The reader
04-05-2005, 02:12 PM
Salam everybody,
This time I will post the final answer in 14 days from now. Meanwhile, I will be commenting on your responses in my convenience. I hope you will enjoy working with this case.
(5) A 37 year old male patient presents to ER with 2 weeks history of generalised fatigability and tiredness. He reports history of night sweats and feeling hot occasionaly. He took Amoxicyllin for 6 days but did not notice a change in his condition. Actually his symptoms worsened with joints pains and significant decrease in his excersise tolerance.
On P/E, temp=38.2, HR= 108 reular, RR= 24, B.P= 100/70 and no postural drop, O2 sat=90% on RA, JVP is 7 CM ASA, S1+ S2 heared clearly with normal splitting of S2. there is a pansystolic murmur, grade 3, radiating to the axilla, bilateral crackles on mid and lower lung zones and mild splenomegaly.
There is palpable purpuric rash on lower limb with pitting edema up to mid-legs, R-knee joint swelling with mild effusion and a positive urine dipstick for blood.
1. What is your provisional diagnosis from the above data?
A) Serum sickness.
B) Subacute bacterial endocarditis.
C) Systemic lupus erythematosus.
D) Systemic vasculitis.
E) Acute myocarditis.
2. What could predict a worse outcome from this patient's presentation?
A) Positive blood cultures.
B) Elevated CRP level.
C) High titer of Anti-ds DNA.
D) Signs of CHF.
E) Acute renal failure.
Good luck.
This time I will post the final answer in 14 days from now. Meanwhile, I will be commenting on your responses in my convenience. I hope you will enjoy working with this case.
(5) A 37 year old male patient presents to ER with 2 weeks history of generalised fatigability and tiredness. He reports history of night sweats and feeling hot occasionaly. He took Amoxicyllin for 6 days but did not notice a change in his condition. Actually his symptoms worsened with joints pains and significant decrease in his excersise tolerance.
On P/E, temp=38.2, HR= 108 reular, RR= 24, B.P= 100/70 and no postural drop, O2 sat=90% on RA, JVP is 7 CM ASA, S1+ S2 heared clearly with normal splitting of S2. there is a pansystolic murmur, grade 3, radiating to the axilla, bilateral crackles on mid and lower lung zones and mild splenomegaly.
There is palpable purpuric rash on lower limb with pitting edema up to mid-legs, R-knee joint swelling with mild effusion and a positive urine dipstick for blood.
1. What is your provisional diagnosis from the above data?
A) Serum sickness.
B) Subacute bacterial endocarditis.
C) Systemic lupus erythematosus.
D) Systemic vasculitis.
E) Acute myocarditis.
2. What could predict a worse outcome from this patient's presentation?
A) Positive blood cultures.
B) Elevated CRP level.
C) High titer of Anti-ds DNA.
D) Signs of CHF.
E) Acute renal failure.
Good luck.