A 60-year-old woman consults a physician because of weakness, headaches,
dizziness, and tingling in her hands and feet. Physical examination demonstrates
multiple areas of bruising on the back of her forearms and shins. On specific
questioning, she reports having had five nosebleeds in the past 2 months, which she
had attributed to "dry air". Blood studies are drawn which show a platelet count of
1,200,00/nanoL, RBC 5,100,000/nanoL, and WCC 10,500/nanoL with a normal
differential count. Review of the peripheral smear demonstrates many abnormally
large platelets, platelet aggregates, and megakaryocyte fragments. No abnormal red
or white blood cells are seen. Philadelphia chromosome studies are negative. Which
of the following is the most likely diagnosis?
- Chronic myelogenous leukaemia
- Myelofibrosis
,- Polycythemia vera
- Primary thrombocythemia
- Secondary thrombocythemia
Give this one a try later!
Primary (essential) thrombocythemia
Condition is due to a clonal abnormality of a multipotent haematopoietic
cell that produces megakaryocytic hyperplasia with resultant increased
platelet count. Since the platelets are often abnormal, either a thrombotic
or a haemorrhagic tendency may be seen.
CML: associated with of Philadelphia chromosome or markedly increased
WCC
Myelofibrosis: would likely show some abnormally shaped (often tear drop)
red cells
Polycythemia vera: associated with increase RBC mass
Secondary thrombocythemia: reactive process that may occur in a variety
of settings. Abnormal platelet forms are not usually seen and platelet
function tests are usually normal.
A 59-year-old man is seen by a specialist because of chronic, intractable, sinusitis. The
decision is made to treat the patient surgically, with evacuation of sinus contents and
dilation of the sinus ostia. The material removed is sent routinely for pathologic
examination.. An unexpected finding is the presence of fungi with broad, nonseptate,
irregularly shaped hyphae. Subsequent review of the patient's chart reveals a long
history of poorly controlled diabetes mellitus. Which of the following is the most likely
causative organism?
- Aspergillus
- Blastomyces
- Candida
- Rhizopus
- Sporothrix
Give this one a try later!
, Rhizopus
Rhinocerebral mucormycosis, which can be caused by fungal species
including Rhizopus, Rhizmucor, Absidia, Basidiobalus. Predisposing
conditions include immunosuppression, uncontrolled diabetes mellitus, and
patients using the iron-chelating drug desferrioxamine.
Although rare, these infections have a tendency to become fulminant and
are frequently fatal
Rx: antibiotic IV amphotericin B +/- surgical embridement
Aspergillus: narrow hyphae
Blastomyces: usually involves lung and is yeast form
Candida: narrow hyphae and is yeast form
Sporothrix: usually infects skin and is yeast form
A 10-year-old girl is brought to the physician by her parents. She was recently
diagnosed with generalised tonic-clonic epilepsy during a clinic visit that her
grandmother took her to. Both of her parents are concerned with the diagnosis and
are seeking advice regarding what they should do when the child has a seizure. Which
of the following suggestions is appropriate?
- Call an ambulance immediately as soon as seizure begins
- Put something in the child's mouth at onset of seizure
- Try to place the child on her side during the seizure
- Try to restrain the child during the seizure
- Do not allow the child to return to her activities after recovery
Give this one a try later!
, Try to place the child on her side during the seizure
During a seizure episode DO:
- Place the patient on their side
- Put a pillow/soft object under head
- Loosen tight clothing around the neck
- Remove sharp objects from surroundings
DON'T:
- Put any object into patient's mouth
- Call ambulance unless lasts >10 mins
- Try to restrain the patient
After the seizures, remains with the patient until he/she is full alert and
allow him/her to return to usual activities.
A 74-year-old woman, who has been followed for the past 25 years for chronic
obstructive pulmonary disease comes to the ED complaining of 48 hours of
temperature to 38.6 C and worsening shortness of breath. She has a chronic
productive cough, which has become more copious. On physical examination, she
has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain
reveals many epithelial cells and multiple gram-positive and gram-negative
organisms; no neutrophils are seen. Which of the following is the most likely organism
causing the symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae
Give this one a try later!
Haemophilus influenzae
Evidence of community-acquired pneumonia and common organisms in
patients with COPD are Strep. pneumoniae, Haem. influenzae and
Moraxella catarrhalis.
Klebseilla pneumonia is typically found in alcoholic patients.
Primary E. coli pneumonia is rare and there is no history of infection
elsewhere (e.g. UTI).
