This site is 100% ad supported. Please add an exception to adblock for this site.



undefined, object
copy deck
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
9yo M with odynophagia and erythematous tonsils with white exudate.
Strep pharyngitis. Rx: oral penicillin V. Streptococcus pyogenes. Complications include glomerulonephritis and rheumatic fever.
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.

Deck Info