Question

   A white male, 17 years of age presented at the emergency room with a severe headache, vomiting, and a stiff neck with pain running up his back. On admission, his temperature was 101°F. The young man appeared to have trouble hearing during the nurse's interview and also seemed to have trouble concentrating. The history revealed that the young man is a wrestler for the local high school team. He had felt as though he were getting a cold the past few days, since his last meet in Hicksville. He did not smoke or drink, but he had attended a party two days earlier thrown by his girlfriend and the other cheerleaders to celebrate his victory in the sectionals. He had been holding his weight at 162lbs for the season, so he ate little and did not drink on the day of meets (today is a day of the meet). On physical exam, the physician noticed several areas of small purplish spots on the skin of the back, thigh and arm. The boy thought those were from wrestling.

For each of the following questions, mark the box at the left of your answer:

·      Which of the following is the most likely diagnosis?

□  Neisseria gonorrhoae induced meningitis

□  E. coli induced meningitis

□  Neisseria meningitidis induced meningitis

□  Streptococcus pneumonae induced meningitis

□  Arboviral encephalitis

Which of the following was a critical factor in your choice of diagnosis?

□  The fact the he is a wrestler and he does not eat or drink much.

□  The headache, vomiting, stiff neck, fever and purplish spots.

□  The party he went to with the cheerleaders.

□  His trouble hearing.

□  The cold symptoms.

Which of the following will likely happen if he is not treated?

□  He will continue to have a fever and stiff neck for a few days and recover.

□  His symptoms will progressively worsen until he develops shock and dies.

□  He may get better in a few days, but will likely have permanent hearing loss.

□  It is impossible to tell, because not enough data is available for an assessment of his condition.

□  He will likely recover from the acute illness, but develop chronic arthritis later.

3.      A 24-year old female automotive technician presents herself at the doctor's office. She complains of fever and of pain in her left hand. On physical examination, the patient had a deep wound on her left palm that was oozing pus. She had purplish, red streaks running up her left arm. She had enlarged lymph nodes at the elbow and under her arm. The patient's skin was warm and dry. In her history, the patient had punctured her left palm with sharp metal from the undercarriage of a "real cherry" 1977 Malibu about a week earlier. She said the wound had bled for a few minutes and she thought that she had washed it "real good" with soap and water. She had covered the wound with a large "band-aid" and gone back to work. She developed a fever about three days later. For the past couple of days, she "did not feel so good" and had vomiting and diarrhea.

For each of the following questions, mark the box at the left of your answer:

What type of infection do you believe she has in this hand?

□  Streptococcus pyogenes                     □   Bordetella pertussis

□  Staphylococcus aureus                      □   Treponema pallidum

□  Clostridium botulinum

From complaint and physical examination, which of the symptoms lead you to your choice of agent?

□  the fever and pain in the hand

□  the fever, wound with oozing pus and enlarged lymph nodes

□  the lymph nodes and red streaks

□  the warm dry skin

□  the pain, red streaks and enlarged lymph nodes

From the history, which of the information confirmed your choice?

□  The wound had bled for a while.

□  The wound was cleaned with soap and water.

□  The wound had been covered and had perhaps become anaerobic.

□  She had diarrhea and vomiting.

□  The cut was from a rusting car frame.

Which of the following is most likely to follow this infection?

□  gangrene and amputation                   □   neurological dysfunction of the hand

□  toxic shock syndrome                        □   arthritis

□  muscle spasms

Answer 1

Ans2a)Neisseria meningiditis inducing meningitis.

Explaination:Symptoms shown by male such as high fever(101°F) Purplish spots on back, thigh and arm skin, severe or extreme headache, stiffness of neck, vomiting , pain in back are characteristic of Meningitidis caused by bacteria-Neisseria meningitidis .

Streptococcus pneumoniae causes pneumonia not meningitis.

E. Coli causes Urinary tract infections and neonatal meningitis but not in adult.

Neisseria gonorrhaea induced Gonorrhea a STD not meningitis.

Arboviral encephalitis symptoms does not include purplish spot on back ,thigh and arm skin.

Ans2b)The headache, vomiting, stiff neck, fever and purplish spots.

Explaination:The main symptoms which leads to diagnosis are purplish spots, stiffness in neck, severe headache, vomiting,back pain.

Ans2c)His symptoms will progressively worsen until he develops shock and dies.

Explaination:If the meningitis caused by Nesseria meningitidis left untreated then, it leads to worsening the symptoms of pateint such as lasting disabilities, impairment of hearing and speech, damage to brain leads to coma, paralysis ,shock and death.

Ans3)

Ans3a)Streptococcus pyrogens

Explaination:-The symptoms such as red and purplish streak and oozing pus at wound site, , lymph gland enlargement at the elbow and under her arm ,fever,are characteristics of Lymphangitis caused by Streptococcus pyrogens bacteria n human .

Ans3b) the pain, red streaks and enlarged lymph nodes

Red streaks at the injury site and enlarged lymph nodes are main symptoms that helps in diagnosis of Lymphangitis.

Ans3c)The cut was from a rusting car frame.

Explaination: The Lymphangitis is a secondary infection which occurs when its causing bacteria reaches lymph vessels from original wound site. The bactetia enters body through puncture wound or cut by rusting sharp objects such as rusting car frame in the given case.

Ans3d)

toxic shock syndrome

Explaination:: The Lymphangitis is folowed by toxic shock syndrome that include high fever, flu like symptoms and even organ failure .