First
Immune System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P2_F5.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027ve had a busy but fairly routine morning at the pediatric clinic.\n\n\u0022Doctor, you should see this boy next\u0022, your nurse says, ushering the next patient in. You are introduced to five-year-old Austin, accompanied by his father and stepmother.\n\nAustin has had fever, nasal congestion, and red eyes for the last three days. Late last night, he developed a red rash on his face; today, this had spread to encompass his entire body. He also started coughing and breathing rapidly. This prompted his father to seek medical advice.\n\nHis only treatment has been acetaminophen (paracetamol) six-hourly for the last two days, based on his stepmother\u0027s assumption that he had \u0022the flu\u0022.\n\nHis medical history is significant for a single episode of otitis media at the age of three, which was successfully treated with a course of antibiotics. Growth and development are both normal.\n\nHe has not been administered the MMR vaccine, as his father and stepmother both believe that vaccination is harmful. His three-year-old sister, Dawn, has not been vaccinated against MMR either.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P2_F7.jpg"}},{"insert":"\n\n"},{"insert":"On examination, Austin is fussy, irritable, and difficult to console. His temperature is 104 \u00b0F (40 \u00b0C), with a pulse rate of 180 bpm, a blood pressure of 100\/60 mmHg, and respiratory rate of 28\/min. Pulse oximetry reveals an arterial oxygen saturation (SpO2) of 97%.\n\nYou note the presence of bilateral exudative conjunctivitis and copious dried rhinorrhea. His oral mucosa is dry and lips are cracked. No oral lesions are present. You also notice a diffuse, blanching, erythematous, papular rash with coalescing lesions over his scalp, face and trunk.\n\nExamination of the respiratory, cardiovascular and neurological systems reveals no other abnormalities. You order an urgent complete blood count, which shows the following results:\n\nLeukocyte count: 6,200\/mm3 (5,500-15,500)\n Segmented neutrophils: 69%\n Lymphocytes: 19% \nHemoglobin: 12.5 g\/dL (11.5-15.0)\nPlatelet count: 218,000\/mm3 (150,000-450,000)\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P2_F5.jpg"}},{"insert":"\n\n"},{"insert":"You make a clinical diagnosis of measles infection and send samples for estimation of IgG titres and viral cultures. You also make sure to report the case to the relevant public health authorities.\n\nYou explain the disease and implications to Austin\u0027s father and stepmother, who look slightly shocked. Austin\u0027s father asks:\n\n\u0022Doctor, can we take Austin home? We moved here recently and don\u0027t have relatives or close friends nearby. It\u0027ll be tough to cope.\u0022\n"}]}
3
{"ops":[{"insert":"What will you do?\n"}]}
1. Manage Austin at home
2. Admit Austin to the pediatric ward
3. Admit Austin for negative-pressure isolation
6
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5
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7
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4
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