Fever, cytopenia - 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 12-01-2009
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 5
Threads: 2
Thanked 15 Times in 3 Posts
Reputation: 25
RBC Fever, cytopenia

23 male hiker from Michigan presented with 4 days history of fever, malaise, nausea, vomiting, joint aches. Physicals unremarkable and no rash seen.
CBC showed severe leukopenia. Gram stain did not help.
Blood film is here
Fever, cytopenia-fasf.jpg
click image to enlarge

What is the drug of choice?
Doxycyclin
TMP-SMX
Amantidine
Flucanazole
Mebendazole
Reply With Quote Quick reply to this message
The above post was thanked by:
abeer (04-11-2011), drali (04-11-2011), Farrukh Munir (04-03-2012), lee-usmle (12-02-2009), Sana Zahid (04-09-2011), smile135 (12-03-2009), wahaha007 (01-19-2010)



  #2  
Old 12-01-2009
iantang's Avatar
USMLE Forums Newbie
 
Steps History: 1 + CS
Posts: 6
Threads: 1
Thanked 33 Times in 4 Posts
Reputation: 43
Default

Is that Ehrlichiosis?
Reply With Quote Quick reply to this message
The above post was thanked by:
wahaha007 (01-19-2010)
  #3  
Old 12-02-2009
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 55
Threads: 7
Thanked 107 Times in 23 Posts
Reputation: 117
Default

This ehrlichiosis as evident by the cytopenia and the mulberry structures inside the luekocyte
The correct answer is doxycylin
Hey Jimmy, am I right
Reply With Quote Quick reply to this message
The above post was thanked by:
tinhi (04-09-2011), wahaha007 (01-19-2010)
  #4  
Old 12-02-2009
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 5
Threads: 2
Thanked 15 Times in 3 Posts
Reputation: 25
Default

Quote:
Originally Posted by Firas View Post
This ehrlichiosis as evident by the cytopenia and the mulberry structures inside the luekocyte
The correct answer is doxycylin
Hey Jimmy, am I right
You nailed the correct answer
Reply With Quote Quick reply to this message
  #5  
Old 04-09-2011
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 91
Threads: 17
Thanked 108 Times in 37 Posts
Reputation: 118
Default

Quote:
Originally Posted by Firas View Post
This ehrlichiosis as evident by the cytopenia and the mulberry structures inside the luekocyte
The correct answer is doxycylin
Hey Jimmy, am I right
Quote:
Originally Posted by Jimmy View Post
You nailed the correct answer
looks like histoplasmosis how can I make the difference between histoplasmosis and ehlichiosis
Reply With Quote Quick reply to this message
  #6  
Old 04-09-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 298
Threads: 45
Thanked 713 Times in 210 Posts
Reputation: 723
Default

This picture is small to really tell if those are yeast forms or not, but the attached picture is what Histoplasmosis would look like on a blood smear.

I think the key here is in the history/presentation. Histoplasmosis does not classically cause leukopenia. Additionally, we are told that the man is a hiker. This should clue us in on some sort of tick borne disease or arbovirus type infection.

I did not know that this was Erlichiosis, but since the question was asking about treatment, I was able to guess right with Doxycycline. As a general rule, many of the rare infections such as those that are tick borne (lyme, RMSF, etc) are usually treated with Doxycycline.
[IMG]file:///C:/Users/Amar/AppData/Local/Temp/moz-screenshot-5.png[/IMG][IMG]file:///C:/Users/Amar/AppData/Local/Temp/moz-screenshot-6.png[/IMG]
Attached Thumbnails
Fever, cytopenia-histo.jpg  
Reply With Quote Quick reply to this message
The above post was thanked by:
tinhi (04-09-2011)
  #7  
Old 04-09-2011
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 91
Threads: 17
Thanked 108 Times in 37 Posts
Reputation: 118
Default

Quote:
Originally Posted by apx85 View Post
This picture is small to really tell if those are yeast forms or not, but the attached picture is what Histoplasmosis would look like on a blood smear.

I think the key here is in the history/presentation. Histoplasmosis does not classically cause leukopenia. Additionally, we are told that the man is a hiker. This should clue us in on some sort of tick borne disease or arbovirus type infection.

I did not know that this was Erlichiosis, but since the question was asking about treatment, I was able to guess right with Doxycycline. As a general rule, many of the rare infections such as those that are tick borne (lyme, RMSF, etc) are usually treated with Doxycycline.
[IMG]file:///C:/Users/Amar/AppData/Local/Temp/moz-screenshot-5.png[/IMG][IMG]file:///C:/Users/Amar/AppData/Local/Temp/moz-screenshot-6.png[/IMG]
thank you
Reply With Quote Quick reply to this message



Reply

Tags
Blood-Films, Hematology-, Microbiology-, Micrographs-, 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
Rashes and fever dr z USMLE Step 1 Mnemonics 10 06-03-2016 08:45 AM
Why September 1st Fever! evavar IMG Residency Match Forum 1 01-10-2011 11:22 PM
question - hyperthyroidism and fever mtoi USMLE Step 1 Forum 1 11-02-2010 05:02 PM
RLQ Pain & Tenderness + Fever? Hohepa USMLE Step 2 CK Forum 6 04-12-2010 04:49 PM
Fever and Cough Sarah-cali USMLE Step 1 Forum 7 03-07-2010 05:01 PM

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)