By: Eric Steinberg, Alumnus
- A 34yo recently divorced female went on a dissociative fugue to Cancun, Mexico and came back to Long island 3 days later with bloody, foul-smelling, straight up nasty diarrhea. About 10 days later, while getting a pedicure, she noticed weakness in her toes. 2 days later, she couldn’t breathe. Whats the dx? What do we see on CSF analysis? How is it treated?
- 4-year-old Cambodian child presents to your office with a 6-day history of fever over 105, bilateral conjunctivitis, a diffuse maculopapular rash, and swelling of his hands and feet. On physical exam, you also note a swollen tonue with red spotting as well as anterior cervical lymphadenopathy. What is the diagnosis? Treatment? After treatment what needs to be done?
- Classic Guillian- Barre Syndrome secondary to a Campylobacter jejuni infection. Campylobacter is the most common cause of infectious diarrhea in the world (along with Salmonella spp.) Look for bloody diarrhea and a travel history. This is also one of the known, rare (but common on COMLEX/ USLME) causes of Guillian Barre Syndrome. GBS is an acute inflammatory demyelinating polyneuropathy, an autoimmune disorder affecting the peripheral nervous system, usually triggered by an infectious process. GBS is rare, with an incidence of 1 or 2 people per 100,000. The typical CSF finding is ALBUMINO-CYTOLOGICAL DISSOCIATION. As opposed to infectious causes, this is an elevated protein level (100-1000 mg/dL), without an accompanying increased cell count (very high yield). It is frequently severe and usually exhibits as an ascending paralysis with weakness in the legs spreading to the upper limbs and face along with complete loss of deep tendon reflexes. With prompt treatment with plasmapheresis or intravenous immunoglobulins and supportive care (on boards choose respiratory support d/t the possibility of Phrenic Nerve paralysis), the majority of patients will regain full functional capacity. However, death may occur if severe pulmonary complications and autonomic nervous system problems are present. GBS is one of the leading causes of non-trauma-induced paralysis in the world.
- Kawasaki’s disease is another rare disease that is commonly tested on boards. This classic presentation is most easily remember by the mnemonic “CRASH and BURN.” C-conjunctivitis, R-rash, A-adenopathy, S-strawberry tongue/skin findings H-hand and feet swelling, BURN- fever for at least 5 consecutive days. The treatment is IVIg and high dose aspirin (one of the only times you give a kid aspirin.) After treatment, it is important to get serial echocardiograms (about 6 months) because these children are at risk for coronary artery aneurysms (very high yield).