CASE STUDY PT. 2 - FINAL MICRO EXAM

Background: Raj recently traveled across several rainforest regions of Central Africa. He started feeling fatigue, muscle pains, and noticed an itchy rash all over his body. 

Symptoms:

• Generalized itchiness.

• Fatigue and muscle pain.

• Swelling in the arms and legs.

• Worm-like movement under the skin.

• Disturbed sleep.

The causative organism of Raj's symptoms is:

Loa loa.

Case Study 4: Mia, a 45-year-old wildlife photographer

Background: Mia recently photographed a documentary on wildlife trade in urban markets. A week later, she developed symptoms resembling chickenpox. 

Symptoms:

• Vesicular rash.

• Fever.

• Chills.

• Sore throat.

• Headache.

What differentiates monkeypox from chickenpox upon observation?

Size of pustules.

Elijah, a 19-year-old college student, complains of a sudden onset sore throat, fever, and a lack of appetite. His roommate had similar symptoms a week ago. The student health center reports several such cases in the past month.

Gram stain: Chains of gram-positive cocci

What might be contributing to the spread of the infection on Elijah's campus?

Eating in crowded cafeterias.

A high school experiences an outbreak of chickenpox. Surprisingly, several vaccinated students also develop a mild version of the disease.

Why might vaccinated students still get chickenpox?

The vaccine offers high but not 100% protection, so breakthrough cases can occur.

Background: Robert has an itchy, red rash on his beard area. 

Symptoms:

• Pustules around hair follicles.

• Swelling.

• Itchiness.

• Hair loss in the affected area.

• Crusting. 

 Tinea Barbae primarily affects which area?

Beard and mustache area.

A 5-year-old boy is brought to the pediatrician by his parents. He has a high fever, is coughing, and complains of chest pain. His vaccinations are up to date. On auscultation, there are diminished breath sounds in the left lower lobe.

What is the best initial treatment for this child?

Oral amoxicillin and supportive care

A 45-year-old woman with HIV, well-controlled on antiretroviral therapy, presents with fever, severe headache, and a dry cough. She reports cleaning an old pigeon nest from her balcony a few days prior. She is tachypneic, and her oxygen saturation is 90% on room air.

What is the most appropriate management for this patient?

Inpatient admission and treatment with a tetracycline antibiotic.

Alex, a 32-year-old construction worker, comes to the clinic complaining of cough and weight loss. He mentions he has been working on a site with old, water-damaged buildings.

Symptoms:

• Cough

• Weight loss

• Hemoptysis

• Fatigue

What should Alex be primarily screened for based on his occupational exposure and symptoms?

Aspergillosis

Layla, a 30-year-old woman, recently gave birth to her first child. She returns to the hospital with a high fever and pain around her cesarean section wound. She is also experiencing fatigue and has a rapid heart rate. The doctors are concerned about a postpartum infection.

What is the most likely risk factor for Layla's condition?

Postpartum state: having a c-section.

A 40-year-old woman living in an urban area presents with fevers, severe headaches, and myalgias lasting two weeks. She recalls a recent weekend trip to a rural area where she visited a friend's farm. She has no pets and denies any known tick bites.

What should be the next step in the evaluation of this patient?

Serologic testing for Q fever.

Emily, a 30-year-old public health advocate, was diagnosed with high-risk HPV after an abnormal Pap smear during her annual exam. She had been vaccinated against HPV as a teenager but understood that the vaccine did not cover all HPV types. Her gynecologist discussed follow-up procedures and monitoring for potential cervical dysplasia.

Question: Despite being vaccinated, what was Emily diagnosed with during her annual exam?

High-risk HPV

A 27-year-old male comes into the clinic after extensive internet research. He has developed a white discharge from the penis and painful urination. He's read about STDs online and comes in with a list of possible diseases he thinks he might have.

Question: What STD is the internet researcher most likely attempting to diagnose? (Mark all that apply)

Chlamydia

Gonorrhea

Lena, a 26-year-old veterinary technician, developed flu-like symptoms, jaundice, and renal dysfunction. She had a history of handling many animals, including several that were ill. Given her profession and symptoms, her doctor suggested testing for leptospirosis, as it can be transmitted from animals to humans.

Question: What aspect of Lena's background is most relevant to her suspected leptospirosis diagnosis?

Being a veterinary technician.

Eli, a 30-year-old coffee shop manager, often works double shifts. To cope with the workload, he rarely takes bathroom breaks, holding his urine for prolonged periods. He's recently started experiencing symptoms of cystitis, such as painful urination and abdominal discomfort. His doctor suspects that urine retention might be contributing to his condition.

Question: What habit of Eli's is most likely increasing his risk for cystitis?

Holding urine for prolonged periods.

