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Comments ...

 +0  (nbme23#48)

FA 2019 page 390. This patient is expressing symptoms of biliary colic due to neurohormonal activation by CCK after a fatty meal. The labs will be normal and ultrasound will show cholelithiasis. However, I think this can be confused with acalculous because it also presents with inspiratory arrest on RUQ palpation due to pain. Acalculous cholecystitis is seen in critically ill patients.

 +1  (nbme23#1)

FA 2019 page 152. The whole getting bitten by kitten things is a distractor. The two giveaways are NO lymphadenopathy and erythematous plaques with central clearing and scaly borders. Bartonella spp. is the cause of cat-scratch disease and causes bacillary angiomatosis. Bacillary angiomatosis can be found on page 469 of FA 2019.

 +1  (nbme22#21)

FA 2019 page 419. Pt's PC is low and BT is increased. TTP presents with the triad (thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury), fever, and neurologic symptoms.

 +0  (nbme22#2)

Page 576 of FA2019. This is the renin-angiotensin-aldosterone system working. A decrease in BP is sensed by the renal baroreceptors causing a release of renin.

Subcomments ...

submitted by sajaqua1(347),

Critical points for this question: 5 year old boy, immunosuppressed because of chemotherapy, 2 day history of fever, cough, shortness of breath, febrile (101.8 F), respirations 46/min, with cyanosis and generalized vesicular rash. Extensive nodular infiltration.

Of the options listed only measles and VZV give a rash. A rash from measles usually starts rostrally and descends caudally, and is flat and erythematous. By contrast, VZV (chickenpox) presents with generalized rash that quickly transitions from macular to papular then to vesicular.

sympathetikey  Good call. +3  
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5  
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +1  
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +1  

submitted by smc213(80),

Mucor, Rhizopus, Absidia (Zygomycophyta) Irregular, broad, nonseptate hyphae branching at wide angles. Sporangiospores are inhaled from soil. The fungi penetrate the cribiform plate (no barriers), proliferate in blood vessel walls, progressing rapidly from sinuses into the brain tissue. • Mucormycosis: Rhinocerebral, frontal lobe abscess; cavernous sinus thrombosis. Characterized by paranasal swelling, necrotic tissues (black necrotic eschar on face), hemorrhagic exudates from nose and eyes, mental lethargy, headache, facial pain; may have cranial nerve involvement. • Occurs in ketoacidotic diabetic and neutropenic (leukemic) patients Treatment: debridement of necrotic tissue and amphotericin B or isavuconazole started immediately. Fatality rate is high due to rapid growth and invasion.

jboud86  FA 2019 page 153. +  

46,XX DSD due to excessive and inappropriate exposure to androgenic steroids during early gestation (i.e. congenital adrenal hyperplasia).

jboud86  I'm just adding the page number from FA 2019 to this comment. FA 2019 page 625. +2  

submitted by dr.xx(93),

The hallmark of ITP is isolated thrombocytopenia.


jboud86  Refer to page 419 in FA2019. +1  
hello  @dr.xx Compared to what? +