Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M15_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Please fill out this prescription - and make sure you complete the course of the medication\u0022 you say with a smile to the pleasant older gentleman whom you\u0027ve just diagnosed with low-grade, community acquired pneumonia.\n\nHe\u0027s the third patient with pneumonia to visit your clinic this morning, and it\u0027s only 11.30 a.m.\n\n\u0022I guess it\u0027s that season again\u0022, you mutter under your breath.\n\nYou\u0027re sorting through some clinical dictations and case notes when the nurse calls the next patient in. You start reading through her case file.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M15_F2.jpg"}},{"insert":"\n\n"},{"insert":"Tamaya is a 23-year-old university student who complains of fever for the last two days.\n \nYou introduce yourself and ask how you can help her today.\n\n\u0022Doctor, I\u0027ve been having a fever and shivering for the last two days. It started suddenly, out of nowhere! I haven\u0027t been able to eat or drink much since,\u0022 she says, looking fatigued.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M15_F3.jpg"}},{"insert":"\n\n"},{"insert":"On further probing you learn that Tamaya\u0027s fever is cyclical and associated with chills, rigors and malaise.\n \nShe also complains of generalized muscle and joint pain, especially in her knees and shoulders.\n\nThis morning, she woke up with a headache, mainly affecting her forehead and around her eyes. She describes it as a sensation of \u0027pressure\u0027 and \u0027stuffiness\u0027.\n \nShe also says that her skin seems flushed after each episode of fever. She denies vomiting, neck stiffness or sensitivity to light.\n\nYou further discover that she recently returned from a two month trip to Southeast Asia. She was healthy throughout her holiday, except for some insect bites.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M15_F4.jpg"}},{"insert":"\n\n"},{"insert":"On inspection, she seems quite fatigued. You notice flushing over her cheeks and forehead\n\nHer vitals are as follows: BP 127\/92 mmHg, pulse 102 bpm, O2 saturation 98% on room air, and a respiratory rate of 22 cycles\/min.\n \nShe is febrile, with a temperature of 101 \u02daF (38.3 \u02daC). There is lymphadenopathy of the submandibular and axillary nodes.\n\nHer heart sounds are normal, although she is slightly tachycardic, with clear lung fields. She has generalized abdominal tenderness but no swelling, rebound tenderness or guarding. No abdominal organs are palpable.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M15_F5.jpg"}},{"insert":"\n\n"},{"insert":"Her blood panel, and renal and liver function tests read as follows:\n\nHb: 13.2 g\/dL (12 - 15.5)\nPCV: 0.45 (0.35 - 0.45)\nWhite cell count: 2,000\/mm3 (3,500 - 10,500)\nPlatelet count: 101,000\/mm3 (150,000 - 450,000)\nBUN: 21 mg\/dL (7 - 20)\nSerum creatinine: 1.14 mg\/dL (0.6 - 1.1) \nAST: 64 IU\/L (9 - 48)\nALT: 55 IU\/L (7 - 55)\n"}]}