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A 52-year-old man weighing 70 kg was brought to the Emergency Department with confusion and delirium. He had a fever for more than 24 hours and during that time complained of severe headache, nausea and vomiting. Lumbar puncture shows elevated pressure and cerebrospinal fluid with increased protein, decreased glucose, and increased neutrophils. A Gram stain of a CSF smear showed gram-positive diplococci, and a tentative diagnosis of purulent meningitis was made. According to the microbiological consultation, for 15% of S. pneumoniae isolates, the minimum inhibitory concentration for penicillin G is 20 mcg/ml. This patient should be treated immediately with intravenous administration of:
A 52-year-old man weighing 70 kg was brought to the Emergency Department with confusion and delirium. He had a fever for more than 24 hours and during that time complained of severe headache, nausea and vomiting. Lumbar puncture shows elevated pressure and cerebrospinal fluid with increased protein, decreased glucose, and increased neutrophils. A Gram stain of a CSF smear showed gram-positive diplococci, and a tentative diagnosis of purulent meningitis was made. According to the microbiological consultation, for 15% of S. pneumoniae isolates, the minimum inhibitory concentration for penicillin G is 20 mcg/ml. This patient should be treated immediately with intravenous administration of:
A patient undergoing treatment for Hansen's disease develops hemolytic anemia. The patient's lab tests indicate the presence of a G-6-PD deficiency. What medication most likely caused the anemia?
A patient undergoing treatment for Hansen's disease develops hemolytic anemia. The patient's lab tests indicate the presence of a G-6-PD deficiency. What medication most likely caused the anemia?
If ampicillin and piperacillin are used in combination to treat Pseudomonas aeruginosa, antagonism may occur. The most likely explanation is:
If ampicillin and piperacillin are used in combination to treat Pseudomonas aeruginosa, antagonism may occur. The most likely explanation is:
John Doe, a 38 year-old man arrives at your free clinic with the chief complaint of irritating small blisters on his genitals. A swab from his sores is taken and sent to the lab for analysis. Based upon the appearance of his sores, a tentative diagnosis of genital herpes is made. Which of the following should you prescribe for treatment, at least until the lab results come back in 3-4 days?
John Doe, a 38 year-old man arrives at your free clinic with the chief complaint of irritating small blisters on his genitals. A swab from his sores is taken and sent to the lab for analysis. Based upon the appearance of his sores, a tentative diagnosis of genital herpes is made. Which of the following should you prescribe for treatment, at least until the lab results come back in 3-4 days?
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A 35-year-old male presents to the general practitioner with complaints of coryza and cough. His symptoms began last evening, and he reports malaise and body aches. His examination reveals nasal mucosal swelling, rhinorrhea, and mild pharyngeal congestion. There is no cervical lymphadenopathy, and examination odd his chest is unremarkable. His procalcitonin reveals a value of 0.1 ng/ml. Which of the following will most likely reduce the symptom duration in this individual?
A 35-year-old male presents to the general practitioner with complaints of coryza and cough. His symptoms began last evening, and he reports malaise and body aches. His examination reveals nasal mucosal swelling, rhinorrhea, and mild pharyngeal congestion. There is no cervical lymphadenopathy, and examination odd his chest is unremarkable. His procalcitonin reveals a value of 0.1 ng/ml. Which of the following will most likely reduce the symptom duration in this individual?
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Candida is the main cause of nosocomial bloodstream infections. Opportunistic fungal infection in a patient with leukemia can be prevented by administration of
Candida is the main cause of nosocomial bloodstream infections. Opportunistic fungal infection in a patient with leukemia can be prevented by administration of
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A 78-year-old man presents to the dermatologist for a full-body skin examination. He has a history of squamous cell carcinoma, for which he has had prior excisions performed. On examination, he has multiple gritty red papules across his scalp, estimated at approximately 30 lesions. He has another 20 lesions across his posterior forearms, arms, and face. Which of the following is the most appropriate treatment recommendation for the patient?
A 78-year-old man presents to the dermatologist for a full-body skin examination. He has a history of squamous cell carcinoma, for which he has had prior excisions performed. On examination, he has multiple gritty red papules across his scalp, estimated at approximately 30 lesions. He has another 20 lesions across his posterior forearms, arms, and face. Which of the following is the most appropriate treatment recommendation for the patient?
