Case 11: A white male, 17 years of age, presented at the emergency room with severe headache, vomiting, and stiff neck with pain running up his back. On admission, his temperature was 101°F. The young man appeared to have trouble hearing during the nurse's interview and also seemed to have trouble concentrating. The history revealed that the young man is a wrestler for the local high school team. He had felt as though he were getting cold in the past few days since his last meet in Hicksville. He did not smoke or drink, but he had attended a party two days earlier thrown by his girlfriend and the other cheerleaders to celebrate his victory in the sectionals. He had been maintaining his weight at 162 for the season, so he ate little and did not drink on the day of the meet (today, the day of the meet). On physical exam, the physician noticed several areas of small purplish spots on the skin of the back, thigh, and arm. The boy thought those were from wrestling. What is the most likely diagnosis? What was the critical factor in your choice of diagnosis? What will likely happen if not treated?
Case 12: A missionary couple, living in West Africa, bring their one-year-old son to the office of their physician on the second day of their visit home to Birmingham. The boy had a mild episode of diarrhea about seven days earlier and would not eat. He seemed to recover, but the mother noticed that the boy was having trouble walking the previous night and had seemed to have trouble dressing himself and walking that day. On examination, the patient had no significant fever (98.9°F) and normal bowel sounds. His chest, ears, and eyes were clear. He had no rebound tenderness in the abdomen. The physician noted that the child had poor muscular reflexes in his arms and legs. The child also was a bit lethargic and seemed confused. The family lives in an isolated village in Africa. The mother opposes vaccination, so the child...