A 68-year-old man in NY presents to the emergency department in late August with a 4-day history of fever and weakness. On exam, he has hyporeflexia and acute flaccid paralysis. His cerebrospinal fluid (CSF) profile shows pleocytosis, with predominance of lymphocytes and elevated protein.
He was recently cleaning out his grandson’s kiddie pool in his backyard. What is the diagnosis?

A 30-year-old man presents with a history of fever and swelling and pain in his right knee. He has a history of intravenous drug use. On exam, he has a temperature of 101°F, and has warmth, swelling, and tenderness of the right knee with limited range of motion. Joint fluid aspiration shows a synovial white blood cell (WBC) count of 75,000/mL (98% polymorphonuclear neutrophils), high protein, and low glucose. What is the most likely diagnosis and causative organism?

A 26-year-old man presents to the outpatient clinic with purulent penile discharge. He has recently become sexually active with a new partner. On
physical examination, he does not have fever, rash, ulcers, or abdominal pain. Gram stain reveals gram-negative intracellular diplococci. He denies any allergies. What is the treatment of choice?

A group of adults eating at a banquet in Michigan developed an illness after eating mahimahi, mushrooms, wonton soup, corn w margarine.8 of16 think the food taste peppery 30 minutes into the meal. They develop a burning mouth, urticaria, felt flush and have a headache. The illness last 10 hours. What do they have?

A 34 y/o male went on a church missionary trip to Africa. When he returned he developed fever, cough, runny nose, conjunctivitis, and a diffuse macular- papular rash. His CBC, Comprehensive panel was normal and CXRY showed bilateral infiltrates. What is the diagnosis?

A 48-year-old man who received a kidney transplant 3 years ago presents to your clinic in February with a 2-month history of headache and low-grade fevers. His neurologic exam is normal and head computed tomography shows no acute changes. A lumbar puncture is obtained with a high opening pressure (24 cm H2O), cerebrospinal fluid (CSF) white blood cell (WBC) count of 180/μL (90% lymphocytes), protein of 200 mg/dL, and normal glucose. Exam of CSF showing budding yeast. What is the most likely diagnosis?

Early-onset (< 3 mos) prosthetic joint septic arthritis is most often caused by which organism?

21-year-old woman presents with dysuria. Laboratory examination of urine shows pyuria and greater than 105 colony-forming units/mm3 of Escherichia coli resistant to ampicillin, cephalexin, and trimethoprim sulfamethoxazole. The organism is sensitive to nitrofurantoin and ciprofloxacin. Her Beta HCG comes back positive. Which antibiotic is most appropriate to treat her infection?

A husband and wife without significant PMH come to ED with fever, abdominal pain, and diarrhea x 1 day, 24 hours prior they ate at a picnic with 40 other parents, 38 are reported with GI illness- they ate deli sandwiches, potato salad, chocolate chip cookies, beer, cola, and chocolate milk. Stool samples from 32 are negative for e.coli 015H7, salmonella, shigella, campylobacter What is the illness?

A 25 y/o student teacher who teaches disadvantaged 2nd-grade students and lives in a dilapidated apartment in upper Manhattan presents with a low-grade fever and a tender right papular on his arm that becomes necrotic. 3 days later he developed a papular vesicular rash on his trunk. He went to ED where a CBC showed a WBC of 3.8, normal differential, and PLT count 110K. What is the most likely diagnosis?

A 21-year-old college student is brought to the emergency department by her roommate because of bizarre behavior. She has had fever and a headache since yesterday; now she is confused and acting strangely. She has been otherwise healthy and is on no medications except birth control pills. On examination, she has a temperature of 103°F, blood pressure of 120/80 mm Hg, pulse of 110 beats/min, waxing and waning level of consciousness, mild photophobia, mild nuchal rigidity, and an expressive aphasia. Lumbar puncture reveals a white blood cell (WBC) count of 80/μL (40% polymorphonuclear neutrophils, 60% lymphocytes), red blood cell (RBC) count of 250/μL, protein of 70 mg/dL, and normal glucose. What is the diagnosis?

A 66-year-old woman with a history of diabetes presents complaining of a 2-day history of pain, swelling, and erythema of her left thigh. She notes that the symptoms have been worsening over the past 24 hours. Her physical examination reveals an obese woman in moderate distress: temperature is 39°C, pulse 115 beats/min, respirations 24 breaths/min, blood pressure 98/60 mm Hg. Examination of the left thigh reveals erythema, swelling, and pain from the midthigh to the perineum, and into the lower abdomen. There are tense bullae scattered throughout the area of erythema. Her labs reveal the following:WBC count: 22,000/μL with 90% neutrophilsHct: 39%Platelet count: 150/μLBUN: 45 mg/dLCr: 2.2 mg/dLBicarbonate: 18 mg/dLABG: pH 7.29, PCO2 44 mm Hg, PO2 82 mm HgWhat is the diagnosis?

A patient with AIDS infection CD4 40 vl 100,000 has recurrent perianal HSV responsive to Valtrex in the past however this time his ulcers do not respond to Valtrex and then a course of high dose acyclovir, what would be the treatment of choice?

