Question

1. For the following cases, what are the signs AND symptoms mentioned, whether the patient has them or not? (30)
   1. The patient was a 4-month-old female with congenital heart disease who was admitted to the hospital in January with severe respiratory distress. Five days prior to admission she had developed a cough and rhinitis. Two days later she began wheezing and was noted to have a fever. She was brought to the emergency room when she became lethargic. On examination she was agitated and coughing. She had a fever of 38.9⁰C, tachycardia with a pulse of 220, tachypnea with respirations of 80/min., and a blood pressure of 90/58 mm Hg.
   2. A 35-year-old woman is seen for easy fatigue for many months. She is now 24 weeks pregnant with her 3rd child in 3 years. She does not see any obstetrician and does not take any vitamins. Lately, she has developed a taste for eating ice. She has no other complaint. Family and past history are negative. She does not smoke or drink. Physical examination is positive for pale conjunctiva, mild spooning of nails, and an II/VI systolic murmur at left lower sternal border. Stools are negative for occult blood
   3. A 26-year-old female presents to you in the STD clinic with a complaint of fever of three days duration, nausea, and lower abdominal pain. She denies a history of dysuria, hematuria, or genital ulcerations. She denies that she may be pregnant. She has an intrauterine device for 2 years. She takes no prescribed medications and she has no allergies. On examination, she has a temperature of 390C, pulse rate of 110 per minute, respiration rate of 28 per minute, and B/P of 100/60. She is ill appearing and diaphoretic. There is no lymphadenapathy. She has right lower quadrant tenderness to deep palpation. Bowel sounds are present but hypoactive. Her pelvic examination reveals right adnexal tenderness and cervical motion tenderness. The uterus is tender and slightly enlarged. Thick yellow vaginal discharge is sent for microbiological studies.

Answer 1