Swollen
Immune System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M36_F1.jpg"}},{"insert":"\n\n"},{"insert":"All set for your day at the clinic, you request that the first patient be sent in.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M36_F2.jpg"}},{"insert":"\n\n"},{"insert":"Thirty-eight year old Sheena is in today due to a swollen right foot.\r\n \r\n\u0022It started around three days ago and has been getting worse since,\u0022 she tells you. \u0022I can barely walk.\u0022\n\nYou learn that the swelling started out as an insect bite, which she kept on scratching because it itched. \r\n \r\n\u0022Our street was flooded, and my feet got soaked yesterday. I\u0027m worried that this might be an infection\u0022, she adds.\n\nThere is no history of fever.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M36_F3.jpg"}},{"insert":"\n\n"},{"insert":"Sheena is non-hypertensive, non-diabetic, and has no history of cancer. Her vitals are stable, and a systemic examination reveals no abnormal findings.\n\nExamining her right foot, you notice that it is red, swollen up to the ankle, and warm and tender to the touch.\r\n \r\nSheena rates the pain as 6\/10 on the pain scale.\n\nThere is no discharge, crepitus, calf pain, inguinal node enlargement, paralysis, or paresis. The superficial collateral veins remain undilated and no distinct mass is palpable within the swelling.\n\n\u0022Should I arrange for a Doppler, doctor?\u0022 asks the nurse.\n"}]}
3
{"ops":[{"insert":"How do you respond?\n"}]}
1. "No, we can pass on imaging studies for now."
2. "Yes, we'll need to rule out deep vein thrombosis."
3. "No, please arrange for a CT instead."
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