A 5 yr old boy is rushed to the emergency room with a fever of 105F and a diffuse petechial rash over his body. The ER physician orders lab work which shows the following. Glc=30mg/dl, ketones=elevated, ACTH=elevated, Na=120mEq, K=5.7mEq, urinary 17-ketosteroids=low, PT=elevated, PTT=elevated, platelets=50,000. The blood pressure is 90/60 and dropping. The patient does not survive and a pathology report is requested by the ER physician. Which of the following findings would be noted on the pathology report?
A. Necrotic cells in the pituitary
B. Hamartoma in the hypothalamus
C. Red blood cells in the zona glomerulosa
D. Lymphocytes in the CSF
E. Warthin-Finkeldy cells in sample skin tissue
40 yr old male with a significant sexual history, presents to the internist with the complaint that he has recently been having trouble walking. A careful history reveals that the patient is a fisherman with a very ravenous appetite for seafood. The internist performs the physical exam and notices that the patient has bilateral loss of proprioception, 2-point-tactile discrimination, and vibratory sensation. Further examination reveals that the patient has bilateral spastic paralysis with hyperreflexia, hypertonia, and a positive Babinski sign. A positive Romberg test was also noted. With respect to the general appearance of the patient, the physician noted that the patient was in slight distress and appeared pale. There were no other remarkable physical findings. The physician ordered lab work which included: CBC, blood cultures, and urinalysis. The CBC revealed an RBC=2.5billion, WBC=11,000, MCV=110, HCT=45%. The urinalysis revealed presence of excess amounts of methylmalonic acid. The blood cultures were negative. Imagine that you are this patients physician, based on the above, what is a reasonable working diagnosis for this case?
A. Tabes Dorsalis
B. Thrombosis of Anterior Spinal Artery
C. Subacute Sclerosing Panencephalitis
D. Friedrichs Ataxia
E. Subacute Combined Degeneration
F. Schwanoma
6 yr old male presents to his pediatrician with weakness in the arms and legs of 3 day duration. The boy's mother states that he recently recovered from an upper respiratory tract infection 1 week ago. History of present illness reveals that the weakness started in the lower extremities and then spread to the upper extremities. The physician orders a spinal tap and the CSF profile returns with the following finding: Albuminocytologic dissociation. What is the diagnosis?
A. Poliomyelitis
B. Multiple Sclerosis
C. Duchene-Muscular Dystrophy
D. Guillain-Barre Syndrome
E. Polymyositis
A 6 mo. old male presents to the clinic with recurrent pulmonary infections. The mother states that the boy had had an uncomplicated delivery, but had difficulty passing stool for weeks after birth. When the child was able to move his bowels the mother noted that the stool was greasy in appearance. The mother also states that the child has recently started coughing up large amounts of sputum. On physical exam the physician notes dullness to percussion in both lung fields and several petechiae on the lower limbs. Which of the following medications are used to treat the organism that most commonly affects patients with this presentation?
A. Ceftriaxone
B. Penicillin G
C. Cefotaxime
D. Azithromycin
E. Cefazolin
F. Ceftazidime
