Hy 2088 Great! Yeah, baby, yeah!….

[tommyk]

Hy 2088 Great! Yeah, baby, yeah!….

35-year-old government agent named Austin Powers presents to the local clinic complaining of fatigue over the past week. He had previously been in excellent physical health and had been able to work 12 hours daily. He complains of diffuse myalgias and temperatures as high as 39.2 C (102.5 F). He has also been complaining of difficulty swallowing because of a sore throat. He drinks approximately 24 ounces of beer on weekends, a few (no more than 2) martinis (shaken not stirred) on weekdays and smokes one pack of cigarettes per day. On examination, his temperature is 38.7 C (101.6 F), and his posterior pharynx is injected. He has bilateral anterior and posterior cervical adenopathy, with lymph nodes measuring as large as 1 cm. They are firm, mobile, and mildly tender. On abdominal examination, his liver span is 14 cm in the midclavicular line, and a spleen tip is palpable. There is no ascites or peripheral edema. What is the dx?

1-Hepatitis B
2-Cirrhosis of the liver
3-Hodgkin’s dx
4-EBV infection
5-Non-Hodgkin’s lymphoma





















ans) #4. This was again another tricky question with a solid concept. All the questions I heard had some kind of “curve ball” distractor. That is why you must read very carefully. The patient is presenting with the classic clinical features of infectious mononucleosis, with fever, fatigue, symptoms of pharyngitis, cervical lymphadenopathy, and hepatosplenomegaly. A heterophile agglutinin test (Monospot) should be positive at this point for EBV infection. Don’t be tricked by the drinking. I said he does not drink that much…and he would not have cervical adenopathy if he had early cirrhosis! If you were rushing and short of time, I bet you would have seen the word "beer and martinis" and then picked cirrhosis...

[usmlethinking]

This is another concept of "acute, subacute, or chronic"

All these things occurred over one week period. This is consistent with acute/subacute so EBV infection is the most logical choice. Austin would have shagged this easily.

[tommyk]

Perfect again, USMLEthinking. Time frame is everything.

On my own test, I had a seemingly easy question on T-cell count and HIV, but they gave me an EXACT number of days from initial infection like 8 days and 5 hours or something silly and asked me about the titer or T-cell count! Can you believe that! That is why I am giving the questions and answers like the NBME would. Good work.

Keep hitting those books,

Tommy

[need help]

the stuff about austin powers makes it funny and it is a good thing to see. i heard the test asks a lot of clincical questions about how long things last.

[md90]

"posterior pharynx is injected" please explain what this means...