Take Home Exam One
Case Study One:
A 63-year-old Mara presented to an outpatient clinic with an 8-week history of nodules on her arms. She recalled cutting her thumbs while cleaning fish that she had purchased at a seafood market in preparation for a meal, and the lesions began to develop 6 weeks later. She had no fevers. She also has no prior significant medical history.
Physical examination at the current clinic revealed painful pink nodules and ulcerations with a haemorrhagic crust on both arms. A biopsy specimen was obtained and revealed multiple granulomas. Cultures grew Mycobacterium marinum, a nontuberculous mycobacterium that is found in aquatic environments. Infections typically result from exposure to contaminated water when there are breaks in the skin.
The patient received treatment with moxifloxacin, rifampin, and clarithromycin for 6 months. She had complete resolution of the infection. At a follow-up visit 1 year later, the nodules had resolved but scarring remained.
Adapted from N Engl J Med 2021; 384:e41
Questions:
- that Mara has developed skin nodules following Mycobacterium marinum infection, propose why nodules have developed and remained localised only to hand in this case study?
(4 marks, approx. 200 words)
b) Explain what is meant by what is ulceration and why it might have occurred in this case?
(4 marks, approx. 200 words)
c) Propose why the physician would describe three different antibiotics in this case for 6 months?
(4 marks, approx. 200 words)
Case Study Two
A 28 year old gentleman Joel received a 1000 milligram iron polymaltose infusion this Friday morning. During the infusion, Joel felt well, and the infusion site was unremarkable. The infusion was administered over 1 hour (as per protocol). He was discharged home. On the following day, Joel developed fever and using tympanic thermometer, he measured his temperature to be 38.7 °C. Within hours, he developed myalgia, nausea, and vomiting. Joel’s partner Mike drove him to the hospital where he was seen by an emergency physician. The provisional diagnosis was delayed hypersensitivity reaction to iron polymaltose.
a) Discuss how iron polymaltose infusion could lead to delayed hypersensitivity reaction. In your answer, clearly outline the mechanism by which this reaction and link that mechanisms to the above observed timeline.
(4 marks, approx.200 words)
(4 marks, approx. 200 words)
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