Pathology EMQ template.

Name: Nick Mulrenan

Candidate number: 00405370

Theme: Mycobacterial disease

OPTION LIST

A	Buruli ulcer	I	Primary tuberculosis
B	Ethambutol side effect	J	Pyrazinamide side effect
C	Ghon complex	K	Scrofula
D	Ghon focus	L	Tuberculoid leprosy
E	Lepromatous leprosy	M
F	Miliary tuberculosis	N
G	Mycobacterium avium-intracellulare	O
H	Pneumocystis jiroveci	P

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 25 year old Kenyan has just returned from his travels around Western Africa. He has developed a nodule on his ankle. Despite the fact that the nodule is painless, he breaks into tears as he gazes at the necrotising lesion. You tell him big boys don't cry and ponder your diagnosis.

2. A woman comes in who has developed a painless bluish nodule in her neck. The patient has also developed a fever and chills over the last couple of weeks. An FNA is done which shows acid-fast bacilli.

3. Mr Kumar is an immunocompromised fellow with a CD4 count of 35 cells/mm³. He has a cough, fever and weight loss. There are large amounts of acid-fast bacilli on gram stain although labs confirm this is a non-tuberculous infection.

4. On elective in Brazil you see a boy brought to the hospital by his mother. He has a single depigmented macular patch on his forearm. It is roughly 3-4cm wide and the boy also explains how there is a sensory loss. A Lepromin test is done and comes back positive.

5. Mr. Cohen, a loud-mouthed Jew, arrives in your clinic with visual problems. He is adamant he has Tay Sachs and says he can see his cherry-red macula in the mirror. You proceed with ophthalmosocopy and see nothing unusual. You see in his notes he is currently on treatment for tuberculosis - a lightbulb appears above your head and you vow to always think twice before trusting hysterical jews.

ANSWERS

1. A

2. K

3. G

4. L

5. B