Exam 3: Case studies

Question 1

A 35 year old female intepreter presents to your ER with lightheadedness and “feeling faint.” She endorses a 2 day history of severe, profuse diarrhea and vomiting. her symptoms began shortly after returning from a medical mission trip in central africa. she recalls eating shrimp that seemed undercooked. she has not had any fever and dnies any abdominal pain. she estimates having an episode of diarrhea every hour for the past 24 hours. she describes her stool as very water and milkly-looking “with flecks in it” but denies any blood in the stool.

Answer 1

Vibrio cholerae – hallmark of cholera is severe, watery diarrhea with mild to severe dehydration
- cholera toxin causes electrolyte and water loss through secretory diarrhea “rice water” stools

Question 2

a 20 year old male presents to your clinic with a rash that he thinks is an allergic reaction and started yesterday. he endorses a mild headache and myalgias for the same time period. his past med history reveals no chronic medical problems but he was treated for gonorrhea 6 mo ago. denies dysuria or penile discharge.
- skin: diffuse, erythematous, maculopapular rash over his entire body including the palsm and soles

Answer 2

early syphilis

Question 3

S: A 25 year old male from Minnesota with no past medical history presents to your clinic complaining of fever, chills, headaches, fatigue, and myalgias for the past week, along with a “weird rash” on his back. He is not sure how long the rash has been there because his girlfriend is the one that noticed it. He denies any foreign travel, but he and his family have a cabin “up north” on the lake. He likes to go backpacking in the woods near there. His last trip up north was a couple weeks ago. Denies any nausea, vomiting, or diarrhea.

Answer 3

lyme disease

Question 4

A 10 year old fully immunized girl with no past medical history is brought to your clinic by her parents for a dog bite that occurred 2 hours ago. The patient reports that she walking home from school on a different route than usual and encountered a “big, mean-looking dog” near an alley. She crossed the street to try to avoid it, but it ran after her and bit her leg through her jeans.

Answer 4

rabies caused by rhabdovirus

Question 5

prevention of rabies by

Answer 5

human rabies immune globulin (HRIB)