Images You Should Know

6/5/2020 A Rapid Review of Key Course Images

You have seen most of these during the course.

On the exam they will give you more clinical context, which will make image recognition easier. But… this is mostly a review! Blood Smears 1. What Are These Images? Both Are Same Organism 1. Morula of in a Monocyte 2. What Are These Images? (Both Are Same Organism) 2. Morula of Anaplasma in Neutrophils 3. What Is This Image? 3. Borrelia in Peripheral Smear 4. What Is This Gram Negative Rod in the Peripheral Blood of a Splenectomized Septic Patient Licked by a Dog?

Wald, Images in Hematology, Am. J. Hematol. 83:879 Researchgate.net 4. Capnocytophaga canimorsus

Wald, Images in Hematology, Am. J. Hematol. 83:879 Researchgate.net 5. What Are These Images in an HIV-Infected Patient in the US (CD4=20 cells/uL) with Septic Shock? All Are Same Organism 5. Histoplasma in Leukocytes (Peripheral Smear) 6. What Are These Images from a Skin Biopsy of a Recent Immigrant from Brazil with Fever and Hepatosplenomegaly? 6. Leishmania Note Difference Between Leishmania (kinetoplast and nucleus) and Histoplasma in Image 5 (nucleus only)

Visceral Leishmania would be in bone marrow, liver, spleen while cutaneous or mucocutaneous would be in skin or mucous membranes. Leishmania would not be seen in blood smears, unlike histoplasma. 7. What Is This Image in a Patient Who Develops Renal Failure After a Prodrome of Diarrhea and Abdominal Pain? 7. Schistocytes, Helmet Cells, and Thrombocytopenia Hemolytic Uremic Syndrome (HUS) or Thrombotic Thrombocytopenic Purpura (TTP)

Schistocytes

No Platelets 8. What Is This Image in a Patient with a Non-Specific Febrile Illness? 8. Atypical Lymphocytes

EBV and…Many Other Viral and Non Viral Organisms 9. What Two Different Organisms are Demonstrated in These Images from Travelers Who Returned from East Africa (left) and Brazil (right)? 9. Trypanosoma brucei rhodesiensis

Trypanosoma brucei rhodesiensis Trypanosoma cruzi (Sleeping Sickness, e.g., East Africa) (Chagas Disease, e.g., Brazil) Peripheral Smear Peripheral Smear 10. What Is This Image in a Febrile Person Who Has Only Resided on the Eastern Seaboard of the US? 10. Babesia in Erythrocytes 11. What Is This Image in a Traveler Who Returned from a Trip That Included West Africa and Asia? 11. Band Form

Plasmodium malariae (Asia and West Africa) or knowlesii (Asia) 12. What Is This Image in a Traveler Who Returned from Malarious Areas? 12. Gametocyte Falciparum Malaria 13. What Is This Image in a Traveler Who Returned from Africa? 13. Vivax Malaria Schizont Xrays 14. What Are These Serial Images in a Patient with Lymphoma and Resolving Neutropenia? 14. Halo (left) and Crescent (right) Signs Neutropenia (left) and Resolving Neutropenia (right) Probably Aspergillus

The above is aspergillus which is different from… To the left is the reverse halo sign due to mucor or… Cryptogenic organizing COP 15. What Is This Image in a COPD Patient with Hemoptysis? 15. Fungus Ball in Pre Existing Cavity Probable Aspergilloma 16. What is Cause of this Bulging, Non Pulsatile Chest Mass in Adult Male with 3 Months of Fever, Weight Loss, Dyspnea, and Cough?

Caceres corner no 34 http://blog.myesr.org/caceres‐corner‐case‐no‐34/ 16. Empyema Extending Through the Parietal Pleura into Surrounding Tissues

Many Causes: TB, Actinomyces, Staph, Molds

Caceres corner no 34 http://blog.myesr.org/caceres‐corner‐case‐no‐34/ 17. What is the Cause of Fever and Chills in this Male Who Had a Sudden Neurologic Event One Week After a Radiofrequency Ablation for Recurrent Arrhythmias? 17. Left Atrial Esophageal Fistula Due to Radiofrequency Ablation Complications Include Air Embolus Causing Stroke and Bacteremia Due to Draining Oral Flora