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Normal human cells undergo a finite number of cell divisions before they enter into a nondividing state called replicative senescence. An enzyme that can be modified by cancer cells, allowing them to continuously divide without limits and avoid entering this form of growth arrest is:
Normal human cells undergo a finite number of cell divisions before they enter into a nondividing state called replicative senescence. An enzyme that can be modified by cancer cells, allowing them to continuously divide without limits and avoid entering this form of growth arrest is:
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Non-sulfanylurea drugs are used to control postprandial serum glucose levels. What is their mechanism of action?
Non-sulfanylurea drugs are used to control postprandial serum glucose levels. What is their mechanism of action?
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A 40-year-old woman presents with frequent urination, dry mouth, and fatigue for the last 6 months. Her menstrual periods are regular, occurring every 28 days with 3-4 days of moderate bleeding. She is sexually active with her husband and desires to get pregnant. Her history is significant for gestational diabetes in her last pregnancy 6 years ago, which was managed successfully with nutritional therapy, exercise, and glyburide. Her family history is positive for type 2 diabetes mellitus in her mother. Vital signs are temperature 37 C (98.6 F), blood pressure 137/87 mmHg, heart rate 77 bpm, and respiratory rate 16 breaths/min. Her BMI is 32 kg/m2. She is diagnosed with type 2 diabetes mellitus, and several oral hypoglycemic agents (OHAs) are discussed. She shares her preference for glyburide due to her experience with it. Which of the following is the most appropriate advice regarding OHAs, including glyburide, for this patient?
A 40-year-old woman presents with frequent urination, dry mouth, and fatigue for the last 6 months. Her menstrual periods are regular, occurring every 28 days with 3-4 days of moderate bleeding. She is sexually active with her husband and desires to get pregnant. Her history is significant for gestational diabetes in her last pregnancy 6 years ago, which was managed successfully with nutritional therapy, exercise, and glyburide. Her family history is positive for type 2 diabetes mellitus in her mother. Vital signs are temperature 37 C (98.6 F), blood pressure 137/87 mmHg, heart rate 77 bpm, and respiratory rate 16 breaths/min. Her BMI is 32 kg/m2. She is diagnosed with type 2 diabetes mellitus, and several oral hypoglycemic agents (OHAs) are discussed. She shares her preference for glyburide due to her experience with it. Which of the following is the most appropriate advice regarding OHAs, including glyburide, for this patient?
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A 42-year-old woman developed a syndrome of polyuria, thirst, and hypernatremia after surgical removal of part of the pituitary gland. A suitable treatment for these symptoms is
A 42-year-old woman developed a syndrome of polyuria, thirst, and hypernatremia after surgical removal of part of the pituitary gland. A suitable treatment for these symptoms is
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A patient diagnosed with H. pylori-associated ulcer is treated with a combination of antibiotics and a proton pump inhibitor. Besides helping damaged stomach tissue heal due to reduced acidity, there is an additional mechanism by which PPIs produce beneficial effects. What mechanism is this?
A patient diagnosed with H. pylori-associated ulcer is treated with a combination of antibiotics and a proton pump inhibitor. Besides helping damaged stomach tissue heal due to reduced acidity, there is an additional mechanism by which PPIs produce beneficial effects. What mechanism is this?
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A 50-year-old man presents with dull stomach pain, weight loss, and nausea. Following endoscopic examination, the patient is diagnosed with a stomach ulcer. The patient's clinician prescribes an H2 blocker. Which of the following would produce a similar effect on stomach pH in this patient as the administration of an H2 blocker?
A 50-year-old man presents with dull stomach pain, weight loss, and nausea. Following endoscopic examination, the patient is diagnosed with a stomach ulcer. The patient's clinician prescribes an H2 blocker. Which of the following would produce a similar effect on stomach pH in this patient as the administration of an H2 blocker?
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A patient on a cruise ship suffers an asthma attack and requires a rapidly acting bronchodilator. Unfortunately the pharmacy has run out of all levalbuterol (levosalbutamol) inhalers. In this situation, what other option if available, might be most effective to treat bronchospasm with a relatively rapid onset of action (but needs to be co-administered along with a corticosteroid)?
