A 32-year-old female experiences an episode of unresponsiveness associated with jerking movements of her arms and legs.
Which one of the following presentations would make a diagnosis of true seizure more likely?
Correct Answer A:
Up to 20% of patients diagnosed with epilepsy actually have pseudoseizures. Eye closure throughout the event is uncommon in true seizures, and a history of fibromyalgia or chronic pain syndrome is predictive of pseudoseizures. If obtained within 20 minutes of the event, a serum prolactin level may be useful in differentiating a true seizure from a pseudoseizure. An elevated level has a sensitivity of 60% for generalized tonic-clonic seizures and 46% for complex partial seizures. Other features suggestive of seizure activity include tongue biting, the presence of an aura, postictal confusion, and focal neurologic signs.
Which of the following that infect humans have an intermediate host?
Correct Answer D:
All tapeworms (cestodes) cycle through 3 stage: eggs, larvae, and adults. Adults inhabit the intestines of definitive hosts, mammalian carnivores. Several of the adult tapeworms that infect humans are named after their intermediate host: the fish tapeworm (Diphyllobothrium latum), the beef tapeworm (Taenia saginata), and the pork tapeworm (Taenia solium).
The other answer choices are found in humans. Bacteroides fragilis in the large intestine. Staphylococcus epidermidis on the skin and Spirochetes in the mouth.
A patient with history of occupational exposure (worked in a silica mine) 20 years back, now presents with 6 month history of cough and weight loss. CXR shows infiltrates and fibrosis in the upper lobes.
What is the most likely diagnosis?
Correct Answer B:
Pulmonary tuberculosis is associated with silica dust exposure as an occupational disease. It is caused by Mycobacterium tuberculosis in employees who have been exposed to crystalline silica dust in the workplace.
Symptoms include cough, hemoptysis, fever, chills and weight loss. Diagnosis is made by sputum cultures and CXR. Treatment is usually with a combination of medicines such as Isoniazid, Rifampin, Ethambutol and Pyrazinamide.
> Pneumonia would not be this long of a duration and would not present with weight loss.
> Mesothelioma usually affects the lower lobes with pleural thickening.
> Rapidly progressive silicosis develops within 6 months of acute exposure.
A 55-year-old patient with a known history of chronic alcohol abuse presents to your office because he has been losing weight, he always feels tired and he has been coughing. A physical examination reveals a temperature of 38.8˚C (101.8˚F). Hepatomegaly is noted on abdominal palpation. A chest radiograph shows diffuse, well-defined nodules that are less than 5 mm in diameter. Alfa-fetoprotein is within normal limit.
Which one of the following is the most likely diagnosis?
Diffuse small pulmonary nodules are characteristic of miliary tuberculosis (TB). This disease is seen commonly in those who are immunosuppressed due to alcohol abuse. This patient's symptoms of weight loss, fatigue, and cough are very common in these patients. The findings of nodules on chest X-ray and hepatomegaly suggest the patient's TB may have multiple organs involvement. This is why miliary TB (choice D) is the best choice.
→ Bronchiectasis (choice A) may be a complication of endobronchial TB, but occurs late in the course.
→ Reactivation pulmonary TB (choice B) may also be a complication and the radiograph typically shows localized lesions.
→ Primary TB (choice C) usually consists of hilar adenopathy and a focal infiltrate (Ghon complex). Primary TB is usually a mild process, but if it becomes severe it usually presents with extensive lobar consolidation rather than diffuse nodules.
→ Hepatic carcinoma (choice E) could be a complication of chronic viral hepatitis or chronic alcohol abuse, however, in the majority of patients it is preceded by cirrhosis and the fact alfa-fetoprotein is negative in this patient should steer us away from this choice.
A 55-year-old man presents to the hospital with the complaint of severe intermittent pain in his right lower back that radiates around his trunk into his lower quadrant and upper right thigh.
Correct Answer C:
Stones, especially tiny ones, may not cause any symptoms. Stones in the bladder may cause pain in the lower abdomen. Stones that obstruct the ureter or renal pelvis or any of the kidney's drainage tubes may cause back pain or renal colic. Renal colic is characterized by an excruciating intermittent pain, usually in the flank (the area between the ribs and hip), that spreads across the abdomen, often to the genital area and inner thigh. The pain tends to come in waves, gradually increasing to a peak intensity, then fading, over about 20 to 60 minutes. The pain may radiate down the abdomen toward the groin or testicle or vulva.
Other symptoms include nausea and vomiting, restlessness, sweating, and blood in the urine. A person may have an urge to urinate frequently, particularly as a stone passes down the ureter. Chills, fever, and abdominal distention sometimes occur.
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