Desai et al, Journal of the American College of Cardiology Volume 71, Issue 11 Supplement, March 2018 18. Why Does This Patient with a Severe Sore Throat Have Pulmonary Embolic Lesions? 18. Lemierre’s Syndrome Usually Fusobacterium Bacteremia

On the first image, note the clot in the jugular system (red arrow) (the blue arrow shows complete filling with dye or contralateral jugular

Image on right shows sagital view of jugular system with clot 19. What Is This Image in an AIDS Patient? 19. Primary Effusion Cell Lymphoma in HIV 20. What Is This Image in a Previously Healthy Patient with Fever and Chills and Dysuria?

Sireineni et al, https://abdominalkey.com/uroradiology/ 20. Eggshell Calcifications of the Bladder Chronic Schistosoma Hematobium with Hydroureter

Sireineni et al, https://abdominalkey.com/uroradiology/ 21. What Is the Cause of 5 Days of Abdominal Pain Associated with Fever, Nausea, and Vomiting in this 70 Year Old Diabetic?

Sireineni et al, https://abdominalkey.com/uroradiology/ 21. Emphysematous Cystitis Due to Gas Forming Organism, Usually E. coli or and Responds to Medical Therapy

Sireineni et al, https://abdominalkey.com/uroradiology/ 22. What Is This Image in a Previously Healthy Patient with Fever and Chills? 22. Emphysematous Pyelonephritis Due to Gas Forming 23. What Is This Image in a Patient with Fever and Dysuria and a Renal Biopsy Showing Lipid Laden Macrophages? 23. Xanthogranulomatous Pyelonephritis 24. What Is This Image in a Healthy Patient with Severe Diarrhea? 24. Pneumatosis Intestinalis Emergent Surgery Unnecessary If No Clinical Sepsis, i.e., Unexplained Hypotension, Hyperlactemia, Metabolic Acidosis, and If No Portal Gas, Bowel Obstruction, Signs of Peritonitis or Perforation 25. What Is This Image in a Neutropenic Patient with Abdominal Pain ? 25. Typhlitis in Neutropenic Patient 25. Note Differences Appendicitis vs Typhlitis

Normal appendix Appendicitis with Appendicolith Contrast is seen filling a normal appearing An enlarged appendix (solid arrows) is seen appendix (arrows) demonstrating a thin wall with an appendicolith (dashed arrows) at the base

Appendicitis Perforated appendicitis The appendix (solid arrows) is abnormally The appendix (solid arrows) is abnormally dilated dilated and demonstrates a thickened with a thickened enhancing wall. Small pockets of enhancing wall and no filling with contrast. extraluminal air (dashed arrows) indicate perforation. http://www.massgeneral.org/imaging/news/radrounds/january_2006/ 26. What Is This Image in an AIDS Patient (CD4=10 cells/uL) Who Just Started ART? 26. Mycobacterium Avium IRIS Syndrome in HIV/AIDS

Could Also Be Other Mycobacteria, Fungi, Lymphoma 27. What Are These Images in a Patient with Resolving Neutropenia?

Cornely et al. Clinical Liver Disease, Vol 6, No 2, August 2015 Fontanilla, https://radiopaedia.org/cases/hepatic-candidiasis-on-contrast-enhanced-ultrasound 27. Hepatosplenic Candidiasis in Resolving Neutropenia

Cornely et al. Clinical Liver Disease, Vol 6, No 2, August 2015 Fontanilla, https://radiopaedia.org/cases/hepatic-candidiasis-on-contrast-enhanced-ultrasound 28. What Is This Image in a Healthy Patient with Fever and Acutely Aberrant Behavior?

http://www.med.harvard.edu 28. Encephalitis Temporal Lobe

http://www.med.harvard.edu 29. What Are These Images in a Patient with Rheumatoid Arthritis and Progressive Confusion? 29. JC Encephalitis (Also known as PML-Progressive Multifocal Leukoencephalopathy) 30. What Is This Image in a Recent Stem Cell Transplant Recipient? 30. Posterior Reversible Encephalopathy Syndrome (PRES) 31. What Is the Cause of 3 Week Decline in Mental Function in An Afebrile Patient With No Other Medical Issues and Hyperintensity of the Cortex, Pulvinar and Dorsomedial Thalamic Nuclei, and Basal Ganglia? 31. Creutzfeldt–Jakob Disease The location “Pulvinar” Should Be a Clue CSF Will Show 14-3-3 and Tau Proteins