Mycoplasma pneumoniae does not present with a lobar consolidation and
dizziness, and tingling in her hands and feet. Physical examination demonstrates
multiple areas of bruising on the back of her forearms and shins. On specific
questioning, she reports having had five nosebleeds in the past 2 months, which she
had attributed to "dry air". Blood studies are drawn which show a platelet count of
1,200,00/nanoL, RBC 5,100,000/nanoL, and WCC 10,500/nanoL with a normal
differential count. Review of the peripheral smear demonstrates many abnormally
large platelets, platelet aggregates, and megakaryocyte fragments. No abnormal red
or white blood cells are seen. Philadelphia chromosome studies are negative. Which
of the following is the most likely diagnosis?
- Chronic myelogenous leukaemia
- Myelofibrosis
,- Polycythemia vera
- Primary thrombocythemia
- Secondary thrombocythemia
Give this one a try later!
Primary (essential) thrombocythemia
Condition is due to a clonal abnormality of a multipotent haematopoietic
cell that produces megakaryocytic hyperplasia with resultant increased
platelet count. Since the platelets are often abnormal, either a thrombotic
or a haemorrhagic tendency may be seen.
CML: associated with of Philadelphia chromosome or markedly increased
WCC
Myelofibrosis: would likely show some abnormally shaped (often tear drop)
red cells
Polycythemia vera: associated with increase RBC mass
Secondary thrombocythemia: reactive process that may occur in a variety
of settings. Abnormal platelet forms are not usually seen and platelet
function tests are usually normal.
A 59-year-old man is seen by a specialist because of chronic, intractable, sinusitis. The
decision is made to treat the patient surgically, with evacuation of sinus contents and
dilation of the sinus ostia. The material removed is sent routinely for pathologic
examination.. An unexpected finding is the presence of fungi with broad, nonseptate,
irregularly shaped hyphae. Subsequent review of the patient's chart reveals a long
history of poorly controlled diabetes mellitus. Which of the following is the most likely
causative organism?
- Aspergillus
- Blastomyces
- Candida
- Rhizopus
- Sporothrix
Give this one a try later!
, Rhizopus
Rhinocerebral mucormycosis, which can be caused by fungal species
including Rhizopus, Rhizmucor, Absidia, Basidiobalus. Predisposing
conditions include immunosuppression, uncontrolled diabetes mellitus, and
patients using the iron-chelating drug desferrioxamine.
Although rare, these infections have a tendency to become fulminant and
are frequently fatal
Rx: antibiotic IV amphotericin B +/- surgical embridement
Aspergillus: narrow hyphae
Blastomyces: usually involves lung and is yeast form
Candida: narrow hyphae and is yeast form
Sporothrix: usually infects skin and is yeast form
A 10-year-old girl is brought to the physician by her parents. She was recently
diagnosed with generalised tonic-clonic epilepsy during a clinic visit that her
grandmother took her to. Both of her parents are concerned with the diagnosis and
are seeking advice regarding what they should do when the child has a seizure. Which
of the following suggestions is appropriate?
- Call an ambulance immediately as soon as seizure begins
- Put something in the child's mouth at onset of seizure
- Try to place the child on her side during the seizure
- Try to restrain the child during the seizure
- Do not allow the child to return to her activities after recovery
Give this one a try later!
, Try to place the child on her side during the seizure
During a seizure episode DO:
- Place the patient on their side
- Put a pillow/soft object under head
- Loosen tight clothing around the neck
- Remove sharp objects from surroundings
DON'T:
- Put any object into patient's mouth
- Call ambulance unless lasts >10 mins
- Try to restrain the patient
After the seizures, remains with the patient until he/she is full alert and
allow him/her to return to usual activities.
A 74-year-old woman, who has been followed for the past 25 years for chronic
obstructive pulmonary disease comes to the ED complaining of 48 hours of
temperature to 38.6 C and worsening shortness of breath. She has a chronic
productive cough, which has become more copious. On physical examination, she
has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain
reveals many epithelial cells and multiple gram-positive and gram-negative
organisms; no neutrophils are seen. Which of the following is the most likely organism
causing the symptoms?
- Escherichia coli
- Haemophilus influenzae
- Klebsiella pneumoniae
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae
Give this one a try later!
Haemophilus influenzae
Evidence of community-acquired pneumonia and common organisms in
patients with COPD are Strep. pneumoniae, Haem. influenzae and
Moraxella catarrhalis.
Klebseilla pneumonia is typically found in alcoholic patients.
Primary E. coli pneumonia is rare and there is no history of infection
elsewhere (e.g. UTI).
Mycoplasma pneumoniae does not present with a lobar consolidation and
