A 38 Year Old Man Complaining Of Cyclic Fever.

A 38-year-old man comes to the emergency department complaining of cyclic fevers and
headaches. The fevers began about 1 week ago; 2 weeks ago the patient returned from a trip to Africa. Physical examination reveals splenomegaly, and brain imaging shows signs of significant cerebral involvement. Which of the following parasites most likely caused this patient’s symptoms?

(A) Babesia microti
(B) Plasmodium falciparum
(C) Plasmodium malariae
(D) Plasmodium ovale
(E) Plasmodium vivax

Answer And Discussion:

A 25 Year Old Woman With A 2 Day History Of Dysuria And Urinary Frequency

A 25-year-old woman complains of a 2-day history of dysuria, urgency, and urinary frequency. She denies the use of any medications and has no significant past medical history.
On examination, her blood pressure (BP) is 100/70 mm Hg, heart rate (HR) is 90 beats per minute, and temperature is 98°F (36.6°C). The thyroid is normal on palpation. The heart and lung examinations are normal. She does not have back tenderness. The abdomen is non tender and without masses. The pelvic examination reveals normal female genitalia. There is no adnexal tenderness or masses.

1. What is the most likely diagnosis?
2. What is the next step in the diagnosis?
3. What is the most likely etiology of the condition?

Answers And Discussion:

A 19 Year Old Woman Presenting With A Vaginal Discharge

A 19-year-old nulliparous woman presents to her gynecologist with the complaint of a vaginal discharge with a fishy odor over the past 2 weeks. The patient is sexually active and states that the odor is especially prominent after intercourse. Her last menstrual period was 3 weeks ago. She denies having any history of sexually transmitted diseases. She is in good health and takes no medications other than an oral contraceptive agent.
On examination, her blood pressure (BP) is 110/70 mm Hg, heart rate (HR) is 80 beats per minute, and temperature is afebrile. The thyroid is normal to palpation. The heart and lung examinations are normal. The external genitalia are normal; the speculum examination reveals a homogeneous, white vaginal discharge and a fishy odor. No erythema or lesions of the vagina are noted.

1.  What is the most likely diagnosis?
2. What is the best treatment for this condition?

Answer And Discussion:

Case Discussion On Osteoporosis

Your patient is an overweight 75 years old female with no history of bone fracture. She has never had a bone mineral density test and asks if she should have one. You are unaware of any risk factors in her other than her postmenopausal status.

1. What will you tell this patient?
2. Which Of the Medications can increase her risk for osteoporosis?

1. What will you tell this patient?
Answer: Bone densitometry screening is currently recommended for all women age 65 years and older.

Case Discussion:

A 40 Year Old Woman With Symptomatic Gall Stone Disease

An otherwise healthy 40-year-old woman sees you because of recurrent abdominal pain. In the past month she has had four episodes of colicky epigastric pain. Each of these episodes has lasted about 30 minutes and has occurred within an hour of eating. Two of the episodes have been associated with sweating and vomiting. None of the episodes have been associated with fever or shortness of breath. There is no history of weight loss. She does not drink alcohol or take any prescription or over-the counter medications. Other than three previous uneventful vaginal deliveries, she has never been hospitalized.
Her examination is negative except for mild obesity (BMI = 32).
On investigation a complete blood count and liver function test is normal. A gallbladder sonogram reveals multiple gallstones.

What is the next best step in the treatment of this patient?

a. Omeprazole, 20 mg daily for eight weeks.
b. Ursodeoxycholic acid
c. Observation without specific therapy
d. Laparoscopic cholecystectomy
e. Weight reduction

Answer And Discussion:

Prognostic Factors For Acute Pancreatitis

A 35-year-old alcoholic man is admitted with nausea, vomiting, and abdominal pain that radiates to the back. He has had several previous episodes of pancreatitis presenting with the same symptoms. Which of the following laboratory values suggests a poor prognosis in this patient?

a. Elevated serum lipase
b. Elevated serum amylase
c. Leukocytosis of 20,000/μm
d. Diastolic blood pressure greater than 90 mm Hg
e. Heart rate of 100 beats/minute

Answer And Discussion: