QUIZ: Lasting fever and other symptoms

Thursday, 07 January 2010 00:00

Case description: 40 yo (years old) male patient was admitted to the hospital because of high fever which he has been having for 2 weeks and with spontaneous shivering. Patient complains of headache, dyspnoea, dry cough and frequent nose bleeding.

QUIZ questions: What questions need to be asked? What's the diagnosis?

Comments

+1 #1 amazontoni 2010-04-18 11:18

When is the dyspnoea? How is his blood pressure? ECG?

-1 #2 Gonzo 2010-04-19 16:11

Dyspnoea is since 3 days. Blood pressure 115/75, ECG - without abnormalities.

-1 #3 redalfred 2010-04-19 20:19

Ausculation for murmurs?

+1 #4 Gonzo 2010-05-07 15:17

In auscultation - phenomens characteristic for pneumonia.

0 #5 poppygonewild 2010-07-09 02:59

why didnt he see a doc sooner?? why did he wait (with a 'high" fever) for two weeks???

0 #6 dr.khaldoun 2010-07-09 21:42

was the temperature measured by the patient during the 2 weeks before hospital? does the fever and shivering come at specific time of day (e.g. at night)? does the dyspnoea come at times of activity or even at rest? what about the patient's past medical and family history?

0 #7 drmark15 2010-07-30 07:44

was the patient went for a vacation somewhere??what was the past medical hstory? any objective signs noted upon physical examination??

0 #8 Emily 2010-12-20 15:11

Nose bleeds could be caused by aspergillosis, which could also explain the fever, dyspnoea and cough.

-4 #9 vanrobod000 2011-01-08 04:50

Before I give my opinion I'd like to note I have no prior medical experience, and have never been inside medical school, but I hope my opinion can help you find out what's wrong with this guy. Did the patient have a history of smoking or drug use? The high fever is usually assosiated with cancer coughing would explain cancers progression to the lungs and nose bleeds could be due to blood in the brain wich explains the cancers progression, I'd get an MRI to be sure.

0 #10 mats 2011-01-08 22:12

x-ray of the chest?
blood analysis CBC (Le, Er, Tr, Hgb, Total serum iron, PT)
is the patient taking any medications, prescribed or over-the-counter?

+1 #11 Gonzo 2011-02-08 14:17

In chest X-ray - features characteristic for atypical pneumonia. In blood leucocytosis. Family history is not important, he didn't travel anywhere since 2 years. But what could be important - he works in the pet shop.

0 #12 Jamil 2011-03-27 17:45

Chlamydia Psittaci infection :) Typical victim if he works in a pet shop. Typical sign: nosebleeding

0 #13 katia 2011-04-13 23:52

prepheral blood smear is needed to rule/out of malaria.

0 #14 dr.premanand@gmail.com 2011-05-11 20:21

can it be coccidiodomycos es?

0 #15 player13.presh 2011-05-13 02:56

perhpas a little information about the fever...duration, when it comes and goes etc...and where this person stays...atleast the country and if possible state...it could be anything from malaria and dengue to Qfever, ricketsia...