Cases Flashcards
(7 cards)
A 18-years old man presented with a 3- day history of fever, diffuse abdominal and chest pain. These symptoms have occurred several times over several years and his past medical history included exploratory laparotomy 2 years ago, he was no drug history and history of travelling to Turkey 6 weeks ago. On examination temperature was 38.5°C and there were signs of peritonitis with normal ultrasound and plain erect X ray.
a) What is the most likely diagnosis of this case?
Familial Mediterranean Fever (FMF)
b) What is the most important investigation?
1-Genetic testing for MEFV gene mutations Confirms diagnosis of FMF.
2-Elevated serum amyloid A (SAA) during attacks can also support the diagnosis.
3-ESR and CRP may be elevated during attacks, but they are nonspecific.
c) What is the treatment of Choice in this case?
Colchicine
Lifelong daily use prevents attacks and the development of amyloidosis, which is the most serious complication
A 24-year-old man presented with swelling of his left foot. The swelling is diffuse and doughy. He was otherwise well with no fever or systemic upset. There were a few enlarged lymph nodes in his groin. Full blood report revealed eosinophilia with the nodes eosinophilia and swollen. His full blood count revealed an eosinophilia of 1.4 x 10$^9$/L (normal 0.04-0.4).
a) What is your diagnosis?
b) Mention the causative agent?
c) How can this disease be prevented?
A 43-years old man develops a cough shortly after returning from a 1-month hiking trip in California. He was previously healthy and did not take any medications. He reports a “flu-like” illness consists of fever, cough and muscle pain, which resolved spontaneously. A chest X ray shows a thin-walled cavity in the right upper lobe of the lung, and his sputum reveals fungal elements.
a) Which fungi can cause this lesion?
b) How to confirm your choice?
c) How to treat this disease?
A 22 years old patient complaining of unwell and headache. He also noticed a large swollen black lesion on his thigh that was painful. Thinking he had injured himself and that it was now infected, he went to his primary health-care provider who gave him co-amoxiclav. Over the next few days, the lesion did not resolve, and he continued to feel unwell with headache and myalgia. The doctor identified the lesion on his thigh as a tick bite. He also noticed that the patient had regional lymphadenopathy. a) What is the most probable diagnosis? b) Which organism is the most likely cause of this infection? c) What are the treatment options?
Lyme
A 36-year-old man presented with a two weeks history of fever and new onset intense myalgia after he had abdominal pain, fever, vomiting and diarrhea. He had no drug history and he was a non-smoker, he gave history of eating smoked pork meat with his friends in Mexico. On examination, his temperature 38.5°C, heart rate 110 beats/min, his respiratory rate was 26 and his oxygen saturation is 93% on room air. He had periorbital edema.
conjunctivitis respiratory distress with bilateral basal crackles and peripheral edema.
a) What is the diagnosis of this case?
b) What are the clues that confirm the diagnosis?
c) What is the treatment of this case?
Trichenella spiralis
ليه مش trypanosoma cruzi
عشان
1-T. cruzi is transmitted primarily by the triatomine (“kissing”) bug, not by eating pork.
This patient ate smoked pork, a classic risk for Trichinella — not T. cruzi.
2-Vomiting, abdominal pain, and diarrhea are classic for trichinellosis, not acute Chagas.
3-Intense myalgia and systemic inflammation are hallmark features of trichinellosis.
4-Periorbital edema:
While Romana’s sign (unilateral painless periorbital swelling) is seen in acute Chagas, this patient has bilateral periorbital edema with systemic signs — more typical of trichinellosis.
72-year-old gentleman retired to the south of Spain but returned to the UK for the summer months. He began to develop fever, malaise, loss of appetite, and weight loss. He was admitted to the hospital and had temperatures reaching 39°C. Both his liver and spleen were palpable. No lymph nodes could be felt. Blood tests showed a pancytopenia. Routine investigations for an infection were negative, and he did not improve with broad-spectrum antibiotics. His condition deteriorated, and the size of the liver and spleen increased. A) What is the causative agent? B) How does it enter the body? C) What are the types?
1-Causative organism
*Leishmania donovani complex
ليه؟
Fever +pancytopenia+hepatosplenomegaly+failure to respond to antibiotics.+weight loss
2-How does it enter the body?
Transmitted via the bite of an infected female phlebotomine sandfly
*The sandfly injects promastigotes into the skin, which are then phagocytosed by macrophages and transform into amastigotes that multiply intracellularly.
