- Joined
- Aug 22, 2006
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Is that a bulls-eye rash? Might be Borrelia burgdorferi
Is that a bulls-eye rash? Might be Borrelia burgdorferi
A 24 y/o female medical student presents to your clinic with the chief complaint of "I have a weird rash on my foot that itches like crazy." Reports first noticing the rash approximately 1 week after traveling with her boyfriend to coastal Mexico during her Spring Break, where they often walked along the beach barefoot for several hours at a time. Patient tried over-the-counter 1% hydrocortisone cream two times a day to no significant relief. Denies any change in skin products or detergent. Review of systems negative for weight loss, fever, chills, N/V, diarrhea, cough, headache, and muscle or joint pain. No known drug allergies or other allergies reported. Not currently taking any medications, vitamins, or herbal products.
On physical exam, you note a 2-in erythematous, serpiginous pruritic eruption along the patient's right foot. Patient is otherwise healthy.
Diagnosis?
Responsible organism(s) or pathogen(s)?
Treatment?
Cutaneous larva migrans, most commonly caused by Ancylostoma braziliense. Tx... ivermectin?
Cutaneous larva migrans
Ancylostoma braziliense (had to look that one up)
albendazole or ivermectin
curse you zippy
Ah.. didn't even know about albendazole.
Ah.. didn't even know about albendazole.
Mother brings in her 4 year old son who complains of a sore throat, malaise, rhinnorhea. Physical exam reveals a very errythematous pharyngeal mucosa.
Culture on blood agar shows the following:
Significantly, the child is allergic to penicillin.
What is your treatment of choice for this child's infection?
but albendazole "bends" worms.... that's what reminds me.
Erythromycin?
Mother brings in her 4 year old son who complains of a sore throat, malaise, rhinnorhea. Physical exam reveals a very errythematous pharyngeal mucosa.
Culture on blood agar shows the following:
Significantly, the child is allergic to penicillin.
What is your treatment of choice for this child's infection?
Alpha-hemolytic? So maybe it's Strep. Pneumo, so I'd probably hit that bug with a macrolide, like azithromycin, due to the PCN allergy and the child's age.
I'll tell you that you're thinking on the right track... but what's more likely to be alpha hemolytic and in the oral cavity?
Strep. Viridans group? Hit it with Vancomycin?
do the symptoms really warrant vanco?
#8 - Shigella
#12 - Lassa virus
9=Mycobacterium Tuberculosis
10=Trypanosoma Cruzi (Chagas).
Mystery pathogen #11 is Haemophilus influenzae. Go go microbiology!
My first thought was that Vancomycin was probably too much for this case of URTI/pharyngitis. I'd probably stick with Azithromycin, since it has good gram positive activity, few side effects, and doesn't have cross-allergenicity with PCN. It's good for respiratory infections.
it is good for bacterial respiratory infx and probably would kill what's growing on the plate... but the culture showed what you correctly identified as viridans strep which is normal oral flora.
Culturing normal oral flora in the context of a URI means it's a virus causing the infx. (no anti-biotic = proper treatment)
It was a trick question but one that showed up on:
-a quiz
-my midterm
-my final
and I'm pretty sure it was in my QBank so worth sharing.
Culturing normal oral flora in the context of a URI means it's a virus causing the infx. (no anti-biotic = proper treatment)
I thought that low-risk antibiotics or placebo was the proper treatment for viral URIs complicated by AMS (annoying mother syndrome), to get them out of your clinic.
It's kind of tough to guess though when you give us such an image trying to guess based on a rod-shaped flagellated bacterium.
Who's that pokemon?!
Giardia lamblia?
I thought that low-risk antibiotics or placebo was the proper treatment for viral URIs complicated by AMS (annoying mother syndrome), to get them out of your clinic.
A 24 y/o female medical student presents to your clinic with the chief complaint of "I have a weird rash on my foot that itches like crazy." Reports first noticing the rash approximately 1 week after traveling with her boyfriend to coastal Mexico during her Spring Break, where they often walked along the beach barefoot for several hours at a time. Patient tried over-the-counter 1% hydrocortisone cream two times a day to no significant relief. Denies any change in skin products or detergent. Review of systems negative for weight loss, fever, chills, N/V, diarrhea, cough, headache, and muscle or joint pain. No known drug allergies or other allergies reported. Not currently taking any medications, vitamins, or herbal products.
On physical exam, you note a 2-in erythematous, serpiginous pruritic eruption along the patient's right foot. Patient is otherwise healthy.
Diagnosis?
Responsible organism(s) or pathogen(s)?
Treatment?
Ok everyone, sorry for being away... life, you know.
These responses are the correct ones to the rapid fire round (although only the genus was given for #8, I'll still count it...this time )
And here is our new hall of fame:
Hall of Fame
1) themule +2
1) cpants +2
1) Mr hawkings +2
1) zipmedic +2
1) TPM-SMX +2
6) Beachblonde +1
6) Whatayear +1
6) Bodonid +1
6) Kaushik +1
Looks like my rapid fire round did not accomplish what it was meant to do
#13
I've ruled out vibrio and h. pylori (different flagella schemes)
the only one left that I could think that fits the profile would be e. coli.
Couldn't help but notice the disturbing amount of hair on this girl's leg and foot
How about the clap? N. gonorhea?
Listeria monocytogenes... bamf kills babies.
I agree. Not because I know these things, but b/c the google image search of L. monocytogenes will bring up the same picture....................
Blastomyces dematitidis?
OOOOOOhhhhh.... yeah... Coccidioides immitis
Listeria monocytogenes... bamf kills babies.
Correct! here is the new hall of fame:
Hall of Fame
1) themule +2
1) cpants +2
1) Mr hawkings +2
1) zipmedic +2
1) TPM-SMX +2
6) Beachblonde +1
6) Whatayear +1
6) Bodonid +1
6) Kaushik +1
6) Forthegood +1