A. Normal FLAIR image for comparison B. Grade 2 hyperintensity of pulvinar

C. Grade 3 hyperintensity of pulvinar D. Grade 4 hyperintensity of pulvinar

The pulvinar sign refers to bilateral FLAIR hyperintensities involving the pulvinar thalamic nuclei, which is classically described in variant Creutzfeldt‐Jakob disease

Collie, American Journal of Neuroradiology September 2003, 24 (8) 1560‐1569; 66 32. What Is This Image in a Healthy Patient with Fever and Facial Pain? 32. Ethmoidal Sinusitis 33. What Is This Image of Unilateral Disease of a Previously Healthy Patient with Fever but No Papilledema or Dysconjugate Gaze?

R

Itzaak Brook, http://sinusitisunderstood.blogspot.com/p/complications-and-referal.html 31. Orbital / Due to Ethmoidal Sinusitis Proptosis, Chemosis, Limitation of Extraocular Movement, Visual Loss

R

Itzaak Brook, http://sinusitisunderstood.blogspot.com/p/complications-and-referal.html 34. What Is This Image of Unilateral Disease in a Previously Healthy Patient with Fever, Ophthalmoplegia, Retinal Hemorrhages, Disc Edema, Vision Loss?

Cooper, https://neuro-ophthalmology.Standford.edu. 34. Cavernous Sinus Thrombosis Associated with Sphenoid or Ethmoidal Sinusitis, Facial or Dental Proptosis, Chemosis, Eyelid Edema, Cranial Nerve Palsies, Vision Loss

Coronal T1 Image with Enlargement and Enhancement Of Sinus Due To Thrombosis

Cooper, https://neuro-ophthalmology.Standford.edu. 35. What Sinus is Infected and What Complication Should be Sought?

Interactive CT Sinus Anatomy: http://uwmsk.org/sinusanatomy2/SphenoidAbnormal.html 35. Sphenoid Sinusitis

Associated with Cavernous Sinus Thrombosis

Cavernous Sinus Thrombosis

Sphenoid Sphenoid Sinusitis Sinusitis Cavernous Sinus Thrombosis

Interactive CT Sinus Anatomy: http://uwmsk.org/sinusanatomy2/SphenoidAbnormal.html 36. What Is This Image in a Patient with a Severe Sore Throat and Trouble Swallowing? 36. “Thumb Sign” of Epiglottitis

Sharma and Niknejad, https://radiopaedia.org/articles/thumb-sign-epiglottitis-1?lang=us and https://www.med-ed.virginia.edu/courses/rad/peds/chest_webpages/ch8.1epig.html 37. What Are These Images in a Healthy Patient Who Emigrated from Mexico? 37. Cysticercosis Soft Tissue Calcifications “Rice Grain Calcifications”

https://rad.washington.edu/about‐us/academic‐sections/musculoskeletal‐radiology/teaching‐materials/online‐musculoskeletal‐radiology‐book/soft‐tissue‐calcifications/ 38. What Are These Images in a Traveler Two Months After Return from Egypt with Urticaria, Fever, Cough, and Abdominal Pain? 38. Katayama Fever (Acute Schistosomiasis)

Clinical Microbiology and Volume 16, Issue 3, March 2010, Pages 225‐231 39. What Is This Image in a Febrile Patient With Gram Positive Coccus Blood Stream Infection? 39. Mycotic Aneurysm Bacterial Endocarditis Skin and Mucous Membrane Lesions 40. A Young Male With No Fever But Crusted Lesions on His Face 40.

• Honey crusted lesions • Staph aureus >Group A Beta Hemolytic • Highly contagious • Acute glomerulonephritis can occur 1-2 weeks after streptococcal impetigo • Therapy can be topical or oral 41. What Syndrome is This in a Healthy Male Presenting With Fever and a Well Demarcated Erythematous ? 41.

