Scratched
Immune System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M37_F2.jpg"}},{"insert":"\n\n"},{"insert":"It looks to be a busy day at the clinic. One of your interns lets you know that Danielle and her son are waiting for you in your office.\n\n\u0022Hi Danielle, what seems to be the problem?\u0022 you ask as you step through the door.\n\n\u0022Dylan\u0027s had a fever for about a week,\u0022 says the single mother, gesturing at her 17-year-old son. \u0022I\u0027ve been traveling and he hasn\u0027t got it checked out yet.\u0022\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M37_F3.jpg"}},{"insert":"\n\n"},{"insert":"Dylan looks well but fatigued. You learn that he has had a fever intermittently for eight days now.\n\nWhile examining him, you notice two round scars resembling bites on the dorsum of his left hand. He also has, on the same side, epitrochlear and axillary adenopathies which are 1.7 cm and 3.9 cm in diameter respectively. These are regular in shape and tender.\n\nHis heart rate is 102 bpm, with a respiratory rate of 17 cycles per minute, blood pressure of 125\/80 mmHg, oral temperature of 38.1 \u00b0C (100.58 \u00b0F), and a 99% oxygen saturation on ambient air. The remainder of the examination is unremarkable.\n\n\u0022How did you get those scars on your hand?\u0022 you ask, feeling concerned.\n\n\u0022From a cat I tried to rescue,\u0022 he responds glumly. \u0022She got frightened when I picked her up, scratched me, and then ran away.\u0022\n\n\u0022She was already vaccinated for rabies,\u0022 Dylan adds.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M37_F4.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Want to take a shot at the diagnosis?\u0022 you ask the intern, who has been watching and listening keenly.\n\n\u0022Toxoplasmosis?\u0022 comes the response.\n\nHow do you reply?\n"}]}
1. "Yes! The clinical findings correlate with toxoplasmosis."
2. "Close, but the clinical findings strongly suggest bartonellosis."
3. "Nope. Looks more like infectious mononucleosis."
4
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6
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5
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3
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