Case Files 2: I'm Hot, and Coughing My Ears Out

Here is a case from Med Case Reports with some addition of questions, and we'll include our discussions here before revealing the answer. Try cracking your rusty head. :P

A 26-year-old female student presents with a 5-day history of cough, low-grade fever (temperature 37.6 C), sore throat, and coryza.
On exam, there is mild conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is seen. Chest exam shows few basilar rales.

Laboratory findings are as follows:
Hct: 38
WBC: 12,000/μL
Lymphocytes: 50%
Mean corpuscular volume (MCV): 83 nL
Reticulocytes: 3% of red cells
CXR: bilateral patchy lower lobe infiltrates

1.The sputum Gram stain is likely to show
a. Gram-positive diplococci
b. Tiny gram-negative coccobacilli
c. White blood cells without organisms
d. Acid-fast bacilli
and what is your reason?

2. This patient is likely to have
a. High titers of adenovirus
b. High titers of IgM cold agglutinins
c. A positive silver methenamine stain
d. A positive blood culture for Streptococcus pneumoniae

And the reason being? What are the other diagnostic tests?

3. Treatment of choice is
a. Erythromycin
b. Supportive therapy
c. Trimethoprim-sulfamethoxazole
d. Cefuroxime

Dosage, mechanism of action, side effects?
4. Further Management and possible complications?

5. Last but not least, what are the general investigations done for patients with suspected pneumonia, and its indications.

Now, take a deep breath, and only check the answers once you've given this a try.

2 referrals:

Jeffrey said...

Hehe....crack my head ok:)

1)most probably is C because this sounds like a viral infection,i.e.common cold(rhinovirus),the RSV or adenovirus. Gram positive cocci in chains may be seen but that is most probably the normal flora of the mouth.

2)If the lab have the equipment, maybe high titre of adenovirus can be seen. However more conventional method to detect viruses is the agglutinin thingy, so i will hazard a guess at that? hahahaha... Other diagnostic test, maybe if a lot money can use PCR,Hemagglutinatin inhibition. and because this disease is so like Strep throat,i would culture the sputum for strep pneumoniae just to rule out.....dats all i can think of haha paiseh

3)If its a viral infection (which i think most likely is adenovirus because u say high titre up there) treatment is B..supportive

4)further management a?Adenovirus generally is transmitted through direct contact or some types is waterborn(especially the eye disease type),so avoid ppl with flu or avoid swimming here and there...hahahha i dunno sorry

5)General investigation is like FBC which show elevated white cell count,from here we can guess the etiology. Other general investigations like LFT, RP done to assess the general condition of the patient and severity of the disease.

Sputum staining and C&S should be done immediately as well as chest X ray. IF cannot get any result maybe more invasive procedures like BAL and bronchoscopy done. If still no result than atypical etiology should be suspected,e.g. Legionella and specific serology should be done.

really rusted dy the brain :(

~YM~ said...

lol..really an elaborate answer..
will send the source link to u, and leave here for others to keep guessing. :P