Question

*While talking to your mother, who is a nurse, she related an interesting story about a 14-year-old patient that she saw in the early 1980s when she worked in a gynecology office. When the young girl first presented, she vomited in the waiting room. She stated that she had been feeling ill the night before and that she had also been having an unusually heavy menstrual flow. She also complained of chills and a diffuse rash on her arms and legs, and she reported having a fever. Upon getting her to the examination room, your mother checked her temperature and blood pressure while the doctor asked her some questions. He asked her if her neck was stiff, to which she answered no; he ordered a lumbar puncture, anyway. At this point, she was starting to look dizzy, and her blood pressure was 80/55. The doctor asked her if she’d ever had sexual intercourse, to which she answered no. The patient’s mother also confirmed that she was up to date on all her immunizations. This young girl was eventually admitted into the hospital for treatment. Your mom mentioned, as an interesting aside, that several days after she was admitted, the skin on the palms on her hands began to slough off.

1. What kind of infectious diseases come to mind when a widespread rash is seen as the primary complaint? (Hint: Why had the doctor asked about her sexual history? Why did he ask about her immunizations?)

2. Her rash was diffuse, with well-separated bumps that were maculopapular. Was it likely to be chicken pox? Why or why not?

3. The cerebrospinal fluid obtained from the lumbar puncture was clear—no evidence of bacteria. This ruled out another infection. Which one?

4. The doctor then asked the patient about her menstrual history and practices. She began menstruating at the age of 12 and reported that her last period began four days ago. She reported that she mainly uses tampons during her period. What infection do you think the doctor had in mind by asking about menstruation? Briefly describe this infection and the likely pathogen that causes it.

5. Your mother says that if you see a patient with these symptoms once you start practicing as a physician’s assistant, it is less likely to be the same infection as what this young girl experienced. Why?

Answer 1

1)the wide spread rash is the common signs for different infectious disease condition .the disease condition are chicken pocks, scarlet fever, measles, syphilis ,meningococcal meningitis.

Due to ask her sexual history the possible disease is syphilis .syphilis is not in that patient because her sexual history is no, so we can eliminate the disease .

Doctor ask about vaccinations is rule out the disease condition measile .MMR vaccines is available for measles disease.

In scarlet fever the bumps are close together.

2)diffuse rash, well separated bumps and maculopapular is not a sign of chicken pocks. Chicken pocks is caused by varicella zoster virus and characterized by fluid fill blisters and turn into itchy .the maculopapular rash is a small, solid ,inflammatory elevation of skin that does not contain pus.therefore this rash is not a sign of chicken pocks.

3)lumbar puncture and cerebro spinal fluid evaluation is to rule out the disease condition meningococcal meningitis. If patient have meningitis CSF culture show the presence of bacteria in that fluid.

From the above scenario the CSF culture is normal, there is no presence of bacteria ruled out that the patient is not have meningitis caused by Neisseria meningitidis. So she have another condition like measles or scarlet fever.

4)Toxic shock syndrome is associated with prolonged use of vaginal tampoons anddoctor think about this condition  while ask about her menstrual history

Toxic shock syndrome

Toxic shock syndrome is a sudden fatal condition caused by Toxins produced by overgrowth of staphylococcus auries and it is commonly affect women less than 19 years of age. If fail to detect and timely management leads to sudden fall in blood pressure, tissue hypoxia and later death happened.

The major cause for this disease is prolonged use of vaginal tampons it may result in overgrowth of staph auries later lead to toxic shock syndrome .it mainly affect the menstruating women.

Syptoms

:sudden drop in BP

:sunburn like rash in palms and bottom of foot

:confusion

:fever

:muscle ache

:red eye,mouth and throat

:freequent watery stool

:seizure and head ache.

5)detailed history collection, physical examination and diagnostic finding is necessary for diagnose a disease condition .Patient and physician interactions is important to understand detail about patient condition. In this scenario detailed history collection help to find out infection.all situation it is not likely that.