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. What would be your presumptive diagnosis for this child? What organism causes this infection? What factors of this case allowed you to make a presumptive diagnosis? What virulence factors about this pathogen contribute to these symptoms? What diagnostic testing would be indicated to follow this exam? What is the most likely treatment for this illness? Why is it important?
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Step 1: Based on the symptoms described in the case, the presumptive diagnosis for this child is acute tonsillitis. Show more…
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At the Boston Children's Hospital, a 10-year-old male child in good general health and physical condition was presented. 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, the patient had a fever of 39.3°C, 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? 4. What factors of this case allowed you to make a presumptive diagnosis?
Adi S.
A three-year-old boy presents at the walk-in clinic in Coolidge Corner, Brookline on February 26th. His caregiver brought him in for evaluation of fever, ear pain and swollen cheeks. A careful history reports that he had 3 or 4 days of low-grade fever and seemed irritable and tired. About 24h previous he developed sudden onset of ear pain, swelling along the cheeks, with a high fever. He is an only child and neither his parents or caregiver are ill. On examination his temperature was 101.6°F and his pulse was 105 beats / min. He has grossly swollen parotid glands bilaterally and opening his mouth causes pain. Upon inspection his tympanic membranes and posterior pharynx appear normal although erythema and swelling of the Stensen duct were noticed. Other history revealed that he had no significant illness in his life and has not received any vaccines due to his parents concerns about autism. What tests would do to diagnose the child and what was the diagnosis?
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Edema is a common clinical problem. On your first day of a clinical rotation, you encounter four patients who have edema for different reasons. Your challenge is to explain the edema in terms of either an increase or a decrease in one of the four pressures that causes bulk flow (see Focus Figure 19.1 on pp. $732-733$ ). (1) First you encounter Mrs. Taylor in the medical unit awaiting a liver transplant. What is the connection between liver failure and her edema? (2) Next in the obstetric ward, Mrs. So is experiencing premature labor and has edema in her legs. Which bulk flow pressures might be altered here? (3) In emergency, Mr. Herrera is in anaphylactic shock. His capillaries have become leaky, allowing plasma proteins that are normally kept inside the blood vessels to escape into the interstitial fluid. Which of the bulk flow pressures is altered in this case and in what direction is the change? (4) Finally, in oncology Mrs. O'Leary is recovering from breast cancer surgery. Her right breast and all of her axillary lymph nodes were removed. Unfortunately, this severed most of the lymphatic vessels draining her right arm. You notice that this arm is quite edematous. Why? Mrs. O'Leary is given a compression sleeve to wear on this arm to help relieve the edema. Which of the bulk flow pressures will be altered by the compression sleeve?
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