Examined III

Immune System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Feels better to be on the other side, doesn\u0027t it?\u0022, your former teacher, and now-colleague, Dr. Ann asks.\n"}]}


{"ops":[{"insert":"\u0022Definitely!\u0022, you reply with a smile.\r\n\r\n\u0022Remember though - being an examiner can still be tricky\u0022, she says and continues, \u0022shall we meet our first candidate then?\u0022\n"}]}


{"ops":[{"insert":"You look down at the list in your hands and ask for the first candidate, Wendy, to be ushered in.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F4.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Hello Wendy, how are you?\u0022, Dr. Ann asks as the student sits down in front of you.\r\n\r\nA smile appears on her face as she responds with a somewhat timid, \u0022I\u0027m doing good, thank you, doctor\u0022.\n\nConjuring up a gentle smile, you ask Wendy to tell you about her patient.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F5.jpg"}},{"insert":"\n\n"},{"insert":"Hector, a 26-year-old professional photographer, presented with fever and generalized weakness for the past week, in a background of anorexia, night sweats, and easy fatigability for around three weeks, and a 5-kg weight loss during the same period.\r\n\r\nThere was no history of cardiac, respiratory, gastrointestinal, or urinary symptoms.\n"}]}


{"ops":[{"insert":"He mistrusts \u0022allopathic\u0022 medicine, preferring to rely on homeopathy.\r\n\r\nHe was given a one-week course of \u0022Chamomilla\u0022 drops by a homeopathic practitioner, at the start of his illness. As his symptoms persisted, he was then persuaded to go to your hospital by his brother.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F7.jpg"}},{"insert":"\n\n"},{"insert":"His medical, surgical, and family histories are unremarkable. His allergic history is significant for an allergy to penicillin.\r\n\r\nHis social history is significant for intravenous (IV) drug abuse for around 3 years: predominantly heroin and cocaine. He claims to have been clean for the past 6 months after the pastor of his church helped him \u0022find his true path\u0022.\n"}]}


{"ops":[{"insert":"He has a single stable female sexual partner now and has had a total of 4 different partners over the years. He was persuaded to undergo HIV testing 3 months ago, which was negative.\n"}]}


{"ops":[{"insert":"He has a 10-pack-year smoking history and has been drinking regularly since the age of 21, with an estimated average consumption of 3 to 4 units per day.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F10.jpg"}},{"insert":"\n\n"},{"insert":"At admission, his vital signs were as follows:\r\n\r\nTemp: 100.94 F (38.8 C)\r\nPulse: 96\/min\r\nBlood pressure: 110\/60mmHg\r\nRespiratory rate: 18\/min\n\nThe general examination was significant for multiple old needle marks on both arms and thighs; grade 2 clubbing of all fingers and toes; on three different fingers, darkened linear streaks running from the tip to the nail bed; and multiple small painless erythematous lesions on the soles of both feet.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F11.jpg"}},{"insert":"\n\n"},{"insert":"Cardiovascular examination revealed a grade 3\/6 holosystolic murmur which was loudest over the apical region, and with radiation to the axilla.\n"}]}


{"ops":[{"insert":"The abdominal, respiratory, and central nervous system examinations were normal.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F13.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Her investigations showed ...\u0022, Wendy continues but is cut short by Dr. Ann.\r\n\r\n\u0022Before we go there, is there anything else important in the examination?\u0022, she asks.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M49_F14.jpg"}},{"insert":"\n\n"},{"insert":"Wendy pauses to think, and then replies, \u0022Yes - findings related to the eyes\u0022.\r\n\r\n\u0022Excellent!\u0022, Dr. Ann says, and continues, \u0022What would you be looking for in the eyes?\u0022.\n"}]}


{"ops":[{"insert":"What do you expect Wendy to say?\n"}]}
1. Osler's nodes
2. Roth's spots
3. Janeway lesions