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| QUIZ: Nurse with recurrent fever *solved* |
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| Sunday, 08 November 2009 19:42 |
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Case description: A 32 years old nurse was admitted to the surgery department. She complains about a strong pain in her abdomen, diarrhea and recurrent fever (up to 40 degrees C). |
Comments
WBC 9,8,
RBC 4,40,
HGB 11,5,
normocytosis.
CRP - normal,
Ultrasound of abdomen: no changes, pancreas picture unclear because of large amount of intestinal gases.
2.Do we know something more from interview with patient? What is meant by "recurrent fever"? Since when, how long does it lasts, after what time does the temperature decrease to normal?
- but which "biochemistry tests" did you order?
- metabolic acidosis
From the interview:
- Currently the patient has been having the fever for one week, after the 3-weeks break. She was having a fever for two weeks before. During her stay at hospital nurses certified the fever on the morning round as well as on the evening one. They noted that temperature doesn't depend on the time of the day.
P.S. This case is authentic.
Does she vomit?
Does the fever occur with a diarrhoea every time?
She complains only about diarrhoea.
Last time she complained only about the fever and strong abdomen pain without any diarrhoea..
AlAT 43 (lab norm: up to 40); AspAT 36 (lab norm: up to 40); LDH 360 (lab norm: 470)
Did she take antibiotics? If yes - what did she take?
She was treated with different antibiotics. She took Augmentin (amoxicilin with clavulanic acid), Dalacin C (clindamycin), Unidox Solutab (doxycycline). Together with the antibiotics she took Nystatin.
Stool cultures in searching for aerobes and anaerobes were negative.
Urinalysis as well.
Besides rehydrating the patient we should set her up on a diet, since she has a fever - we perform blood culture and try to decrease temperature using Paracetamol.
Do any skin changes occur? Excessive sweating?
Does diarrhoea occur?
Was the abdomen examined?
Was the appendix after past appendectomy examined?
1. auscultation - correct peristalsis
2. No skin changes
3. Diarrhoea is present
4. In palpation of the abdomen diffuse tenderness, with no peritoneal signs and no pathological resistance.
5. Appendix was histologically examined - it was correct! (right track...!)
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