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حالات سريرية


حالة صعبة ... مين قدها |

حالة سريرية

الوصف الكامل Background

A 14-year-old, previously healthy, fully immunized girl is presented to the emergency department (ED) with a 2-week history of left ear pain and discharge. She has just completed a 10-day course of antibiotic therapy, prescribed by her primary care provider, for marked left ear pain and swelling with purulent bloody discharge, headache, and left temporal and facial pain. She denies any history of foreign body in the ears, hearing loss, or fever. The review of systems is not contributory. Her past medical history is unremarkable, and the patient has no known history of allergy.

On examination, the patient is a young white girl who is ill-appearing but in no obvious distress. Her vital signs include a temperature of 97.9°F (36.6°C), a regular heart rate of 86 bpm, a respiratory rate of 16 breaths/min, and a blood pressure of 110/80 mm Hg. On examination of the head, swelling and tenderness are noted behind the left ear lobe, with purulent bloody discharge from the left ear. The central nervous system (CNS) examination reveals an alert and well-oriented young girl with a Glasgow Coma Score of 15/15. She is unable to wrinkle the left side of her forehead, she can not close her left eyelid, and the left nasolabial fold is flat and with deviation of the mouth to the right. The cardiovascular, respiratory, and abdominal examinations are all normal.

The initial laboratory analysis, which includes a complete blood cell count (CBC) and basic metabolic panel, are normal. Computed tomography (CT) scanning of the brain confirms a left-sided mastoiditis, but no findings to suggest increased intracranial pressure are noted. An analysis of the cerebrospinal fluid (CSF) shows no significant white or red blood cells or abnormalities in the glucose and protein concentrations. A swab of the purulent discharge from the left ear, blood, and CSF samples are sent for culture. She is admitted for suppurative otitis media, mastoiditis, and seventh nerve palsy. Infectious disease, head and neck surgery, and neurology specialists are consulted. Her initial management includes intravenous fluid, pain medications, tympanostomy for drainage and culture, and intravenous meropenem pending the culture and sensitivity results. On admission day 2, however, the patient develops severe left orbital pain, double vision, and the inability to abduct the left eye. The neurologist clinically confirms a sixth nerve palsy, and a request is made for magnetic resonance imaging (MRI) of the temporal bones, as well as magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) to rule out venous sinus thrombosis.

المرجع

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ألم شديد في الفخذ تلاه احمرار وانتفاخ انتشر إلى الأعضاء المجاورة |

حالة سريرية

الوصف الكامل Background


A 66 year-old man presents complaining of fever and thigh pain. 24 hours ago he noted intense pain followed by redness and swelling in a small area of the right lateral thigh. Since then, the affected area has progressively increased to the current state, which on exam includes almost all of the right thigh and buttock, the lateral aspect of the right leg, and extends to the abdomen and right flank, 5 cm above the iliac crest. Crepitus is present on palpation. Leukocyte count is 14,000/mm3. Blood cultures are pending. Which organism is the most common etiologic agent of this clinical scenario?
A. Group A Streptococcus
B. Moraxella catarrhalis
C. Mycoplasma pneumoniae
D. Staphylococcus aureus
E. Staphylococcus epidermidis


حالة خمجية.. شاب يشكو من ألم في ساقه وقدمه |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 19-year-old male has a history of athlete’s foot but is otherwise healthy when he develops the sudden onset of fever and pain in the right foot and leg. On physical exam, the foot and leg are fiery red with a welldefined indurated margin that appears to be rapidly advancing. There is tender inguinal lymphadenopathy. The most likely organism to cause this infection is:
a. Staphylococcus epidermidis
b. Tinea pedis
c. Streptococcus pyogenes
d. Mixed anaerobic infection

microbiology case:sore throat and fever |

حالة سريرية

الوصف الكامل Background
At the Mount Union hospital, a 5-year old white male child in good general health and physical condition was presented at the Saturday walk-in clinic by his mother. He was brought in because he had a fever, was cranky and had complained of a sore throat for about 24 hours. On physical examination by the attending resident, the patient had a fever of 39.3C, and he had considerable swelling and drainage of the pharynx and in the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His chest sounded clear and he had no additional remarkable findings on routine examination.
1. What would be your presumptive diagnosis for this child? Why?
2. What diagnostic testing would be indicated to follow this exam?
3. What is the most likely treatment for this illness? Why is it important?

joint disease 1 |

حالة سريرية

الوصف الكامل Background

An 18-year-old man is evaluated because of a 2-day history of fever, chills, and migratory arthralgias involving the ankles, knees, elbows, and shoulders. On physical examination there are subcutaneous nodules on the volar surface of both forearms, and a grade 2/6 systolic murmur and an S3 heard at the left ventricular apex. There is no objective evidence of joint disease.

Which of the following additional findings establishes a definite diagnosis of acute rheumatic fever in this patient?

( A ) Arthritis
( B ) Erythema marginatum
( C ) Choreoathetosis
( D ) An elevated erythrocyte sedimentation rate
( E ) A throat culture positive for group A streptococci

المرجع

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أحياء دقيقة 19: طفح على الرقبة والجذع انتشر إلى الذراعين Microbiology 19: Rash on Trunk and Neck has spread to Arms |

حالة سريرية

الوصف الكامل Background
A young girl is brought to her doctor because of a rough-apperaing rash on her trunk and neck that has spread to her arms.
Physical exam reveals that her axilla are most affected but her palms and soles are spared.
Her parents say that she has been suffering from fever and sore throat.
Lab studies reveal her serum is ASO+.

What's the diagnosis? What's the treatment?

اُحضِرَت فتاة إلى طبيبها وهي تعاني من طفح خشن المظهر على جذعها ورقبتها وقد انتشر إلى ذراعيها.
وبالفحص السريري تبين أن إبطها هو أكثر مكان متأثر بالإصابة ولكن راحتي يديها وأخمصي قدميها غير مصابة.
والداها قالا أنها كانت تعاني من حمى والتهاب بلعوم.
الفحوص المخبرية أظهرت أن مصلها إيجابي مضاد الستريبتوليزين O.

ما هو التشخيص؟ وما هو العلاج؟

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