#idboardreview 35 F s/p kidney transplant 4mo ago w/cough, dyspnea. 1 mo later:H/A, vertigo, ataxia. No travel/animal exposure, grows indoor potted plants. CT chest wedge shaped opacity. CT head brain abscess. Skin lesion. Biopsy: Fungal forms brown on hematoxylin-eosin stain. #medEd #idmedEd #IDsky

#idboardreview 60 M w/atrial fibrillation & recent esophageal candidiasis on fluconazole x2wks. Current meds: warfarin, metoprolol, lisinopril. Seen in clinic w/several large bruises on arms & legs. Which of the following best explains the mechanism of this interaction? #idsky #meded #idmeded

#idboardreview 30 M PLWH not on ART, CD4 22, VL 70k w/ worsening "floaters" & blurred vision in L eye x 2 wks. Funduscopy: yellowish-white retinal necrotic lesions w/adjacent hemorrhage along superior temporal artery. Lesion is located in peripheral retina. Treatment? #idsky #idmeded #meded

#idboardreview 62 M from rural S Korea consumes fresh water fish w/RUQ abd pain, wt loss, intermittent jaundice x 2mo. Ct: 4cm mass L hepatic lobe w/dilated bile ducts. ELISA+Clonorchis. Pathology linking chronic infection to biliary tract malignancy? #idsky #idmeded #meded

#idboardreview 45 M 2-months post-kidney transplant on tacrolimus, mycophenolate, prednisone. What advice can you provide regarding live vaccines for her 8-year-old daughter and 40-year-old wife? #idsky #idmeded #meded #vaccination

#idboardreview Person w/ borderline leprosy was started on rifampicin, dapsone, clofazimine 4 wks ago, now w/F 102F, diffuse exfoliative rash, cheilits, subconjuctival hemorrhage, b/l ulnar claw hand deformity, ALT 540, AST 250, bil 3.8, Hb 9. dx? #idsky #idmeded #meded

#idboardreview PLWH (CD4 50) admitted w/Pneumocystis jirovecii pneumonia (PJP) pneumonia on trimethoprim-sulfamethoxazole (TMP-SMX) at 15 mg/kg/day. On day5: petechiae, gingival bleeding, no fever/no rash. drop in platelets 8k. Hb normal, no schistocytes. dx? #idmeded #meded #idsky

#idboardreview 62 M w/fever, cough, dyspnea, diarrhea x5d. Retired landscaper who spent the weekend potting plants & moving compost in his garden. wbc10k, Na130, Tbili7, Alk270, AST 75, ALT 110 , LLL consolidation. urine strep/legionella neg. next diagnostic step. pic for ref #idsky #idmeded #meded

#idboardreview 24 F w/lower abd pain worse over 4d, purulent vaginal discharge & 100F. No N/V/urinary sx. preg neg, New partner for 1 mo, no barrier contraception. +cervical motion tenderness, tx w/IM ceftriaxone, po doxy/metronidazole. What advice for her partner? #idsky #idmeded #meded

#idboardreview 70 M with cough x 3 wks, occasionally so bad that he vomits. Recently visited newborn grandkid who is now sick. pic for ref only. Diagnosis? #medEd #IDMedEd #idsky

#idboardreview A immunocompetent pt visited an unvaccinated community 2d ago, now several members of the community have varicella. Pt asymptomatic, NO rash. He cant recall having chicken pox and didnt receive varicella vaccine. Next step for pt? Pic for ref only #idsky #idmeded #meded

#idboardreview 16 yo person with history of nail biting presents w/ swollen/tender left fourth finger s/p I&D +purulence. Anaerobic gram neg bacillus. Pitting on chocolate agar. #medEd #idmedEd #idsky

#idboardreview A German girl presents w/ fever, lymphadenopathy & circumscribed nodules with central necrosis and inflamed edges on neck, chest & abdomen. Recently bought a pet rat who died within a week. Dx? #medEd #idmedEd #IDsky

#idboardreview Pt living in southern highlands Tanzania, hx of walking bare foot & exposure to volcanic soil, w/progressive b/l foot/ankle ‘water bag’ like swelling stops at knee, no groin edema, Mossy-like papillomata & block-shaped toes. #IDsky #idmeded #meded

