Q1.A 49 year old male presents with dyspnea and general malaise of 2 months duration. He denies any travel, allergies or injury. However, he does report fever and a sore throat several months ago. He is on no medications but is a heavy smoker and drinks alcohol regularly. Blood work is pending. His Chest x-ray is shown. What is your working diagnosis?
a. Ruptured esophagus
b. Lung mass
c. Post pneumonic effusion
d. Chylothorax
e. CHF
f. Tuberculosis
For more on the case and answer
Q1. A 27 yo with no significant past medical history presents with a cough, dyspnea and chest discomfort of 4 weeks duration. He revealed an URTI about 6 weeks ago which spontaneously resolved. His past medical history is unremarkable, he denies smoking and has no allergies. Vital signs are normal and the exam reveals rubbery nodules in the left neck. His chest x-ray is shown. The radiologist feels that there is a mass lesion in the mediastinum. Which of the following is the least likely cause of his symptoms?
While on a trip to Hawaii, a teenager swallowed the creature shown in the image. The 16-year then returned back to this home in NY only to develop nausea, vomiting, and severe abdominal cramps a few days later. Over the next few days, the GI symptoms eased but then he developed a fever, headache, and stiffness of the neck. He presented to the ED where he was found to have facial nerve palsy on the right side. A lumbar puncture revealed marked eosinophilia but the fluid was negative for any organisms. All other workup was negative. He was admitted and monitored in the ICU. Because the patient was showing gradual clinical improvement, no antibiotics were administered. The infectious disease expert felt that the infection may have been due to a parasite endemic to the Hawaii and Pacific region. By the end of 2 weeks, all the symptoms had resolved and the patient was discharged. Based on the history and presentation, what is the definitive HOST for this parasite?
A. Mosquito
B. Pig
C. Rat
D. Bird
For answer & explanation
https://www.youtube.com/watch?v=r4pKz1yji8w
A 27-year old male presents with complaints of general malaise, fever, vague joint and muscle pain that have been going on for about 12 weeks. Last 4 days, he has had 2 episodes of hemoptysis and coughing spells. He claims that he has never had an appetite for food and was never able to participate in sports because he was always short of breath. He has been to many healthcare providers but no cause was ever found. On physical, his vitals are BP 160/95, P 110, RR 26 and T 99.8 F. Auscultation reveals crackles bilaterally. He has mild pedal edema. Blood work reveals elevated BUN and creatinine levels with a mild leucocytosis. The urine shows microscopic hematuria and red cell casts. The patient is admitted and referred to a nephrologist who performs a kidney biopsy. The immunofluorescence stain is shown in the image. Five days later, the patient develops massive hemoptysis and his blood pressure is 90/55. The patient’s arterial blood gas is pH 7.21, PO2 87, PCO2 50 and bicarbonate 18.3. What is your next step in the management of this patient?
A. Hemodialysis
A young patient is brought in by EMS after developing a syncopal episode. In the ED, the patient has regained consciousness and the vital signs are stable. The patient is unable to provide much of a history except to state that her primary healthcare provider had started her on terfenadine for her allergies. She denies any other past medical history and has no allergies. A 12-lead ECG is shown below. The astute medical student highlights what he believes is the problem area. For people who develop this syndrome in response to medications, the MOST common risk factor is?
A. Age
B. Female gender
C. Use of digitalis
D. Underlying renal dysfunction
E. Exercise
F. Fever
For answer & explanation
https://www.youtube.com/watch?v=r4pKz1yji8w
