Dumpster Kitty

A twenty-one-year-old Caucasian male homosexual presents to the student health clinic with a complaint of fever and swelling on the left side of his head and neck. He appears to be normally developed with no obvious trauma. His history reveals he is a student at the college of business and has recently moved off campus. He says his neck recently developed several bumps under the skin, but only on the left side. Soon after, his head presented with the same symptoms, and now his left armpit reveals several bumps as well. You believe that they are swollen lymph nodes.

Question 1 - Single Best Answer

Which of the following can cause lymphadenopathy?   

A) Yersinia
B) Rickettsia
C) HIV
D) Brucella
E) All of the above

He is not sexually active at this time, nor does he have a steady boyfriend. He had rheumatic fever when he was eleven years old, but has not been seriously ill since then. He had all the normal childhood vaccinations. He took tylenol when the fever began, but became concerned when it did not go away. With the odd swelling he decided to get some help. He does no drugs, drinks alcohol infrequently, and does not smoke.

Upon physical examination his fever is 101.0 F. His respiration is normal as is his pulse. His heart is healthy except for a mild murmur with no discernable rubs.

He does appear to have a few short scratches upon his cheek, and on his left forearm. He says he acquired these wounds from a kitten he had found in the dumpster.

Question 2 - Single Best Answer

Could his symptoms be related to his rheumatic fever?   

A) Yes
B) No

Question 3 - Single Best Answer

What is the etiology of rheumatic fever?   

A) active Streptococcal infection
B) a variety of bacteria growing on the heart valves
C) sequela of Streptococcal infection
D) a symptom of HIV infection
E) a bacterium carried by cats

EENT exam reveals obvious lymphadenopathy, though it is unilateral, only on the left side. One node in the region of his parotid gland appears to be somewhat painful. Besides the swollen nodes and fever he is fine. You think you know what he has based on this limited information. You get his permission for tests.

You are surprised that he is HIV negative as this was what you thought he had, but you have another idea.

Question 4 - Single Best Answer

Which of the following agents might be responsible for the disease you now suspect?   

A) Bartonella henselae
B) Pasteurella multocida
C) Any of the above
D) None of the above

Question 5 - Single Best Answer

Do the presence of Gram+ cocci in the throat culture indicate disease?   

A) definitely yes
B) maybe yes
C) definitely no
D) probably no
E) more than one of the above

He returns the next day and you tell him what you suspect based upon his symptoms, but you would like to run additional tests to confirm this diagnosis.

Question 6 - Single Best Answer

What do you suspect?   

A) diphtheria
B) mumps
C) Cat Scratch Disease
D) endocarditis
E) Strep throat

Question 7 - Single Best Answer

You believe that he has cat scratch disease (cat scratch fever). What can cause this disease?   

A) Bartonella henselae
B) Pasteurella multocida
C) Brucella abortus
D) more than one of the above.

Question 8 - Single Best Answer

How could you confirm a diagnosis of cat scratch disease?   

A) culture of exudate from lymph node
B) histopathology
C) all of the above
D) none of the above

Question 9 - Single Best Answer

What is the primary virulence mechanism for the bacteria causing CSD?   

A) capsule
B) intracellular growth
C) alpha toxin
D) IgA protease
E) adhesins

Question 10 - Single Best Answer

What is the most serious consequence of P. multocida infection?   

A) painful wound
B) anorexia
C) endocarditis
D) cellulitis
E) rheumatic fever

Question 12 - Single Best Answer

Which of the following diseases are also carried by domestic animals?   

A) Brucellosis
B) Anthrax
C) Salmonellosis
D) Campylobacter diarrhea
E) All of the above