Roxanne uses a diaphragm to avoid pregnancy. A few days after her menstrual period began, she suddenly experienced a high fever, muscle aches, and a sunburn-like rash. Which of the following was the MOST likely cause of her illness? O pregnancy O premenstrual dysphoric disorder O miscarriage (pregnancy loss) O toxic shock syndrome
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Roxanne experienced a high fever, muscle aches, and a sunburn-like rash. These symptoms are not typical of pregnancy, premenstrual dysphoric disorder, or miscarriage. Show more…
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Scenario #1: A pregnant 27-year-old woman comes into the clinic. She is complaining of morning sickness. Her pregnancy is at 21 weeks and has been progressing normally. She complains of flu-like symptoms with fever, chills, headache, and body ache. When you check her, you see a rash covering her abdomen. The rash is diffuse with slightly raised red bumps that cover most of her trunk. You are afraid that she may be suffering from a more severe condition that could threaten her baby. You ask her about her sexual history. She has had numerous sexual partners. This is an unplanned pregnancy, but she and the father decided to keep the baby. They have been monogamous since they found out at about week 6. Previously, the woman did have one genital lesion, but she thought it was an ingrown hair since it went away quickly. She has had no other genital lesions. You take a swab of her vagina, stain the slide, and view the specimen under the light microscope. No bacteria are identified. What is your diagnosis? Why were no bacteria visible on the stained slide? What diagnostic test should you use to definitively diagnose this infection? What treatment would you prescribe to this patient? How could this woman have protected herself and her baby?
Madhur L.
While talking to your mother, who is a nurse, she related an interesting story about a 14-year-old patient that she saw in the early 1980s when she worked in a gynecology office. When the young girl first presented, she vomited in the waiting room. She stated that she had been feeling ill the night before and that she had also been having an unusually heavy menstrual flow. She also complained of chills and a diffuse rash on her arms and legs, and she reported having a fever. Upon getting her to the examination room, your mother checked her temperature and blood pressure while the doctor asked her some questions. He asked her if her neck was stiff, to which she answered no; he ordered a lumbar puncture, anyway. At this point, she was starting to look dizzy, and her blood pressure was 80/55. The doctor asked her if she'd ever had sexual intercourse, to which she answered no. The patient's mother also confirmed that she was up to date on all her immunizations. This young girl was eventually admitted into the hospital for treatment. Your mom mentioned, as an interesting aside, that several days after she was admitted, the skin on the palms of her hands began to slough off. 1. What kind of infectious diseases come to mind when a widespread rash is seen as the primary complaint? (Hint: Why had the doctor asked about her sexual history? Why did he ask about her immunizations?) 2. Her rash was diffuse, with well-separated bumps that were maculopapular. Was it likely to be chickenpox? Why or why not? 3. The cerebrospinal fluid obtained from the lumbar puncture was clear—no evidence of bacteria. This ruled out another infection. Which one? 4. The doctor then asked the patient about her menstrual history and practices. She began menstruating at the age of 12 and reported that her last period began four days ago. She reported that she mainly uses tampons during her period. What infection do you think the doctor had in mind by asking about menstruation? Briefly describe this infection and the likely pathogen that causes it. 5. Your mother says that if you see a patient with these symptoms once you start practicing as a physician's assistant, it is less likely to be the same infection as what this young girl experienced. Why?
Adi S.
Tiff is 5 months pregnant with twins. All her life, cats were her babies. Now that she is pregnant, she has been trying to prepare her fur baby for the twins' arrival as her cat is always by her side. Her husband has been caring for the cat full time, but he is away on business, and as a result, she has had to take over the care of the cat. Over the past week, she has been feeling tired and slightly achy all over. She believes it is related to her pregnancy progressing, but she brings up these symptoms to her obstetrician. Her obstetrician is quick to request a test because she is concerned that Tiff may be experiencing more than just pregnancy symptoms. What is the diagnosis of the individual? What is the infectious agent? Should she be concerned? Why or why not? How should she be treated at this point? What could happen without treatment?
Suman K.
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