• Fever and chills and clear demarcation • Caused by acute beta-hemolytic group A streptococcal infection • Superficial dermal lymphatic involvement with marked swelling • Legs and face are most frequently affected • Face: a classic butterfly distribution involving the cheeks and the bridge of the nose • Legs: edema and bullous lesions 42. What Syndrome Does This Patient Have? Sore Throat with Swollen Tonsils, Sore Throat, Fevers, Chills, Strawberry Red Tongue, and Non Pruritic Sandpaper Rash Starting on Abdomen 42.

(Diffuse blanching erythema with punctate papules that cause the rash to have a sandpaper-like quality)

https://emedicine.medscape.com/article/1053253‐overview https://www.mayoclinic.org/diseases‐conditions/scarlet‐fever/symptoms‐causes/syc‐20377406 43. What Are These Migrating Skin Lesions That Appeared One Month After A Febrile Illness Associated With Sore Throat, Symmetrical Joint Pain Treated With Non Steroidal Anti-Inflammatory Drugs? 43. Erythema Marginatum Associated With Acute Rheumatic Fever

https://online.epocrates.com/diseases/40471/Rheumatic‐fever/Image‐Library and https://www.hxbenefit.com/erythema‐marginatum.html 44. What Does This Young Diabetic Woman Have? Fever, Severe Leg Pain, Tachycardia and Hypotension 44.

https://www.orthobullets.com/trauma/1007/necrotizing‐fasciitis https://en.wikipedia.org/wiki/Necrotizing_fasciitis 45. A Toxic Diabetic Male with Necrotic , Scrotal Crepitance, and Air in the Perineal Area on CT Scan – What Is This Syndrome? 45. Fournier’s Aggressive Necrotizing Fasciitis of Genitalia Due to Mixed Aerobic/Anaerobic Flora Especially in Diabetics or Persons with Renal or Hepatic Disease

Massive scrotal swelling with air https://www.researchgate.net/figure/A‐classical‐presentation‐of‐Fourniers‐gangrene_fig 1_32599354139 https://radiopaedia.org/articles/fournier‐gangrene 46. A 60 Year Old Diabetic With Fever, Hypotension, Air in Soft Tissues at a Site of Recent Trauma and Gram Positive Rods on Gram Stain 46. Clostridial Myonecrosis () • Hematogenous from bowel Or • Localized Due to Contaminated Wound (spores) – Skin popping – Trauma – Septic abortion – Surgery 47. What Are These Images in a Healthy Patient with Fever and Weight Loss? 47. Subacute Bacterial Endocarditis Conjunctival Osler Node Janeway Lesion Hemorrhage 48. What Is This Image? 48. Splinter Hemorrhages Subacute Bacterial Endocarditis 49. What Is This Image in a Healthy Patient with 4 Weeks of Fever? 49. Oslers Node Due to Endocarditis 50. What Are These Images of Skin Lesions x 2 Months in a Patient with HIV Infection? 50. HSV in HIV-Infected Patient (Consider Acyclovir Resistance If Patient Has Been On Long Term Valacyclovir/Famciclovir) 51. What Is This Image in a Healthy Patient with an Annoying Rash After Relaxing for a Weekend? 51. Hot Tub Pseudomonas 52. What Is This Image of a Painless Lesion in a Febrile Returning Traveler from Africa? 52. Cutaneous Anthrax 53. What Is This Image? 53. Ramsay Hunt Syndrome VZV 54. What Is This Image in a Man With Painful Vesicles on His Nose? 54. Hutchison Sign

VZV-Often Associated With Corneal Ulcers 55. What Are These Images in a Patient with Septic Shock?

Day 1 Day 2

Mukul P. Agarwal and Vishal Sharma CMAJ January 12, 2010 182 (1 55. Meningococcemia (Or Rocky Mountain , Pneumococcus, Staph Aureus, or Many Other Bacteria and ) Day 1 Day 2

Mukul P. Agarwal and Vishal Sharma CMAJ January 12, 2010 182 (1 56. What Are These Images in a Person With HIV and CD4 Count <50 Cells/uL? 56. Histoplasmosis 57. What Are These Evolving Lesions in a 31 Year Old Woman with AML and Neutropenia?

