A 57 year old man presents to the ER with a cough and progressively increasing shortness of breath. The patient has been a plumber for 20 yrs, and before that job he worked in a ship. High-resolution CT of thorax reveals area of pleural thickening with calcifed plaques in the lungs. A specially stained specimen from a patient with a similar condition is shown in the image.

A. Compared to the general population, smoking would present an increased risk of lung cancer in this patient.

B. Langs in this patient will have silicotic nodules.

C. The findings are associated with exposure to air pollution.

D. The parent does not have an
increased risk of mesothelioma.


EXPLANATION

Answer is option A.

EXPLANATION:
The image shows the classic "barbell" ferruginous bodies seen in asbestosis. These bodies can only be seen when the slide is stained with Prussian blue. Asbestosis is most common in plumbers, construction workers, and shipbuilders. Pleural plaques are suggestive of asbestos exposure.

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A female with the following symptoms of sudden high fever, associated with headache and vomiting along with nuchal rigidity, presented to the hospital. CSF analysis of this patient showed the growth of this organism a gram negative diplococci shown in the image,identify the organism:

a) Neisseria meningitis
b) Streptococcus pneumoniae
c) Staphylococcus aureus
d) Mycobacterium tuberculosis

EXPLANATION
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ANS: A. Neisseria meningitis:

Gram negative cocci (catalase/oxidase positive)
Ferments glucose and maltose( capsulated)
Culture media : thayer martin media, muller hinton agar
Transport media stuwart amile media
Complications: water-house friderichsen syndrome( B/L adrenal haemorragic necrosis)
Deficiency of C5-C9(MAC): Prone for neisserial infections.
DOC: Ciprofloxacin( carrier), ceftrioxan (cases)

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A 15 year old female presented to the emergency department with history of recurrent epistaxis, hematuria and hematochezia. There was a history of profuse bleeding from umbilicus stump at birth. Previous investigations revealed normal prothrombin time, activated partial thromboplastin time, thrombin time and & fibrinogen levels. Her platelet counts as well as platelet function tests were normal but urea clot lysis test was positive. Which one of the following clotting factor is most likely to be deficient?

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A) Factor X
B) Factor XI 
C) Factor XII
D) Factor XIII

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EXPLANATION

Ans. D. Factor XIII

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Individuals with a positive bleeding history, particularly with features such as delayed bleeding, umbilical stump bleeding or miscarriages and in whom the initial panel of screening test is negative, should be tested for Factor XIII deficiency.

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A 25-year-old black woman presents with a 3-month history of cough and shortness of breath on exertion. A chest X-ray reveals enlargement of hilar and mediastinal lymph nodes. Laboratory studies e show elevated serum levels of angiotensinconverting enzyme and an increase in 24-hour urine calcium excretion. An open-lung biopsy is shown in the image.Stains for microorganisms in the tissue are negative.

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What is the diagnosis?

A) Silicosis
B) Tuberculosis
C) Sarcidosis
D) Good Pasteur Syndrome


EXPLANATION

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Ans: C

Sarcoidosis is a granulomatous disease, the lung is the most frequently involved organ, but the lymph nodes, skin, and eyes are also common targets. Angiotensin-converting enzyme (ACE) is produced by epithelioid macrophages and is elevated in the blood. Spontaneous regression of lesions is common, but in some cases, the disease causes pulmonary fibrosis and respiratory failure.

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A neonate was born with signs of encephalitis, chorioretinitis, hepatosplenomegaly, fever and jaundice. The mother gave a history of fever two to three times during pregnancy. History taking revealed that she has many cats as pets. On examination of the neonate, intracranial calcifications were found. IgM Ab titer was also raised. What is the most likely Microorganism responsible?

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A) Treponema pallidum
B) Toxoplasma gondii
C) Rubella virus
D) Cytomegalovirus



EXPLANATION
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The Correct Answer is B

This is a typical case of congenital toxoplasmosis caused by organism Toxoplasma gondii.

Primary mode of transmission includes:
i) Cat feaces
ii) Raw meat or insufficiently cooked meat
iii) Unpasteurised milk

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An 11-year-old boy presents to the out patient department with his mother for the evaluation of his weight loss, rash, and several weeks of bloating and diarrhea and generalised weakness. On physical examination, the patient is pale with dry mucous membranes. There is blistering lesions on the bilateral lower extremities, which he says is "very itchy."
Laboratory findings would help screen for the most likely diagnosis in this patient?

A. Anti histone antibodies
B. HLA DQ2
C. Anti TTG antibodies
D. Alpha fetoprotein evaluation

CORRECT ANSWER WITH EXPLANATION POSTED IN

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