In a Nursing Home an outbreak of gastroenteritis develops, nearly all residents have vomiting and many have watery diarrhea, a few have chills, the director gives them pepto-bismol and many feel better, the outbreak lasts 1 week What is the dx?

A 39 y/o female presents with painful erythematous lesions on both anterior surfaces of her legs, associated with fever and arthralgias for a few weeks. She recently visited New Mexico with the group to make a new church for 3 weeks. They ate local cheeses, she had unprotected sex with one of the church goers and she had trauma with a rock when she wore open-toe shoes, but no abnormality of her toes, feet are noted or adenopathy. What is the cause of the lesions?

A 68-year-old woman presents with a 2-month history of fever of unknown origin (FUO). Her past medical history is significant for mild hypertension, which is well controlled. Over the last 2 months, she reports headaches and a 10-pound weight loss. She is a housewife and has lived in a suburban setting on the East Coast all her life. Physical exam is normal except for a temperature of 38.4°C. Laboratory studies reveal a white blood cell count of 7800/μL, hematocrit of 31%, and platelet count of 300,000/μL. Liver enzymes and creatinine are normal; erythrocyte sedimentation rate (ESR) is 110 mm/hr; antinuclear antibody (ANA) is less than 1:40. Three sets of blood cultures drawn show no growth to date. Lumbar puncture was performed in the emergency room and is unrevealing. A purified protein derivative (PPD) is placed and is negative, and chest x-ray is normal. The most likely diagnosis is?

A 36-year-old woman with no significant past medical history presents complaining of pain and stiffness in her hands, knees, and elbows. She reports that the symptoms began about 1 week ago and notes that they are migratory in nature. She denies any history of cigarette, alcohol, or drug use. She is divorced and has two young children. Of note, one of her children had fever and a facial rash about 2 weeks ago and, when she took him to the pediatrician, she was told that he had a viral illness. She is sexually active and reports having her partner use condoms. Her family history is notable for gout in her father and some sort of "rheumatism" in her mother. Her physical examination reveals no evidence of swelling or erythema of any of the joints. What is the most likely diagnosis?

49 y/o Haitian male was told by a prostitute to get a lesion on his penis checked which has been present for 2 years. It is painless 2x3 cm ulcerated lesion, a cobblestone base, heaped up edges. A biopsy performed to r/o carcinoma reveals macrophages w numerous intracellular safety pin-like structures on Wright Giemsa stain. Bacterial culture grew staphylococcus epidermidis. What is the etiologic agent?

2 hours after eating in a hotel buffet in Hawaii, a tourist gets abdominal pain, vomits and has 1 loose stool, 2 days after he develops numbness of his extremities, tongue and throat, cold objects feel hot, hot objects feel cold, develops bradycardia, tachycardia, hypotension and is hospitalized where he makes a slow convalescence of more than 1 month of neurologic symptoms. What is the dx?

A florist presents with painless, violaceous nodules spreading lymphangitically and proximally along her arm. What is the causative agent?

A 45-year-old man presents with a 2-day history of fever, chills, and headache. He has a history of hypertension, for which he is on hydrochlorothiazide, and has had a splenectomy for a gunshot wound to the abdomen 15 years ago. On examination, he is lethargic, with a temperature of 104°F, photophobia, nuchal rigidity, and a purpuric rash on the lower extremities. Blood work reveals a white blood cell (WBC) count of 25,000/μL, with 80% polymorphonuclear neutrophils (PMNs) and 15% bands. Lumbar puncture reveals an opening pressure of 30 cm H2O, WBC count of 1000/μL (98% PMNs), glucose of 22 mg/dL, and protein of 350 mg/dL. Gram stain shows gram-positive cocci in pairs. Which would be the most appropriate initial therapy?

A 26 y/o housewife cut her hand making a dish using lamb head. She is an emigrant from Sudan. A week after -she noted a tender crusted nodular lesion, no fever, no adenopathy. She went to ed where a small amt of serous fluid was aspirated and she starts Bactrim for ca MRSA. While on Bactrim the lesion gets bigger, this time they excised it, pathology showed epidermal necrosis, dermal infiltrate of mixed inflammatory cells, no organisms seen. What is the dx?

A 60 y/o male with CLL presents with 2 weeks of fever and chills. Patient has a violaceous nodule on his forearm since he was febrile. WBC 30K with ANC of 1500 and Comprehensive panel is normal. He is on 10 mg of prednisone with chlorambucil. He recently cleaned up a park and got bites ,scratches from rats, cats .and mice. He has multiple sexual exposures. He goes fishing and camping. A biopsy of the lesion showed endothelial and vascular proliferation with inflammatory infiltrate, fungal and gram stain negative, warthin-starry stain show bacilli

You are consulted for twin 15 y/o girls with diarrhea. Both have had diarrhea for more than a week and are missing school. 4 of the girls friends are also sick. On asking more questions, the girls had a birthday party at a water park with 10 friends 6 days before they developed diarrhea. All swam in the pool and sat in the water spray, No food was eaten at the park, 4 drank chocolate milk, rest drank soda. 6/10 sick with nausea, watery diarrhea, no fever. What is the dx?

What is the Exanthem (one of Jone’s major criteria) in rheumatic fever called?