An. Bras. Dermatol. vol.92 no.5 Rio de Janeiro Sept./Oct. 2017 57. Gangrenosum

An. Bras. Dermatol. vol.92 no.5 Rio de Janeiro Sept./Oct. 2017 58. What Is This Image in a Male Who is Asymptomatic Except for Face? 58. Bells Palsy HSV or VZV, , HIV, Others 59. What Is This Image in an Asymptomatic Butcher? 59. ORF 60. What Are Painful, Non Pruritic Lesions That Abruptly Occurred in a Lymphoma Patient Who Was Febrile With Leukocytosis? 60. Sweet’s Syndrome Also Associated With Drugs, Pregnancy, Inflammatory Bowel Disease, Respiratory and GI Infections 61. What Is This Image in a Healthy Suburbanite With No Fever or Constitutional Signs and These Mildly Painful Lesions? 61. Sporotrichoid Lesions Consider Sporothrix, Nocardia, Mycobacterium marinum, , Leishmania 62. Young Adult with Tender Pre-auricular Lymph Node 62. Henselae Cat bite or scratch or lick

Goldsmith, Fitzpatricks Dermatology in General Medicine, 8th Edition 63. 50 Year Old Man from Missouri Present with Fever and Progressive Painful Swelling 2 Days After His Cat Died 63. Glandular Tularemia No Ulcer at Inoculation Site Unlike Ulceroglandular Form 64. What Is This Image in Patient with HIV Infection and Fever? 64. Bartonella in HIV/AIDS (or Kaposi Sarcoma) 65. What Is This Image 1-2 Weeks After Onset of a Syndrome That Appeared to Be Blood Culture Negative Septic Shock? 65. Staphylococcal

http://www.liberaldictionary.com/toxic-shock-syndrome/ 66. What Are These Images of a Healthy Young Adult with Fever and Rash? 66. Measles Cough, Conjunctivitis, Coryza, Koplik Spots 67. What Is This Image in a Patient With Exotic Animal Exposure and Fever and These Lesions Over Face, Trunk and Extremities? 67. Monkey Pox Smallpox, Monkeypox, Varicella Have Similar Vesicles However, Small Pox Appears in One Crop

In Contrast, Monkey Pox and Varicella Appears in Sequential Crops

Monkey Pox‐US Monkey Pox‐Africa

https://emedicine.medscape.com/article/1134714‐overview https://www.cdc.gov/poxvirus/monkeypox/index.html These are the Crops of Lesions in Chicken Pox (Varicella) 68. What Is the Cause of This Pneumonia with Nodular Infiltrates Occurring Several Days After Onset of Fever and Vesicular Rash? 66. Varicella Pneumonia 69. What Is This Image in a Child Living in Latin America? 69. Romana Sign of Chagas Disease Unilateral Swelling of the Upper and Lower Eyelid 70. What Is This Image of the Leg of Patient with Long Standing Bouts of Cramps and Diarrhea? 70. gangrenosum Painful Ulcer Associated With Underlying Diseases Especially Ulcerative Colitis and Crohn's Disease, Malignancies

https://www.merckmanuals.com/home/skin‐disorders/hypersensitivity‐and‐inflammatory‐skin‐ disorders/pyoderma‐gangrenosum https://www.researchgate.net/figure/Pustular‐pyoderma‐gangrenosum_fig2_6928017 71. What Are These Images in a Traveler Returning from a Safari in Sub-Saharan Africa? 71. Eschar and Rash of Rickettsial Diseases

Eschar seen as in these photos - , , , R. conorii

NO Eschar - (Rocky Mountain Fever), R. Prowazeki (Epidemic ) or R. Typhi ()

Case #02069: A man with fever and rash after travel to Africa. [Internet]. Partners Infectious Disease Images. Available from: http://www.idimages.org/idreview/case/caseid=352 72. What Is This Image of a Healthy Male with Fever and a Cough? 72. Erythema Multiforme Many Causes () Also Associated with Mucositis 73. What Disease is Likely Occurring in a Febrile Previously Healthy Male With A Sore Throat and Non Pururitic Rash Whose Children Had This Illness One Week Previously?