A patient on a cruise ship suffers an asthma attack and requires a rapidly acting bronchodilator. Unfortunately the pharmacy has run out of all levalbuterol (levosalbutamol) inhalers. In this situation, what other option if available, might be most effective to treat bronchospasm with a relatively rapid onset of action (but needs to be co-administered along with a corticosteroid)?
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A 7-year-old boy presents with itching over his face and hands. He was attending a birthday party, and exotic animals, including a large spider, were brought in to entertain the children. Her son held the spider but denied being bitten. Physical examination reveals erythema of the skin of the face and hands with injected sclera bilaterally. What is the most appropriate management strategy?
A 7-year-old boy presents with itching over his face and hands. He was attending a birthday party, and exotic animals, including a large spider, were brought in to entertain the children. Her son held the spider but denied being bitten. Physical examination reveals erythema of the skin of the face and hands with injected sclera bilaterally. What is the most appropriate management strategy?
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A 46-year-old woman presents to the emergency department with 9/10 right upper quadrant abdominal pain and a temperature of 38.6 °C (101.5 °F). The examination is notable for jaundice and a positive Murphy sign. Further questioning reveals the patient is being treated for familial hypertriglyceridemia. Which of the following medications is most likely responsible for this patient's presentation?
A 46-year-old woman presents to the emergency department with 9/10 right upper quadrant abdominal pain and a temperature of 38.6 °C (101.5 °F). The examination is notable for jaundice and a positive Murphy sign. Further questioning reveals the patient is being treated for familial hypertriglyceridemia. Which of the following medications is most likely responsible for this patient's presentation?
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Megaloblastic anemia as a result of vitamin B12 deficiency is due to a lack of
Megaloblastic anemia as a result of vitamin B12 deficiency is due to a lack of
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A pregnant patient was prescribed a sympathomimetic as a tocolytic. What is most important in patient follow-up?
A pregnant patient was prescribed a sympathomimetic as a tocolytic. What is most important in patient follow-up?
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A 32-year-old woman with early-stage ER+ breast cancer requires treatment. You elect to start therapy with a selective estrogen receptor modulator that exerts its effect by binding to and inhibiting the estrogen receptor expressed in breast tumor cells. Which medication will you prescribe for this purpose?
A 32-year-old woman with early-stage ER+ breast cancer requires treatment. You elect to start therapy with a selective estrogen receptor modulator that exerts its effect by binding to and inhibiting the estrogen receptor expressed in breast tumor cells. Which medication will you prescribe for this purpose?
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A patient who has recently suffered from weight gain, chronic fatigue, cold intolerance, and myxedema is diagnosed with hypothyroidism. Which of the following would be the best treatment choice for this patient?
A patient who has recently suffered from weight gain, chronic fatigue, cold intolerance, and myxedema is diagnosed with hypothyroidism. Which of the following would be the best treatment choice for this patient?
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On a pregnant patient who is prescribed a sympathomimetic as a tocolytic, what is the most important aspect to monitor during follow-up?
On a pregnant patient who is prescribed a sympathomimetic as a tocolytic, what is the most important aspect to monitor during follow-up?
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A patient diagnosed with H. pylori-associated ulcer is treated with a combination of antibiotics and a proton pump inhibitor. Besides helping damaged stomach tissue heal due to reduced acidity, what is an additional mechanism by which PPIs produce beneficial effects?
A patient diagnosed with H. pylori-associated ulcer is treated with a combination of antibiotics and a proton pump inhibitor. Besides helping damaged stomach tissue heal due to reduced acidity, what is an additional mechanism by which PPIs produce beneficial effects?
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Study Notes
Patient Case Studies
- A 52-year-old male, weighing 70kg, presented to the Emergency Department with confusion, delirium, fever (over 24 hours), headache, nausea, and vomiting.
- Lumbar puncture revealed elevated pressure, increased protein, decreased glucose, and elevated neutrophils in the cerebrospinal fluid.
- Gram-positive diplococci were observed in the cerebrospinal fluid.
- A preliminary diagnosis of purulent meningitis was made.
- Microbiological consultation indicated a 15% minimum inhibitory concentration (MIC) of penicillin G at 20mcg/ml for S. pneumoniae isolates.
