Term 4, CPC 3 Quiz

The most likely diagnosis for the patient's symptoms and the appearance of his foot is Reiters syndrome. Reiters syndrome is a reactive arthritis that typically occurs after an infection, often involving the genitourinary or gastrointestinal tract. It is characterized by the triad of arthritis, urethritis, and conjunctivitis, which aligns with the patient's symptoms of dysuria, conjunctivitis, and malaise. The image of his foot also suggests the presence of keratoderma blennorrhagica, a skin manifestation commonly seen in Reiters syndrome. Rheumatoid arthritis, Crohn's disease, ulcerative colitis, and dengue fever do not typically present with the same constellation of symptoms and skin findings seen in Reiters syndrome.

The most likely causative organism in this case is Trichomonas vaginalis. The greenish vaginal discharge with an ammonical odor is a characteristic symptom of trichomoniasis. The oval motile organisms seen on wet film examination also support this diagnosis. Additionally, the pH of the vagina being 7.4 is consistent with trichomoniasis, as the pH is typically elevated in this condition. Chlamydia trachomatis, Gardnerella vaginalis, Candida albicans, and Neisseria gonorrhoeae are not typically associated with these specific symptoms.

The gram staining image provided is indicative of Neisseria gonorrhoeae. This bacterium is known to cause gonorrhea, a sexually transmitted infection that commonly affects the genital tract. Gram staining is a technique used to classify bacteria based on their cell wall composition, and the image suggests that the organism is a gram-negative diplococcus, which aligns with the characteristics of Neisseria gonorrhoeae.

The most likely diagnosis in this case is a mature teratoma. A teratoma is a type of germ cell tumor that can contain tissues from all three germ cell layers (ectoderm, mesoderm, and endoderm). In this case, the histopathological examination showed a large tumor with a mixture of mature skin and appendages, cartilage, and blood vessels, which are characteristic features of a mature teratoma. Seminoma testes, embryonal carcinoma, immature teratoma, and trophoblastic tumor are less likely diagnoses in this context.

The most likely causative organism for a painless ulcerative lesion on the penis without much exudate or oozing is Treponema pallidum. This is because Treponema pallidum is the bacterium responsible for causing syphilis, which commonly presents with painless ulcers called chancres. Other options such as Herpes simplex virus, Human papilloma virus, Cytomegalo virus, and Chlamydia trachomatis may cause genital ulcers, but they typically have different characteristics such as pain, exudate, or oozing.

Nick is most likely to have developed gonococcal arthritis. This is indicated by the acute joint pain and swelling over his toe and ankle. Gonococcal arthritis is a complication of a gonococcal infection, which is caused by the bacterium Neisseria gonorrhoeae. This infection can spread to the joints, leading to inflammation and pain.

Chlamydia trachomatis is the most common organism causing the presented symptoms in a 28-year-old male. Chlamydia is a sexually transmitted infection that can cause pain and swelling in the testes, as well as mucoid discharge from the penis while passing urine. Other options such as Mycoplasma, Ureaplasma, Neisseria gonorrhoeae, and Escherichia coli are not typically associated with these specific symptoms.

The main feature shown on the slide is multinucleated giant cells. This is suggested by the presence of painful, recurrent, multiple genital ulcers, which are characteristic of a condition called genital herpes. Genital herpes is caused by the herpes simplex virus (HSV), which can be identified on a smear by the presence of multinucleated giant cells. These giant cells are formed when infected cells fuse together, resulting in multiple nuclei within a single cell.

Embryonal carcinoma is a type of testicular cancer that has a high propensity for metastasis. The para-aortic lymph nodes are located near the aorta in the abdomen, and they drain lymphatic fluid from the testes. As a result, they are more likely to show metastasis in cases of testicular cancer. The iliac lymph nodes are located in the pelvis and may also be involved in metastasis, but the para-aortic lymph nodes are the most likely site for metastasis in this case. The scrotal lymph nodes are not commonly involved in testicular cancer metastasis, and the mediastinal lymph nodes are not directly related to the testes. The inguinal lymph nodes may be involved in cases of testicular cancer, but they are not the most likely site of metastasis in this specific scenario.