Question

Help.. 1-9 please

For the Disease Summary for this case study see the CD-ROM. PATIENT CASE History of Present IIlness K.I. is a 14-year-old white female, who presents with her mother at the hospital emergency room complaining of a "very sore throat, a rash all over, and chills." She has had the sore throat for two days, but the rash and chills have developed within the past 12 hours. Past Medical History Negative for surgeries and hospitalizations Negative for serious injuries and bone fractures Measles, age 3 Chickenpox, age 6 Strep pharyngitis and severe case of rheumatic fever (arthritis, carditis, chorea), age 8, treated with ibúprofen and penicillin Has worn eyeglasses since age 12 Family History Oldest of 6 siblings (3 sisters, 2 brothers) Father co-owns and manages tile company with his brother Mother is homemaker Youngest sister also developed strep pharyngitis and rheumatic fever 6 years ago Social History "A-B" student in 9th grade Would like to attend University of Wisconsin-Madison and major in computer science Enjoys reading, music, and using the internet

Answer 1

1).

The characteristic diagnostic findings of the patient are given below:

• Severe sore throat, a rash all over, and chills
• Strep pharyngitis, and severe rheumatic fever at age of eight
• Widespread “scarlet” rash on arms, legs, chest, back, and abdomen
• Normal heart rate and rhythm
• Normal heart sounds, and absence of S₃ or S₄
• Absence of chest pain or difficulty in breathing
• Electrocardiogram (ECG) normal
• Latex agglutination for group A streptococci – positive (+)
• C-reactive protein – 19.5 milligrams per deciliter (mg/dL) (normal range, 0-0.5 mg/dL)
• Anti-streptolysin O – positive (+)

From the above diagnostic findings, it can be observed that the patient had a scarlet fever caused by Streptococci bacteria. It is not rheumatic fever because there are no abnormal findings in the heart or ECG, no joint inflammation reported.

2).

From the above diagnostic findings, it can be observed that the patient had a scarlet fever caused by Streptococci bacteria. No abnormal findings in the heart or ECG, no joint inflammation reported.

The clinical manifestation of the patient are given below:

1. Severe sore throat, a rash all over, and chills
2. Strep pharyngitis, and severe rheumatic fever at age of eight
3. Widespread “scarlet” rash on arms, legs, chest, back, and abdomen
4. Lymphadenitis
5. Normal heart rate and rhythm
6. Normal heart sounds, and absence of S₃ or S₄
7. Absence of chest pain or difficulty in breathing
8. Electrocardiogram (ECG) normal
9. Latex agglutination for group A streptococci – positive (+)
10. C-reactive protein – 19.5 milligrams per deciliter (mg/dL) (normal range, 0-0.5 mg/dL)
11. Anti-streptolysin O – positive (+)

3).

From the above diagnostic findings, it can be observed that the patient had a scarlet fever caused by Streptococci bacteria. It is not rheumatic fever because there are no abnormal findings in the heart or ECG, no joint inflammation reported.

4).

The patient had high CPR levels, which is also present in rheumatic heart disease. However, the patient do not had rheumatic fever or rheumatic heart disease because there are no abnormal findings in the heart or ECG, no joint inflammation reported.

5).

In the given case, the patient had scarlet fever caused by Streptococci bacteria. The patient had high CPR levels, which is also present in rheumatic heart disease.

However, the patient do not had rheumatic fever or rheumatic heart disease because there are no abnormal findings in the heart or ECG, no joint inflammation reported.

It is important to regularly monitor the patient for the carditis, polyarthritis (inflammation in multiple joints), and ECG changes (prolonged PR interval) as they indicate rheumatic heart disease.

Rheumatic fever and carditis are the two serious complications of Scarlet fever, so the patient must be monitored for these changes.

6).

The patient had high CPR levels (19.5 mg/dL), and it is as expected as the patient previously had rheumatic fever (an inflammatory condition), and had a Streptococcal infection at present.