Gyrus Daily Questions; Internal Medicine #31 - 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 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Arrow Gyrus Daily Questions; Internal Medicine #31

I-27. A 24-year-old healthy man who has just returned from a 1-week summer camping trip to the Ozarks presents to the emergency room with fever, a severe headache, mild abdom-inal pain, and severe myalgias. He is discharged home but 1 day later feels even worse and therefore returns. Temperature is 38.4°C; heart rate is 113 beats/min; blood pressure is 120/ 70. Physical examination is notable for a well-developed, well-nourished, but diaphoretic and distressed man. He is alert and oriented to time and place. His lungs are clear to auscultation. He has no heart murmur. His abdomen is mildly tender with normal bowel sounds. Neurologic exam-ination is nonfocal. There is no evidence of a rash. Labora-tory evaluation is notable for a platelet count of 84,000/µL. A lumbar puncture is notable for 5 monocytes, no red blood cells, normal protein levels, and normal glucose levels. What should be the next step in this patient’s management?

A. Atovaquone
B. Blood cultures and observation
C. Doxycycline
D. Rimantadine
E. Vancomycin, ceftriaxon
Reply With Quote Quick reply to this message



  #2  
Old 09-26-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 617 Times in 234 Posts
Reputation: 627
Default

C. Doxycycline
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (09-26-2012)
  #3  
Old 09-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Answer C Doxycycline

Seems like Q fever to me ,since no rash .Blood culture is of no use for intracellular bugs .
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
The above post was thanked by:
cingulate.gyrus (09-26-2012)
 
  #4  
Old 09-26-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 720
Threads: 217
Thanked 552 Times in 309 Posts
Reputation: 562
Default

The answer is C. Doxycycline.

This patient likely has Rocky Mountain spotted fever. The headache and thrombocytopenia after a recent camping trip in a rickettsial en-demic region are typical findings. As this is usually a serologic diagnosis requiring signif-icant laboratory processing time, and can be fatal, empirical therapy with doxycycline is warranted. The lack of a rash does not preclude this diagnosis because the characteristic macular rash spreading from the wrists and ankles centripetally appears 2–5 days after the first fever. Atovaquone is used for babesiosis, a disease that is defined by hemolysis and is not prevalent in the Ozarks. The patient has no evidence of bacterial meningitis to warrant empirical coverage. While fever and myalgias are typical of influenza, it is most common in winter and does not typically cause thrombocytopenia.
Reply With Quote Quick reply to this message
The above post was thanked by:
drsmosa (10-09-2012), step_enhancer (09-26-2012), XpaezX (09-26-2012)
  #5  
Old 09-26-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 617 Times in 234 Posts
Reputation: 627
Default

OMG RMSF(triad of fever + headache + rash). It seems to be like Q fever ( fever, a severe headache, mild abdominal pain, and severe myalgias, abdomen is mildly tender, platelet count of 84,000/µL)
Ok both are treated with Doxy
Reply With Quote Quick reply to this message



Reply

Tags
Infectious-Diseases, Internal-Medicine-, Step-2-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
Gyrus Daily Questions; Internal Medicine #20 cingulate.gyrus USMLE Step 2 CK Forum 9 01-10-2013 09:21 AM
Gyrus Daily Questions; Internal Medicine #24 cingulate.gyrus USMLE Step 2 CK Forum 2 09-23-2012 09:54 AM
Gyrus Daily Questions; Internal Medicine #17 cingulate.gyrus USMLE Step 2 CK Forum 5 09-22-2012 09:42 AM
Gyrus Daily Questions; Internal Medicine #17 cingulate.gyrus USMLE Step 2 CK Forum 6 09-22-2012 12:31 AM
Gyrus Daily Questions; Internal Medicine #8 cingulate.gyrus USMLE Step 2 CK Forum 4 09-20-2012 08:08 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)