conjunctiva | Loa loa (nematode/roundworm); Tx = diethylcarbamazine
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| Transmitted by black flies; river blindness | Onchocerca volvulus (nematode/roundworm); Tx = Ivermectin
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| Food contaminated w/eggs; Granulomas (retina = blindness); visceral larva migrans | Toxocara canis (nematode/roundworm); Tx = Diethylcarbamazine
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| Female mosquito; blocks lymphatics = elephantiasis | Wuchereria bancrofti (nematode/roundworm); Tx = Diethylcarbamazine
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| bloody diarrhea (dysentery), liver abscess; trophozoites or cysts in stool | Entamoeba histolytica; Tx = Metronidazole and Iodoquinol
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| Bloating, flatulence, foul-smelling diarrhea; trophozoites or cysts in stool | Giardia lamblia; Tx = Metronidazole
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| Severe diarrhea w/AIDS (mildly watery in healthy); Cysts on ACID FAST stain | Cryptosporidium; NO TX available
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| Brain abscess in HIV and birth defectsl; Cysts in meat or cat feces; Serology or Bx | Toxoplasma gondii; Tx = Sulfadiazine + Pyrimethamine
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| Malaria: cyclic fever, HA, anemia, splenomegaly; anopheles mosquito; blood smear | Plasmodium (vivax, ovale, malariae, faciparum - severe cerebral type); Tx = Chloroquinone (primiquine prevents vivax/ovale relapse), Sulfadoxine + pyrimethamine, mefloquine, quinine
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| Foul smelling, green vaginal discharge w/itching and burning; STD; Trophozoites on wetmount | Trichomonas vaginalis; Tx = metronidazole
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| Chagas disease (heart), reduvid bug; blood smear | Trypanosoma cruzi; Tx = Nifurtimox
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| African sleeping sickness; tsetse fly; blood smear | Trypanosoma gambiense or rhodesiense (rapid); Tx = Sumarin for blood or Melarosprol for CNS penetration
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| Visceral leishmaniasis (kala-azar); sandfly; MQs w/amastigotes | Leishmania donovani; Tx = Sodium stibogluconate
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| Babesiosis (flu-like); Ixodes tick; Blood smear no RBC pigment & "maltese cross" | Babesia; Tx = Quinine, Clindamycin
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| Rapidly fatal meningoencephalitis; acquired from swimming in lakes; enters nose; Amoebas found in CSF | Naegleria floweri; NO TX
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| Pseudohyphae + budding yeast; germ tubes at 37*C | Candida; thrush in immunocomp (neonates, AIDS, steroids, DM), vulvovaginitis (hi pH, DM, Abx); Tx = Nystatin for superficial or Amphotericin B for systemic
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| 45* angle branching septate hyphae; rare fruiting bodies; fungus ball in empty lung cavities; NOT dimorphic | Aspergillus; allergic bronchopulmonary infxn
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| 5-10um yeasts with wide capsular halo; narrow based unequal budding; pigeons/soil; Sabouraud's agar; India ink; latex agglutination for polysach capsular Ag; meningitis | Cryptococcus neoformans
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| Irregular broad (empty-looking) nonseptate hyphae w/wide angle (>90*) branching; Ketoacidotic diabetics or leukemia pts; blood vessel infarcts | Mucor and Rhizopus sp.
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| Diffuse interstitial pneumonia; immunosuppressed pts; Bx or lavage; Methenamine silver stain | Pneumocystis carinii; Tx = TMP-SMX (prophylax when CD4<200)
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| dimorphic fungus on roses; draining lymph nodules; cigar-shaped budding yeast in pus | Sporothrix schenckii; Tx = Itraconazole
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| San Joaqin valley/desert fever; SW states | Coccidiodomycosis
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| Bird, bat droppings in caves; Intracellular fungus usu in MQs (no person-person transmission); Mississippi/Ohio river valleys | Histoplasmosis
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| "Captain's Wheel" appearance; rural latin american fungus | Paracoccidiodomycosis
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| Big, Broad-Based Budding; SE states and central america | Blastomycosis
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| Systemic mycoses | Coccidiomycosis, histoplasmosis, paracoccidiodomycosis, blastomycosis; ALL are DIMORPHIC (mold in soil, yeast in tissue except coccidio. which is spherule)
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| Treatment for local infection with systemic mycoses | Fluconazole or Ketoconazole
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| Treatment for systemic infection with systemic mycoses (can mimic TB granuloma formation) | Amphotericin B
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| Systemc Mycoses Dimorphic fungus: Heat versus Cold | Mold versus Yeast
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| Cutaneous Mycoses | Tinea versicolor, Tinea nigra, Tinea pedis, cruris, corporis, capitus
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| Tinea versicolor; hypopigmented skin lesions in hot, humid weather | Malassezia furfur; Tx = Topical Miconazole, Selenium sulfide
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| Tinea nigra; infxn of keratinized layer of skin; appears as brown spot | Cladosporium werneckii; Tx = Topical Salicylic Acid
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| Tinea pedis, cruris, corporis, capitus; Pruritic lesions w/central clearing resembling a ring; Mold hyphae visualized with KOH prep (not dimorphic) | Dermatophytes (Microsporum, Trichophyton, Epidermophyton); Tx = Topical Azoles
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| Fungal Spores | Coccidiodomycosis and Histoplasmosis are inhaled as asexual spores (conidia)
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| chemist presents with MPTP exposure; what NT is depleted? | Dopamine; eliciting a parkinson-like effect
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| Woman on tetracycline is photosensitive; what are clinical manifestations? | rash on sun-exposed skin
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| Nondiabetic pt is hypoglycemic, but has low levels of C peptide; what is dx? | accidental insulin injection
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| African-American man goes to africa, develops hemolytic anemia after taking malarial prophylaxis; what is his enzyme deficiency? | Glucose-6-phosphate dehydrogenase
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| 27yo female with h/o psych illness now has urinary retention d/t a neuroleptic; how do you treat it? | Bethanechol
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| Farmer presents w/dyspnea, salivation, miosis, diarrhea, cramping, blurry vision; what caused it and what is MOA? | Insecticide poisoning; inhibition of ACh-esterase
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| Pt w/recent kidney transplant is on cyclosporine for immunosuppression; he requires an antifungal for candidiasis, which would result in cyclosporine toxiticy? | Ketoconazole
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| Man on many meds including antidepressants, antihypertensives, has mydriasis and becomes constipated; what is the cause of his symptoms? | TCA (amitriptyline) overdose
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| 55yo postmenopausal woman on tamoxifen; what is she at an increased risk for getting? | endometrial carcinoma
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| Woman on MAO inhibitor has hypertensive crisis after a meal, what did she ingest? | tyramines (wine or cheese)
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| After taking clindamycin, pt develops toxic megacolon and diarrhea; what is MOA of diarrhea? | Clostridium difficile overgrowth
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| Man starts meds for hyperlipidemia, but then develops rash, pruritis and GI upset, what drug is it? | Niacin
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| Pt on carbamazepin, which routine labs be done? | LFTs
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| 23yo female on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant; why? | Rifampin augments estrogen metabolism in liver, rending it less effective
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| Pt develops cough and must discontinue captopril; what is a good replacement drug and why doesn't it have the same side effects? | Losartan, and angiotensin II receptor antagonist; it does not increase bradykinin like ACE-i
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