136 - infectious diseases mcqs - 1

Match the clinical description with the most likely etiologic agent.

a. Candida albicans
b. Aspergillus flavus
c. Coccidioides immitis
d. Herpes simplex type 1
e. Herpes simplex type 2
f. Hantavirus
g. Tropheryma whippelii
h. Coxsackievirus B
i. Histoplasma capsulatum
j. Human parvovirus
k. Cryptococcus neoformans

55. An HIV-positive patient develops fever and dysphagia; endoscopic
biopsy shows yeast and hyphae.

56. A 50-year-old develops sudden onset of bizarre behavior. CSF shows
80 lymphocytes; magnetic resonance imaging shows temporal lobe abnormalities.

57. A patient with a previous history of tuberculosis now complains of
hemoptysis. There is an upper lobe mass with a cavity and a crescentshaped
air-fluid level.

58. A Filipino patient develops a pulmonary nodule after travel through
the American Southwest.

59. A 35-year-old male who had a fever, cough, and sore throat develops
chest pain after several days, with diffuse ST segment elevations on ECG.

60. Overwhelming pneumonia with adult respiratory distress syndrome
occurs on an Indian reservation in the Southwest following exposure to
deer mice.

The answers are 55-a, 56-d, 57-b, 58-c, 59-h, 60-f.

(Kasper,
pp 1038, 1055–1056, 1144–1146, 1172, 1180–1181, 1186–1187, 1188, 1413,
2480–2483.)

There are several causes for dysphagia in the HIV-positive
patient, including C. albicans, herpes simplex, and cytomegalovirus. The
biopsy result in this patient confirms Candida infection with the typical picture
of both yeast and hyphae seen on smear.

Herpes simplex encephalitis can occur in patients of any age—usually
in immunocompetent patients. Most adults with HSV encephalitis have
previous infection with mucocutaneous HSV-1. The bizarre behavior
includes personality aberrations, hypersexuality, or sensory hallucinations.
CSF shows lymphocytes with a close-to-normal sugar and protein. Focal
abnormalities are seen in the temporal lobe by CT scan, MRI, or EEG.

The patient who has had a previous history of tuberculosis and now
complains of hemoptysis would be reevaluated for active tuberculosis.
However, the chest x-ray described is characteristic of a fungus ball—
almost always the result of an aspergilloma.

The Filipino patient who has developed a pulmonary nodule after
travel through the Southwest would be suspected of having developed coccidioidomycosis.Individuals from the Philippines have a higher incidence
of the disease and are more likely to have complications of dissemination.

The 35-year-old with cough, sore throat, and fever went on to develop
symptoms of myopericarditis with typical ECG findings. Coxsackievirus B
infection is the most likely cause of URI symptoms that evolve into a picture
of myocarditis. Myocarditis may be asymptomatic or can present with
chest pain, both pleuritic and ischemic-like. Enteroviruses rarely if ever
attack the pericardium alone without involving the subepicardial
myocardium.

Hantavirus pulmonary syndrome begins with a prodromal illness of
cough, fever, and myalgias that is difficult to distinguish from other viral
illnesses such as influenza. However, the illness progresses to increased
dyspnea, hypoxia, and hypotension. The picture resembles adult respiratory
distress syndrome (ARDS), and most patients require mechanical ventilation.
The infection should be suspected when a previously healthy adult
develops unexplained pulmonary edema or ARDS without known causes.
Thrombocytopenia is also a useful clue. Transmission of hantavirus usually
occurs through aerosolization of urine from infected rodents or through the
bite of an infected rodent

135 - lung diseases diagnosis mcqs

For each set of patients below, select the most likely diagnosis.

a. Laryngeal carcinoma
b. Small cell carcinoma of the lung
c. Large cell carcinoma of the lung
d. Beryliosis
e. Sarcoidosis
f. Laryngeal papilloma
g. Bronchial adenoma
h. Cystic fibrosis
i. Hodgkin’s disease
j. Chronic obstructive lung disease
k. Acute bronchitis

135. A 20-year-old male has a cough and history of bronchitis with thick
greenish sputum. There is no history of cigarette smoking. The patient has
also been treated for abdominal cramping and malabsorption.

136. A 60-year-old black male who has a long history of cigarette smoking
and alcohol abuse complains of pain on swallowing. Pain is also
referred to the ear. The patient speaks with a hoarse voice.

137. A 55-year-old women, who began smoking cigarettes as a teenager,
has been losing weight for 3 months and complains of hemoptysis and
cough. She has also had 1 week of severe leg and back pain. Routine laboratory
data shows hyponatremia and anemia.

138. A 40-year-old electronics worker has noted increasing shortness of
breath and cough over many years, which he attributes to working conditions.
On physical exam there is dermatitis of the face and bilateral inspiratory
crackles. Chest x-ray shows hilar adenopathy and bilateral
interstitial markings.

139. A 42-year-old male is evaluated for fever, night sweats, and pruritus.
There is a 2-cm fixed supraclavicular node on physical exam as well as
bilateral axillary nodes. Chest x-ray shows mediastinal lymphadenopathy.

The answers are 135-h, 136-a, 137-b, 138-d, 139-i.

(Kasper, pp 506–516, 654, 1489, 1524, 1543–1546.) The 20-year-old male
has evidence of chronic airway infection not associated with cigarette
smoking. Cystic fibrosis is a multisystem disease with signs and symptoms
usually beginning in childhood. However, 7% of patients are diagnosed as
adults. This is an autosomal recessive disease with a gene mutation on
chromosome 7. In addition to respiratory tract infection, there are intesti-
nal complications and exocrine pancreatic insufficiency. This results in
malabsorbtion with bulky stools.

The 60-year-old black male presents with symptoms of laryngeal carcinoma.
The disease is closely correlated with smoking. Alcohol is also an
important risk factor, and the disease is more common in blacks than
whites. Symptoms depend on the anatomic region of the cancer. Pain on
swallowing is the most common symptom, sometimes with dysphagia or a
mass sensation. For glottic and subglottic tumors, hoarseness is often
present. Pain may also be referred to the ear by the recurrent laryngeal
nerve.

The incidence of small cell carcinoma of the lung is increasing in
women. The 55-year-old woman suggests the diagnosis of small cell carcinoma
because symptoms have developed quickly and there is evidence for
early metastatic disease. In addition, the syndrome of hyponatremia caused
by inappropriate ADH secretion is more likely to occur with small cell carcinoma.

The 40-year-old electronics worker is an example of environmental
lung disease. Berylliosis occurs in the high-tech electronics field as well as
in the manufacture of alloys, nuclear material, and ceramics. Usually, 2 to
15 years of exposure are required before becoming symptomatic. Dermatitis
may be present, along with nonspecific respiratory symptoms. This is a
granulomatous disease presenting in a manner similar to sarcoidosis. Tissue
levels of beryllium can be measured for definitive diagnosis.

The 42-year-old with fever, night sweats, and pruritus gives symptoms
very characteristic of Hodgkin’s disease. Most patients present with palpable
lymphadenopathy, and more than half will have mediastinal lymphadenopathy
on presentation. About half will have symptoms of fever,
night sweats, or weight loss. There may be unexplained itching as well as
cutaneous lesions such as erythema nodosum, or icthyosis.