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 +0  (nbme22#49)

In addition to all the great points already made, FA also says that Azithromycin is first-line and favored in general because it's a one-time treatment. You would use doxy though to treat lymphogranuloma venereum (FA 2019 and 2020, pg 148-149).

Neisseria gonorrhea - ceftriaxone

  • chlamydia coinfection: +azithromycin or doxycycline

Chlamydia - azithromycin (1st line); doxycycline (2nd line, or for LGV)

  • gonorrhea coinfection: +ceftriaxone
anjum  It's probably simpler to just memorize treatment as: chlamydia: azithromycin gonorrhea: ceftriaxone It's correct and won't trip you up on pregnant women questions

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The clues for trichotillomania were the death of her grandmother suddenly, since trichotillomania is often stress-induced. I also narrowed it down by it saying the hair was in different growth stages in the patchy areas, which makes sense if she’s plucking them out at different times.

Telogen effluvium is most common in middle-aged women, so she doesn’t fit the profile (but you’re right about it being caused by stress).

zpatel  What about telogen effluvium? psychological stress-related hair loss. +  
elephantbuddy  Just to add on, telogen effluvium is usually due to physical stressors such as surgery, pregnancy, serious illnesses, or severe/life-threatening psychological stress. So although this patient is going through psychological stress, it's not exactly life-threatening enough to result in hair loss unless personally inflicted. I think the question stem also kind of hints at trichotillomania with her doing more things to her hair. But this article is pretty useful in distinguishing between different causes of hair loss: https://www.aafp.org/afp/2003/0701/p93.html#sec-4 +  

Per multiple sources: measles can be vesicular and also can lead to giant cell pneumonia in the immunocompromised. ?!?!?!?

elephantbuddy  I was stuck on that too, but I think that measles more commonly presents with a maculopapular rash whereas a vesicular rash is more typical of VZV. +  

submitted by castlblack(8),

Huh. Who else thought this was Gaucher until you had to pick D?

elephantbuddy  I think that the hepatosplenomegaly is definitely a common characteristic but you would see more bone abnormalities in Gaucher. This patient has no bone crises and exhibits developmental delay, HSM, and foam cells which is more characteristic of Niemann-Pick. +  

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