Fujimoto et al Emerging Infectious Diseases 18: Feb 2012 73. Hand Foot and Mouth Disease Due to an Enterovirus, Often Coxsackie

Fujimoto et al Emerging Infectious Diseases 18: Feb 2012 74. What are These Non Healing, Cutaneous Lesions Unresponsive to Beta Lactams? 74. Cutaneous Diphtheria

CDC 75. What Is This Image in a Well Appearing Patient? 75. 76. What Are These Images in a Homeless Man with AIDS? 76. Norwegian

Case #06017: A man with HIV and AIDS and a skin rash. [Internet]. Partners Infectious Disease Images. Available from: http://www.idimages.org/idreview/case/caseid=111 77. What Is This Image in Someone Who Lives in an Area with No Lyme Disease? 77. Southern Tick Associated Rash Illness (STARI) 78. What Are These Images in a Patient from Mexico? 78. spp rhinoscleromatis 79. What Is the Cause of These Chronic Facial Changes in a Man from Philippines Before Therapy? 79. Lepromatous

https://web.stanford.edu/class/humbio103/ParaSites2006/Leprosy/snsx.htm 80. What Is This Image of Anesthetic Lesions in a Patient from ? 80. Anesthetic Lesions of 81. What Are These Images That Had Persisted for 11 Years in an Immigrant from Mexico? 81. Madura Foot Molds, Nocardia and Other Branching Bacteria

Courtesy of CDC 82. What Are the Causes of These Lesions in Light Exposed Cutaneous Areas in a Patient With HCV? 82. Porphyria Cutanea Tarda Consider Underlying Liver Diseases Especially HCV 83. What Is This Pruritic Rash That Had Developed Over Several Weeks in Man with HCV? 83. Lichen Planus

Kraft R, Usatine RP. Lichen planus. In: The Color Atlas of Family Medicine 84. What Is This Image in a Patient with Fever and Jaundice? 84. Conjunctival Suffusion 85. What Is This Image? “Fleeting, Evanescent Rash” in a Woman with Fever 85. Adult Stills Disease

“Evanescent, Salmon-Colored” Maculopapular Rash 86. Why Are the Eyes Drooping in a Patient Doing “Skin Popping?” 86. Wound Botulism Slurred Speech, Diplopia, Dysphagia, and Skin Lesions

https://en.wikipedia.org/wiki/Botulism and CDC 178 87. Facial Non Pruritic Nodule in a Well Appearing Man in Rural Illinois with Normal Chest Xray

6 Months Ago He Had a Febrile Pneumonia That Resolved After Azithromycin Treatment Although….Maybe Azithro Did Nothing and the Pneumonia Cleared Spontaneously 87. Cutaneous Blastomycosis

Image from: Dr fungus 88. What Is This Image in a Traveler Returning from Sub-Saharan Africa? 88. Myiasis in a Returning Traveler

Dermatobia hominis (botfly) or Cordylobia anthropophaga tumbu larvae 89. What Is This Image in a Woman Who Went to a Salon to Have Her Legs Shaved? 89. Nail Salon Furunculosis Mycobacterium fortuitum Most Common Consider M. abscessus and M. Chelonei Also 90. What Is This Image in an AIDS Patient Who is Asymptomatic? 90. Hairy Leukoplakia in HIV STDs 91. What Are These Images of a Painful Penile Ulcer Associated With Short Gram Negative Rods? 91.

Painful Ulcer and Lymph Node Due to Hemophilus Ducreyi

http://hit‐micrscopewb.hc.msu.edu/Microbiology/Lab/S2‐ Geni_Image_23.html 92. What Are These Images of a Painless Ulcer Associated with Large Gram Negative Rods? 92. Painless Lesion Due to Klebsiella granulomatis 93. What Are These Images of a Painless Ulcer with Painful Nodes?

Erica Weir CMAJ January 18, 2005 172 (2) Funom Theophilus Makama Hubpages.com 93.