- Immediate intravenous administration of ceftriaxone + vancomycin was recommended.
Drug Resistance
- Pneumococcal isolates with an MIC for penicillin G above 2mcg/ml are highly resistant to penicillin G and ampicillin.
- Nafcillin shows weak activity against penicillin-resistant pneumococci, while piperacillin primarily targets gram-negative rods.
- Cefotaxime and ceftriaxone are the most effective cephalosporins against penicillin-resistant pneumococci.
- Vancomycin is recommended for highly resistant strains.
Hansen's Disease and Anemia
- A patient with Hansen's disease developed hemolytic anemia.
- Lab results indicated a G6PD deficiency.
- Dapsone was a likely causative medication for the anemia.
Pseudomonas aeruginosa Infections
- Combining ampicillin and piperacillin to treat Pseudomonas aeruginosa may result in antagonism.
- Ampicillin induces beta-lactamase production.
- Piperacillin blocks the attachment of ampicillin to penicillin-binding proteins.
Genital Herpes Treatment
- A 38-year-old man presented with genital herpes symptoms.
- A swab sample was analyzed, and a diagnosis was made.
- Amantadine or lamivudine should be prescribed for treatment.
Upper Respiratory Tract Infection (URTI)
- A 35-year-old male presented with coryza, cough, malaise, and body aches.
- Examination showed nasal congestion and normal procalcitonin levels.
- A viral upper respiratory tract infection (URTI) was likely.
- Zinc supplementation within 24 hours of symptom onset (75mg +) was recommended to reduce symptom duration.
Candidiasis in Immunocompromised Patients
- Candida is the main cause of nosocomial bloodstream infections.
- Opportunistic fungal infections in leukemia patients can be prevented by administering antifungal medicines (e.g. caspofungin).
Actinic Keratosis Treatment
- A 78-year-old man presented with multiple gritty red papules across his scalp, estimated to be approximately 30 lesions.
- Prior excisions for squamous cell carcinoma (SCC) were performed.
- Topical 5-fluorouracil or cryotherapy are suitable treatment options.
Megaloblastic Anemia
- Megaloblastic anemia is a result of vitamin B12 deficiency due to a lack of cobalamin.
- Vitamin B12 deficiency leads to tetrahydrofolate deficiency, which affects DNA synthesis, resulting in a build-up of homocysteine and methyltetrahydrofolate.
Familial Hypertriglyceridemia and Cholecystitis
- A 46-year-old woman presented with RUQ pain, jaundice, and a positive Murphy sign.
- The patient was being treated for familial hypertriglyceridemia.
- Cholecystitis secondary to choledocholithiasis was diagnosed.
H2 Blockers and Stomach Ulcers
- H2 blockers increase stomach pH to treat ulcers.
- Gastrin increase stomach acid production, unlike decreased levels which would cause increased pH,
- Acetylcholine also increase stomach acid production, unlike decreased levels which would cause increased pH,
Rapid-Acting Bronchodilators for Asthma
- A patient with asthma attack required a rapid-acting bronchodilator in a cruise ship emergency
- Formoterol, used combined with an ICS is considered the most effective option if levalbuterol is unavailable
- Formoterol is a long-acting beta-2 agonist similar to SABAs.
- Formoterol, in combination with an ICS, has shown to be effective for acute asthma attacks and as a maintenance drug.
Tarantula Hairs and Urticaria
- A 7-year-old boy presented with itching on his face and hands after being exposed to a tarantula.
- Systemic symptoms such as envenomation were not present, only localized effects.
- Diphenhydramine and/or topical treatments may be used with consideration for ophthalmology consultation prior to releasing the patient.
Diabetes Insipidus Treatment
- A 42-year-old woman presented with polyuria, thirst, and hypernatremia after a pituitary surgery.
- A diagnosis of diabetes insipidus (DI) was made.
- Desmopressin is a selective V2 vasopressin receptor agonist for central DI, which can treat the symptoms.
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Description
This quiz explores a case study of a 52-year-old male presenting with symptoms indicative of purulent meningitis. It also examines drug resistance patterns of pneumococcal isolates, focusing on minimum inhibitory concentrations (MIC) and recommended treatments. Test your knowledge on these critical topics in infectious diseases.
