Case Review 3

13 year Male child came with complains of swelling of the body starting from the periorbital area for 8 days and then pitting oedema on the legs for 2 days.There is no history of fever but he complains of headache, temporal aggravated by heat and there is Blurring of vision as well.

He complains of occassional productive cough with blood stained sputum.

No H/O sore throat, TB or other disease in tha past.

He is staying at hostel and his senior has tuberculosis.

O/E:

GC: fair

Vitals: BP=140/100, rest stable

JALCyClOD= Pitting Edema, Bilateral legs

Systemic Examination:
Chest/CVS/PA= No Abnormality detected

local: legs=pustular, echtymic rashes.

Xray: fluffy infiltrates bilateral

Urine:frothy,albumin ++,RBC-,pus cell-normal

Local: Rash in leg: Picture

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Case Review 2

A 69 year-old male farmer, non-smoker, was admited to our department due to dyspnea on exertion, night sweats during the last two months and severe thrombocytopenia revealed during a routine screening by his general practitioner. The patient had a medical history of congestive heart failure, and osteoarthritis.

Physical examination

• temperature 36.8°C, 
• pulse rate 80 beats/min, 
• blood pressure 150/90 mmHg, 
• respiratory rate 20 breaths/min and oxygen saturation 94% on room air.
• Auscultation disclosed decreased breath sounds at the right lower base, with dullness on percussion. 
• In addition the patient had ecchymoses in his lower limps and trunk without petechiae. Laboratory work-up showed: hemoglobin 15.6 g/dL, white blood cell count 10,900 cells/µL (71% neutrophils and 18% lymphocytes), and platelet count 20,000 cells/µL. Prothrombin time and partial thromboplastine time where within normal limits, as well as the rest of the laboratory tests
• Chest XRay:

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Case Review 1

USMLE case: surgery or medicine

 

A 13-year-old boy has a 3-day history of low-grade fever, upper respiratory symptoms, and a sore throat. A few hours before his presentation to the emergency room, he has an abrupt onset of high fever, difficulty swallowing, and poor handling of his secretions. He indicates that he has a marked worsening in the severity of his sore throat. His pharynx has a fluctuant bulge in the posterior wall. Which of the following is the most appropriate initial therapy for this patient?

A.Narcotic analgesics

B.Trial of oral penicillin V

C.Surgical consultation for incision and drainage under general anesthesia

D.Rapid streptococcal screen

E.Monospot test

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Answers To All Cases

 ANSWERS

Case Review 1 : C.Surgical consultation for incision and drainage under general anesthesia

 

Case Review2:

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