Question 26

62 year old Caucasian alcoholic male is brought to the ER in a semi-concious state. He remains drowsy and is unable to answer to questions. On examination, he is drowsy, responds to shaking, and then goes back to drowsiness. His Serum ketone levels are high, and his blood sugar level on glucometer shows 36 mg%. He has swelling on his great toes bilaterally. Serum AST is greater than ALT. Serum Bilirubin is 9.2 mg%. What is the biochemical cause of his swelling of toes?

A) Lactic Acid & Beta Hydroxy butyric Acid

B) Raised GGT

C) Hypertriglyceridemia

D) Mitochondrial Toxins

E) Increased NAD

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Question 25

A 47 year old veterinarian from Texas arrives at ER with history of low grade fever and cough. He has been having flu like symptoms for the past few days, and non productive cough since three days. He does not remember of being exposed to cases of TB and his last PPD test done 2 months back was negative. He also complains of myalgias and headaches since three days which was relieved with Acetaminophen. On Chest X ray, the physician finds patchy interstitial infiltrates. On chest auscultation, air entry is equal bilaterally and few rhonchi are heard which are scattered. The patient does not look toxic. He has not lost weight recently, and has not experienced any loss of appetite or night sweats. The liver is mildly enlarged and otherwise all examination is unremarkable. What is the vector involved in transmitting the pathogen causing the symptoms?

A) Tse-Tse Fly

B) Wood Tick

C) Dog Tick

D) Rat Tick

E) Body Louse

F) Lone Star Tick

G) No vector involved

Answer will be posted under the Comments section.

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Question 24

The patient in question 22, is stabilised in the ER, and the physician admits him and administers an antibiotic to take care of his infective source. The patient get a red rash all over the chest and abdomen, with the rash being more prominent on his Neck. What is the next best step of Management?

a) Administer an anti-histaminic

b) Stop the drug

c) IVF rapid infusion with NaHCO3

d) Slow the infusion rate of drug

e) IV dexamethasone

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Question 23

What is the Causative Organism in the vignette discussed in question 22?

a) Salmonella typhi Muriam

b) Staphylococcus aureus

c) Streptococcus pyogenes

d) Streptococcus viridans

e) Staphylococcus epidermidis

f) Streptococcus Bovis

g) Mycobacterium TB

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Question 22

24 year old man comes to the emergency room with history of fever, malaise, and shortness of breath. He has been having fever for last 7 days for which he tried over the counter acetaminophen for symptomatic relief. He appears in moderate distress. He is disheveled, and has smell of alcohol on his clothes. There are some scars on his both forearms. He confesses to be an alcoholic and drug abuser. He has a past history of pulmonary TB treated at the community center about 3 years ago. He has no past histroy of any neurological or psychiatric illnesses. He usually does not visit a doctor, and does not remember about his vaccination status. The veins on his right forearm are thick and cord like but are non tender. He has history of sulfa and penicillin allergy. On examination his Temp is 101.2 degrees, BP is 98/46 mm Hg, and Pulse is 112/min. His chest examination reveals few rhonchis. On cardiac examination the physician hears an abnormal sound in his left lower border of sternum (see media). He does not remember of any childhood cardiac illness. He has no neck stiffness. What is the most likely diagnosis?

a) Rheumatic Heart Disease

b) Ventricular Septal Defect

c) Tuberculous pericarditis

d) Cardiac Tamponade

e) Infective Endocarditis

This vignetter applies to Question 22 to 24

Answers will be posted under comments section soon.

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