Pathology EMQ template.

Name: Chengyuan Zhang  

Theme: Zoonoses and Diseases Related to Travel

OPTION LIST

A	Malaria (P. falciparum)	I	Dengue fever
B	Malaria (P. vivax)	J	Yellow fever
C	Malaria (P. malariae)	K	Chikungunya fever
D	Lassa fever	L	Typhus fever
E	Marburg fever	M	Typhoid fever
F	Ebola fever	N	Bubonic plague
G	Poliomyelitis	O	Brucellosis
H	West Nile fever	P	Lyme disease

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1.  A 33 year old woman presents with a history of sudden onset fever, headache and myalgia. She spent most of the summer outside and recalls getting bitten by multiple mosquitos. On examination, she is pyrexial with a maculopapular rash of the trunk and extremities. CSF sample shows elevated protein and cell count, with a PMN predominance, and decreased CSF glucose. In addition, the doctor mentions to you that most patients with this condition are asymptomatic, and finding specific IgM would establish the diagnosis.

2.  A 20 year old man presents with sudden onset fever, myalgia and headache. Just before feeling unwell, he had noticed an intensely painful swelling in his left groin. He has just returned from a field trip in New Mexico and mentioned that there were some small bites on his legs which were very itchy. When you go to see him, his leg is held flexed and in external rotation and the lump is about 5cm long and tender to touch, with local oedema. Blood cultures reveal a gram negative coccobacillus.

3. A 16 year old woman presents with three days of constantly high fevers and aches and pains of the lower back. There is a predominantly frontal headache and retro-orbital pain worse on eye movement. Temperature is 38.4, BP 110/80 and radial pulse of 92. There is generalised flushing of the skin over her body on examination. Laboratory tests report a thrombocytopenia and leucopenia.

4. A 56 year old woman presents to her GP with a history of a fever and headache with chills and rigors, and she feels her heart racing during these episodes. She mentions that the fever now occurs which at regular intervals every 72 hours. She mentions that she flew to New Zealand to visit relatives but the plane stopped over in Nigeria to refuel. Her GP makes a diagnosis of influenza and tells her to go home. Two days later, she presents to A&E with similar symptoms and vomiting. She is now mildly jaundiced.

5. A 25 year old man presents with 6 weeks of fever, joint pain and weight loss. Two months ago, he had worked extensively in the animal industry in Romania and mentions he has been exposed to their products of conception, urine and faeces many times. He also drinks unpasteurised goats’ milk frequently. On examination he has hepatosplenomegaly and is tachycardic. He mentions that his immunisations are all up to date. The first year medical student thinks that the patient is going to die and palliative care should be initiated.

ANSWERS

1. H

2. N

3. I

4. C

5. O