What past medical history? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-08-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow What past medical history?

A 31-year-old female has the following findings on oral examination: She has no significant past medical history and no other complaints. Which of the following components of her medical history is most likely to reveal the cause underlying this condition?




A. Personal allergies
B. Alcohol consumption
C. Recent travel
D. Animal contact
E. Sexual practices
F. Cave exploration
Reply With Quote Quick reply to this message
The above post was thanked by:
Evergreen (10-19-2011), Mondoshawan (02-08-2011), zitney (02-08-2011)



  #2  
Old 02-08-2011
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 405
Threads: 55
Thanked 523 Times in 155 Posts
Reputation: 533
Default

B. Alcohol consumption
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #3  
Old 02-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 55
Threads: 2
Thanked 93 Times in 27 Posts
Reputation: 103
Default

is it alcohol consumption??
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #4  
Old 02-08-2011
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 590
Threads: 31
Thanked 1,227 Times in 410 Posts
Reputation: 1251
Default E. Sexual practices

I would guess E. Sexual practices - could it be pharyngeal gonorrhea?
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #5  
Old 02-08-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

what makes people think alcohol?
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #6  
Old 02-08-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow

Quote:
Originally Posted by Mondoshawan View Post
I would guess E. Sexual practices - could it be pharyngeal gonorrhea?
It's definitely not a bacterial infection.... gonococcus!!!! not a chance. It does not produce white exudate. I'll give your extra time.... think!!
Reply With Quote Quick reply to this message
The above post was thanked by:
Mondoshawan (02-08-2011)
  #7  
Old 02-08-2011
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 244
Threads: 16
Thanked 198 Times in 86 Posts
Reputation: 208
Default

oropharyngeal candidiasis - pointing towards immunosupression - at this age (31) - possibly HIV - sexual pratices..
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011), Mondoshawan (02-08-2011), mzee74 (06-06-2012)
  #8  
Old 02-08-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by drarnab View Post
oropharyngeal candidiasis - pointing towards immunosupression - at this age (31) - possibly HIV - sexual pratices..
Doesn't that show up on the tongue rather than posterior part of hard palate?
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #9  
Old 02-08-2011
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 244
Threads: 16
Thanked 198 Times in 86 Posts
Reputation: 208
Default

Quote:
Originally Posted by patelMD View Post
Doesn't that show up on the tongue rather than posterior part of hard palate?
yeah the tongue is involved for sure, but also the other mucous membranes of the mouth - i think id seen this image used though - maybe UW or kaplanQb...

And i now think that it should be personal allergies : ( with those asthma inhalers ... arrrggh!! definitely not "Sexual practices"
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #10  
Old 02-08-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by drarnab View Post
yeah the tongue is involved for sure, but also the other mucous membranes of the mouth - i think id seen this image used though - maybe UW or kaplanQb...

And i now think that it should be personal allergies : ( with those asthma inhalers ... arrrggh!! definitely not "Sexual practices"
Okay, he just changed the picture.... lol..

that's Oral Thrush forsure.. so candidiasis..

Etiology is oral thrush can be a result of immunosupression or even immunocompromises, so I guess.. this case Sexual Practices results in HIV which would lead to immunosupression..
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011), Mondoshawan (02-08-2011)
  #11  
Old 02-08-2011
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 244
Threads: 16
Thanked 198 Times in 86 Posts
Reputation: 208
Default

Quote:
Originally Posted by patelMD View Post
Okay, he just changed the picture.... lol..

that's Oral Thrush forsure.. so candidiasis..

Etiology is oral thrush can be a result of immunosupression or even immunocompromises, so I guess.. this case Sexual Practices results in HIV which would lead to immunosupression..
lol yea..

yickkk!! i wud not want my patient saying aaaaaa with that one!
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)
  #12  
Old 02-08-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,175
Threads: 38
Thanked 852 Times in 478 Posts
Reputation: 862
Default

Quote:
Originally Posted by drarnab View Post
lol yea..

yickkk!! i wud not want my patient saying aaaaaa with that one!
Saw it in a patient once, problem was on top of the thrush, they hadn't used a mouth wash, so there was yellow starch / protein deposits (the stuff we all have in the morning), and so it was white mixed with yellow haha nasty
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011), Mondoshawan (02-08-2011)
  #13  
Old 02-08-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow

Thank you so much guys, I see all of you are trying so hard to get that right but the picture was confusing b/w allergy or oral thrush. Actually, I took this qn from UW and made some changes on qn stem. On the actual qn they have given a picture that I Could not copy down so, I was searching one from Google.

Later updated picture looks more relevant to the diagnosis. Please don't get mad at me for putting a simple and confusing picture. I attached a funny mouse picture that also got infected with Candidias. lol found it on google as well. lol
Reply With Quote Quick reply to this message
The above post was thanked by:
drarnab (02-08-2011), Mondoshawan (02-08-2011), patelMD (02-08-2011)
  #14  
Old 02-08-2011
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 487
Threads: 95
Thanked 1,458 Times in 356 Posts
Reputation: 1468
Arrow E) Sexual practices

Here is the full explanation for your diagnosis:

White plaques on the oral mucosa as shown in the image above are characteristic of oral thrush, a localized manifestation of Candida albicans infection. The other types of superficial disease associated with this fungus include cutaneous candidiasis (“diaper rash” in infants) and Candida vulvovaginitis.

Oral thrush occurs in denture wearers, diabetics immunosuppressed patients, and patients receiving steroids, antibiotics or chemotherapy. Oral thrush in an otherwise healthy individual is suggestive of immunosuppression and is a common presentation of HIV infection. Vulvovaginal candidiasis is associated with antibiotic and contraceptive use, pregnancy, diabetes mellitus and HIV. Cutaneous candidiasis occurs in areas exposed to heat and high humidity (such as the groin and perianal area in infants).

Oral thrush most commonly presents with white patches on the oral mucosa (membranous candidiasis). The patches can be scraped oft, revealing an erythematous mucosal surface. Microscopic examination of KOH-treated scrapings shows Candida yeast and pseudohyphae.
Reply With Quote Quick reply to this message
The above post was thanked by:
adrenaline rush (02-08-2011), conspicous (02-08-2011), Mondoshawan (02-08-2011), zitney (02-08-2011)
  #15  
Old 02-08-2011
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 590
Threads: 31
Thanked 1,227 Times in 410 Posts
Reputation: 1251
Default

Great question - and great discussion!
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011)



  #16  
Old 02-08-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 55
Threads: 2
Thanked 93 Times in 27 Posts
Reputation: 103
Default

Quote:
Originally Posted by patelMD View Post
what makes people think alcohol?
''no significant past medical history and no other complaints'' made me think of oral leucoplakia due to chronic irritation caused by excessive alcohol consumption. after changing the picture, it clearly is indicative of oral thrush.
Reply With Quote Quick reply to this message
The above post was thanked by:
aktorque (02-08-2011), Mondoshawan (02-08-2011), patelMD (02-08-2011)



Reply

Tags
Clinical-Signs, Figures-, Microbiology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
MCC Past exam questions and lots more on sale drsanchana For Sale & Wanted Items 0 10-18-2010 06:52 AM
type 1 diabetes mellitus for the past 15 years khushboo USMLE Step 1 Forum 4 06-13-2010 03:26 AM
Social History X 3 lee-usmle USMLE Step 2 CS Forum 0 02-04-2010 12:02 PM
Past Experiences jessp687 USMLE Step 1 Forum 4 10-17-2009 06:54 PM
LIQORAAA; History of present illness mnemonic apnepal USMLE Step 2 CS Mnemonics 0 07-31-2009 11:30 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)