Author Topic: Case (68)  (Read 3816 times)

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Offline Diagnostic

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Case (68)
« on: March 12, 2011, 08:23:48 PM »
19 years old male, well known Quranic school (dugsi) teacher in his village brought to the casaulty with loss of consicious and enalrged neck.

The history started 14 days ago with headache, muscular pain & fever which he was using paracetamol for.
After 1 week he drunk 1 cup of lemonade which cause him severe pain in his mouth and the next day he developed neck stiff & gradually increasing neck swelling.

He used tradional medicine to relieve the swelling but it was increasing until he become confuse and lost of his conscious.

The patient looks sick, unconsciouse, febrile 38.1 with fast breathing of 32/m.
He has neck stiffnes & bilateral enalrged salivary glands.

Other systems are normal.

All the routine investigations done including TWBC Count & Peripheral blood picture were normal.
Blood glucose was normal.
Serum creatinine and urea were normal.
Skull x-ray was normal.
Throat swab was negative.
Pastorex Meningitis Test was negative.

After all these tests, the doctor told the relatives that this condition has no treatment but self limiting. and ordered to keep the patient in a seperate room and give him supportive therapy.

After 6 days, the patient got improved and discharged in a healthy condition but the doctor sent a message with the patient regarding his students!

Questions:
1- What is the diagnosis?
2- What is the importance of patient's occupation to his diagnosis?
3- What is the importance of the lemonade here?
4- Why the patient developed neck stiffness and become confused?
5- What is the only important question you like to ask the co-patient about patient's childhood history?
6- What are the differential diagnosis that can be excluded by normal TWBC count?
7- What for the doctor did for the throat swab?
8- What was the message given to the patient regarding his students?


In diagnosis think of the easy first.
Martin H. Fischer

Offline Dr.Habiib

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Re: Case (68)
« Reply #1 on: March 13, 2011, 02:01:06 AM »
ANSWERS:

1. The most probably diagnosis is MUMPS (ACUTE VIRAL parotid glands).

Because it is more common in children and incubation period is 14- 20 days with average of 17 days.
It is usually bilateral enlargement of parotid gland.
Using of paracetomol relieves pain and fever because it is inhibits COX3 in CNS.

2. The patient is important for his diagnosis because:

A. The young children with mumps are generally good because the symptoms should pass within two weeks without causing any long-term problems.
B.The teenagers and adults with mumps are slightly less positive because they have a higher risk of developing complications, some of which can be serious.

 3. What lemonade caused to the patient?
Because drinking of fruits specially (lemonade) stimulates excess saliva secretion of salivary glands can cause pain.

4. Neck stiffness is very important alarm as complication of mumps   to the Brain inflammation (encephalitis or meningitis) which is an uncommon complication.

5. I can ask that this has like this disease because has very long immunization.
Here I am not asking that he has a vaccine or no because we know our country there no vaccine.

6.  Usually, WBC count and differential are normal. Leukocytosis has been seen in mumps.

7. Throat swabs are important test in the Clinical Virology Laboratory for diagnosis of mumps: PCR is the most sensitive test.

8. the most important message is to take vaccine:

MMR Vaccine: The best way to prevent catching mumps is to be immunized with the measles, mumps and rubella (MMR) vaccine.

Advice children:
 MMR vaccine is part of the routine childhood immunization programmer.
One dose is given to a child at around 13 months of age
 A second booster dose is given before they start school, usually between 3-5 years old.

Advice adult:
The MMR vaccine can be given at any age, so there may be circumstances where you are advised to have the MMR vaccine.


Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient

Offline Diagnostic

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Re: Case (68)
« Reply #2 on: March 14, 2011, 12:13:24 AM »
Well done! Your answer is correct.

Thanks You.
In diagnosis think of the easy first.
Martin H. Fischer

 

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