Divine Intervention Episode 2

Viral Cases
Some MS4
1
HIV patient presents with disseminated, raised skin
lesions with central umbilication. Diagnosis?
Method of spread? Special viral “class”
characteristics (DNA or RNA, point of replication,
envelope, available vaccines). The cowpox virus.
2
Patient on natalizumab presents with a 3 week
history of quadriplegia. MRI is notable for an
increased preponderance of white matter lesions.
Diagnosis? Bug? Classic populations affected (2)?
Hemorrhagic cystitis in a patient who recently got a
kidney transplant. Other HY causes of hemorrhagic
cystitis (2 bugs, 1 drug).
3
Pet store owner is rushed to the hospital by
ambulance with a 24 hr history of bloody diarrhea
and vomiting. PE is notable for hemorrhagic ocular
and oral effusions. He returned from a 1 week trip
to Nigeria where he performed studies on rats.
Diagnosis? Bug? Treatment strategies (low yield)?
4
17 yo F who went “spelunking” 3 months ago is
comatose in the ICU. She was initially brought to
the hospital by concerned family members when
she did not bathe or eat/drink for a 2 week period.
Diagnosis? Bug? Classic “animal” associations?
Histology? Cell biology tie-in. Treatment after
exposure. HY psychiatric med associated with
hypersalivation.
5
3 yo M from San Francisco + lipase and amylase
elevations at 5x ULN + enlarged testicles + enlarged
parotids + low grade fevers. Diagnosis? Bug?
Preventive strategies. Boy with enlarged testicles +
long face + large ears + moderate mental
retardation. Diagnosis? Pathophysiology? Genetics?
6
A discussion of the Herpes viruses (general
characteristics and by category). HSV1 and 2, VZV,
EBV, CMV, Roseola, and KSHV.
7
12 mo child with wheezing. There is no family
history of asthma or atopy. The child had a sore
throat and rhinorrhea for the past week. Diagnosis?
Bug? Treatment strategies? Preventive strategies.
What are the 2 things on your differential if you see
a kid < 5-6 yo on an NBME with stridor (not
wheezing)?
8A
8B
The HIV Family of Diseases -> Candida, EBV,
CMV, P. Jirovecii (vs lobar consolidation with high
fevers), Coccidioides Immitis, Histoplasma
Capsulatum, Meningitis, Diarrhea, KSHV, JC Virus,
Ring enhancing lesions on an MRI, CD4 < 50,
Purplish skin lesions in an AIDS patient that herds
cats.