Caused by 3 Serovars of trachomatis

Erica Weir CMAJ January 18, 2005 172 (2) Funom Theophilus Makama Hubpages.com 94. What is the Cause of Recurrent Painful Oral and Genital Ulcers in Previously Healthy Male? No Sexual Contacts for 2 Years and Negative RPR and Negative HSV PCR

https://www.researchgate.net194 http://alancam.com/study/path/view 94. Behcet’s Disease

https://www.researchgate.net194 http://alancam.com/study/path/view Fundus Photos 95. What Is This Image? 95. Stellate Lesion Bartonella 96. What Is This Image? 96. Cotton Wool Spots 97. What Are These Images in a Patient with a Low CD4 Count? 97. CMV Retinitis “Ketchup and Mustard Lesions” 97. What Is This Image? 97. Roth Spot Due to Endocarditis Head and Neck 99. Man with a Tooth Ache, Fever, Chills, Difficulty Swallowing with Neck/Chest Pain But No Stridor 99. Ludwig’s Angina Due to Oral Flora, with Extension to Chest 100. What is Cause of Fever, Sore Throat, Hoarseness, Bull Neck in Unimmunized Adult Who Recently Traveled to India? Scraping of Exudate Led to Bleeding Mucosa 100. Respiratory Diphtheria

Gram stain, demonstrating that it is a Gram‐positive with “clubbed” ends

Cole and Cole,Infections of the Ears, Nose, Throat, and Sinuses pp 231‐24 and Helminths 101. What Is This Image in A Small Bowel Biopsy? 101. Microsporidia 102. What Is This Image in A Stool Sample? 102. Strongyloides Rhabditiform Larva 103. What Is This Image of a Stool Culture? 103. Strongyloides stercoralis Migrating Larvae on Blood Agar Plate 104. What Are These Migrating Pruritic Lesions in a Patient Recently Treated With High Dose Corticosteroids?

Clin Infect Dis. 2018;66(10):1637-1638. doi:10.1093/cid/cix1050 104. Larva Currens (Running Larvae) Due to Strongyloides Stercoralis

(Most Characteristically on Buttocks and Lumbar Area)

Clin Infect Dis. 2018;66(10):1637-1638. doi:10.1093/cid/cix1050 105. What Are These Images from a Modified Acid Fast Stain of Stool? 105. Modified Acid Fast Organisms in Stool (Determine by Size) Cryptosporidia Cyclospora Cystoisospora 106. What Is This Organism in a Small Bowel Biopsy? 106. Cryptosporidia 107. What Are These Images from a Stool Specimen? 107. Entamoeba histolytica Ingested Erythrocytes Within Ameba 108. What Is This Image from a Stool Specimen? 108. Giardia 109. What Are These Images? 109. Ascaris 110. What Is This Worm in a Patient With Chest and Gastric Pain 2 Hours After Eating Sushi?

BMJ Case Reports, http://dx.doi.org/10.1136/bcr‐2016‐218857 110. Gastric Anisakiasis

https://medcoi.com/health/anisakiasis‐symptoms‐causes‐treatment‐and‐preve2n30tion/ 111. What Is This Eye Worm in a Person Who Lived in Africa Recently? 111. Loa Loa This is Loa Loa (a Filaria)-image left This is not Toxocara (Dog or Cat Round Worm)-image right

Loa Loa in Conjuctiva Retinal Granuloma of Toxocara 112. What Are These Images in a Traveler Returning from a Tropical Area?

Emerg Infect Dis 2009 Nov http://wwwnc.cdc.gov/eid/article/15/11/09-0261 112. Cutaneous Larva Migrans (Dog or Cat Hookworm)

Emerg Infect Dis 2009 Nov http://wwwnc.cdc.gov/eid/article/15/11/09-0261 Organisms 113. What Is This Image?

Partners’ Infectious Disease Images; Accessed 4/15/16 from http://www.idimages.org/idreview/case/?CaseID=76 113. Mucoid Klebsiella Liver Abscess

Partners’ Infectious Disease Images; Accessed 4/15/16 from http://www.idimages.org/idreview/case/?CaseID=76 114. What Is This Image-Blood Culture Bottle from a Septic Patient?

100x 114. Anthrax

100x 115. What Is This Image from a Lung Biopsy? 115. Coccidioides 116. What Is This Image- Modified Acid Fast Stain? 116. Beaded Rods Modified Acid Fast Stain-Nocardia 117. What Is This Image from a Lung Biopsy? 117. Rhizopus Species (Mucor) Non Septated Hyphae 118. What Is This Image from a Lung Biopsy? 118. Aspergillus and Others Septated Hyphae The End