Jonathan, a 35-year-old college counselor, came to the clinic with concerns about several small bumps that had formed around his anus. He had been in a monogamous relationship with his partner for several years and was surprised by these developments. A biopsy of the growths confirmed HPV, likely from a strain that causes genital warts.

Question: Jonathan's biopsy confirmed HPV. What were his symptoms?

Bumps around the anus

Julia, a 28-year-old elementary school teacher, has been experiencing intense anal itching, especially at night. Remembering her lessons on parasitic infections, she suspects an infection with a small, white, thread-like worm that commonly affects crowded environments such as her classroom.

 

Enterobiasis (pinworm)

Derek, a 25-year-old backpacker, developed a rash along with abdominal pain after a trip in the Andes. A stool sample reveals eggs with radial striations. He remembers reading about a cestode infection associated with dogs in South America and suspects a condition that may require surgical intervention.

Echinococcosis

Sarah, a 28-year-old expat working in Asia, develops acute liver failure after consuming undercooked shellfish. She was previously vaccinated against hepatitis A and B, so she suspects a different kind of enterically transmitted virus.

Hepatitis E

Sophie, a 30-year-old working in international development, has been experiencing weight loss and chronic abdominal pain. She's been living in an area with poor sanitation where she knows that a certain nematode, which can cause trichuriasis, is common. She suspects her symptoms may be due to an infection with this organism.

Whipworm

After eating at a quick-service restaurant known for its chicken dishes, 25-year-old nutrition student Luke experiences gastrointestinal distress characterized by diarrhea and abdominal pain but no vomiting. He suspects a bacterium that produces an enterotoxin during sporulation in the intestines.

 

Clostridium perfringens food poisoning

History: A 50-year-old, frequently engaging in outdoor activities, presents with palpitations, dizziness, and a history of tick exposure.

Symptoms: Cardiac arrhythmias, fainting spells, and a history of migrating joint pains and rash.

Differential Diagnosis:

Lyme disease

History: A 30-year-old recent immigrant from a war-torn region presents with fever, severe headache, and muscle pain.

Symptoms: Rash beginning on the trunk, spreading to extremities, and altered mental status.

Microbiological Clues: Blood PCR positive for Rickettsia prowazekii.

Differential Diagnosis:

Epidemic typhus

History: A 45-year-old develops severe pain and swelling at a recent surgical site on the abdomen.

Symptoms: The surgical wound is discharging a foul-smelling fluid; the tissue around the wound is discolored and crepitant.

Microbiological Clues: Gram-positive rods producing gas in tissue, isolated from the wound.

Differential Diagnosis:

Gas gangrene

History: A 30-year-old returns from a camping trip with fever, headache, and muscle aches. Recalls multiple tick bites.

Symptoms: High fever, chills, and a mild rash.

Microbiological Clues: increased liver enzymes.

Differential Diagnosis:

Ehrlichiosis

History: A 24-year-old individual presents with fever, chills, and a rash, 10 days after being bitten by a pet rat.

Symptoms: A maculopapular rash on the hands and feet, joint pain, especially in the knees and ankles.

Microbiological Clues: Blood culture showing Gram-negative, pleomorphic rods.

Differential Diagnosis:

Rat bite fever

History: A 20-year-old college student living near a swampy area presents with a sudden high fever, severe headache, and vomiting. The patient also mentions recent mosquito bites.

Microbiological Characteristics: RNA virus, belongs to the genus Alphavirus, family Togaviridae, transmitted by mosquitoes.

Diagnosis Options:

Eastern equine encephalitis virus

History: A 35-year-old patient presents with neck stiffness, photophobia, and severe headaches. They recently returned from a camping trip in an area known for mosquito activity.

Microbiological Characteristics: Member of the Togaviridae family, vector-borne, causes inflammation of the brain (encephalitis).

Diagnosis Options:

Eastern equine encephalitis virus

History: A 70-year-old patient presents with double vision (diplopia), dysphagia, and descending paralysis. They recently consumed canned fish.

Microbiological Characteristics: Gram-positive, rod-shaped, produces botulinum toxin, anaerobic growth.

Diagnosis Options:

Clostridium botulinum

History: A 3-year-old child presents with a high fever, stiff neck, and sudden onset of asymmetric paralysis of the lower limbs. The child has not been vaccinated against polio.

Microbiological Characteristics: RNA virus, member of the Enterovirus genus in the Picornaviridae family, transmitted through fecal-oral route.

Diagnosis Options:

Poliovirus

History: A 70-year-old patient presents with progressive muscle weakness and difficulty breathing. They had polio as a child)

Microbiological Characteristics: Can cause post-polio syndrome decades after initial infection, non-enveloped, acid-stable RNA virus.

Diagnosis Options:

Poliovirus