#idboardreview 27 F from rural Mexico exposure to cattle, pigs, sheep, dogs 🐄🐖🐏🐕 presents with 1 yr of progressive headaches, excessive drooling/ sweating, now with bladder/bowel incontinence, dec consciousness. previous CT negative. diagnosis? #medEd #idmedEd #idsky

#idboardreview Recently returned traveler from camping trip in Mexico presents w/ abdominal pain, nausea, fever, and bloody diarrhea. O&P: structure with ingested erythrocyte (arrow). dx? #medEd #idmedEd #idsky

#idboardreview Adolescent girl eating lot of salad mixes from the store present with explosive watery diarrhea, bloating, flu like sx. Stool specimen shown with 8 micrometer oocyst. Patient improved without any treatment. dx? #meded #idmedEd #idsky

#idboardreview 60 M asymptomatic(farmer from rural county, south of Houston. farming at night in open fields, many years of hunting/skinning deer) gave blood donation. EKG: 1st degree AVblock. diagnosis? #medEd #idmedEd #idsky

#idboardreview patient admitted with #influenza virus respiratory infection & is in standard & #droplet isolation. There is plan for bronchoscopy. What additional precautions are needed? #idsky #idmeded #meded

#idboardreview 40 yo, snake 🐍 owner/feeds snake, presents with unable to stand, acute progressive dyspnea, F, L knee, R wrist arthralgia x2wks. flaccid tetraplegia, sensitivity at T4 level. C5-T1 abscess, Wbc15k, dx 16SRNA synovial fluid. Pic for Ref #idmeded #meded #idsky

#idboardreview A patient w/ profound, prolonged neutropenia w/ rapid onset of fever & painful skin lesions. Name of the rash? #medEd #idmeded #dermsky #idsky

#idboardreview 60 M farmer 👨‍🌾 from Colombia🇨🇴 w/ 3 months of fever, multiple skin lesions & 10 kg weight loss. Diagnosis? #MedEd #idmedEd #idsky

#idboardreview An adolescent from India w/ neck swelling x 1month. Exam w/ matted, non-tender non-warm fixed cervical lymph nodes. Rest of exam normal, no animal exposure, dx? #meded #idmeded #idsky

#idboardreview college student w/fever, myalgia, sore throatx2d. +enlarged tonsils +exudates & few palpable, freely movable ant/post cervical lymphadenopathy. HIV neg, monospot & rapid strep neg. Throat culture +Gp A Strep 1d later. Pt is feeling better. Do you treat? #idtwitter

#idboardreview A wildlife biologist w/swelling of finger, Fever, unilateral axial LNopathy, cough. 15 days ago, nicked her finger through glove while performing necropsy on harbor seal. Used gloves/PPE/N95. Fluid from finger grew gramneg cocobacilli (urease-ve, oxidase-ve, catalase+) #idsky #idmeded

#idboardreview 25 F dog🐕 bite on hand🤚 3d ago (no hand hygiene or medical care) presents w/ intermittent feeling hot & cold w/ worsening H/A, palpitations, progressive difficulty opening jaw & walking. EMG sustained motor unit activity in masseter.pic for ref. Dx? #medEd #idmedEd #IDsky

#idboardreview 40 M had LASIK refractive surgery a month ago and now presents with eye 👁️pain. AFB+ #medEd #idmedEd #idsky

#idboardreview 70 M from Montana w/Ulcerative colitis, PSC c/b cirrhosis w/fever & acute R leg pain/redness. 5days ago went fishing, walked barefoot on riverbed & fell in soil. No other travel/exposure. BC+GNR w/susceptibilities shown #idsky #idmeded #meded

#IdBoardReview 60 M ESLD, aortic regurgitation, hx of prosthetic aortic valve, recent pneumonia s/p abx, previous hx cdiff currently on probiotics presents w/ new onset heart failure, fever, Blood culture gram-positive rod with vancomycin resistance. Diagnosis? #medEd #idmedEd #IDsky

#idboardreview 30 M recent travel to Japan, consumed seafood/sushi, tap water, raw fruits/vegetables, drank 4 alcoholic drinks/day, presents w/ severe epigastric pain, N,V, no relief with antiulcer tx, EGD several small mass lesions in stomach w/erosion #idsky #meded #idmeded