Why Do Doctors Visit

Why Do Doctors Visit
Reflection on doctors visit
Please find evidence of visit attached
The patient I Observed ,Ms Maggie, is a female patient in her 60s who has previously suffered a
stroke, DVT and is currently taking a diuretic to prevent any further thrombi or emboli from
forming. She presented complaining of a persistent urinary tract infection
She had:
A BP of 132/75 – Normal
Pulse 62 Beats/M – Normal
Respiratory rate 13 Breaths/M– Normal
Oxygen sat– No machine was present
Glasgow coma scale– 15/15– Concious
Finger prick glucose– did not perform but I was explained how
Urine test revealed– blood, lymphocytes and Nitrites– Clearly bacteria cystitis
No cyanosis
No anemia
No jaundice
No clubbing
No oedema
No lymphadenopathy
Finally ... Show more content on Helpwriting.net ...
And others with variable efficacy however the most important is insulin and potassium.1
Reference
Only one was used in conjunction with my prior knowledge earned in BOK 1 and 3.
1. Barrett KE, Barman SM, Boitano S, Brooks HL. Ganong's review of medical physiology. 24th
edition. International Edition: Mc Graw Hill Education
... Get more on HelpWriting.net ...

Case Study Of Carcinoma
A recent report by Abadi et al evaluated the value of positron–emission tomography CT (PET/CT)
and concluded that it was the primary imaging modality to help clinicians differentiate between
benign and malignant lesions in patients presenting with a single cystic lesion in the neck [41].
Based on their results, the overall incidence of malignancy was 34.5%, and PET/CT could reliably
rule out malignancy (96% negative predictive value), although with a high frequency of false
positive scans (26%), thus requiring further diagnostic workup. Age alone is not a reliable clinical
variable because both congenital cervical cysts and metastatic disease show considerable overlap in
their presentation along the age spectrum. However, a tendency for ... Show more content on
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They found that this technique could show DNA aneuploidy in cells from cystic metastases and a
diploid karyotype in benign lesions in cases with inconclusive cytology. Unfortunately, this
technology is not available at all institutions. With the availably of molecular and biochemical
analysis techniques, the detection of HPV, Epstein–Barr virus (EBV), and thyroglobulin within FNA
samples may facilitate the pathological diagnosis of malignant cystic lymphadenopathy and the
detection of occult primary tumors. Fluid aspiration in association with thyroglobulin washout levels
was found to be helpful, particularly in cases in which the lymph nodes are cystic, cytologic
evaluation of the lymph node is inadequate, or the findings on cytologic and sonographic
evaluations are divergent [43–45]. HPV detection may be performed by means of a variety of
methods, including p16 as a surrogate immunohistochemical marker, in situ hybridization and/or
polymerase chain reaction detection of viral DNA or RNA [4,46–48]. Chandan et al found glucose
transporter–1 immunostaining to be a useful adjunct in differentiating BrCC from cystic metastasis
of H&N SCC [49]. Pai et al reported that p16INK4A immunohistochemical staining was helpful in
distinguishing BrCC from cystic metastasis H&N SCC originating from the oropharynx [50]. Based
on our proposed algorithm,

Outline Of The Workup Of Cervical Lymphadenopathy
Discuss the workup of cervical lymphadenopathy. How would your recommendations differ for
adult, pediatric, and geriatric patients? Cervical lymphadenopathy is the enlargement or swelling of
the cervical lymph nodes. Cervical lymph nodes are the lymph nodes located at the anterior and
posterior aspect of the neck and under the jaw. A thorough knowledge of the anatomy of the neck is
essential to formulate a differential diagnosis. Cervical lymphadenopathy is not uncommon,
especially in children and therefore differential diagnoses are broad (Lang, & Kansy, 2014). The
causes of cervical lymphadenopathy can be infections, autoimmune disorders, or malignancy. What
test would you do first and why? First and foremost, thing to do when a patient comes with cervical
lymphadenopathy is to get a detailed history. The history should include questions such as the onset
of lump; pain on lump; if the lump is unilateral or bilateral and other lumps present anywhere else in
the body; any associated symptoms like fever, cough, sore throat, shortness of breath, hemoptysis,
night sweats, weight loss, or poor appetite; and any recent foreign travel, upper respiratory infection
or TB exposure. It may be necessary to obtain a detailed sexual, smoking and drug abuse history.
Next step is the physical examination by palpating the nodes to assess the size, shape, matting and
consistency (Mohseni et al., 2014). In addition, check for tenderness, mobility, erythema and
warmth. It is important to

Ethical Dilemma Paper
A 76 year old Asian Immigrant from China came into the hospital with his wife who was 73 at the
time. He comes in constantly for check ups due to his hypertension. The patient had a history of
smoking and was diagnosed with cold about 2 years ago. His Xray test revealed a 3 1/2 cm mass on
the lower right lobe. The CT scan also also showed lymphadenopathy and a 3cm mass on the left
adrenal gland. The needle biopsy diagnosed for non small cell lung cancer. A PET scan also showed
an increase in uptake in the lung. The patient lived with his daughter's family also with his wife. The
daughter requested to speak to the health care provider. She said she consulted with their siblings
and they had decided that the best thing to do was to withhold the information from their dad and
mom, because they felt that if they ... Show more content on Helpwriting.net ...
This brings up a ethical dilemma that is common with people who are diagnosed with terminal
illnesses. In this circumstance, is it okay to go against autonomy, to save the patient days of
mourning or is it important to always allow the patient to make the decisions they would want for
themselves? Initially, they took into consideration that if they told the father, they would also have to
tell the mother and that could cause the mother to begin to stress and worry which would eventually
lead to her speedy deterioration. They took all this into consideration, but eventually they decided
that it would be better to tell their parents what was going on. Then they decided that it was best to
tell them so that they know and complete anything they would have wanted to do. They used the
ethical decision–making principle "Justice" to solve the dilemma. They asked themselves if they
would want to know and if they would be happy if they later found out that they had cancer and
someone didn't tell them. They all would have wanted to be told despite the days that could be full
of

Rocky Mountain Spotted Fever Case Study
What will be your differential diagnoses for this patient?
Differential diagnoses for the child includes, Pediatric Rocky Mountain Spotted Fever, Measles and
Kawasaki Disease (Bennet, 2015).
What specific physical exam findings support these differential diagnoses?
Pediatric Rocky Mountain Spotted Fever
Clinical presentation of rocky mountain spotted fever includes, fever, headache, rash, myalgia,
toxicity and confusion. Other symptoms may include gastrointestinal symptoms such as abdominal
pain, nausea and vomiting. Conjunctival hyperemia and photophobia may also be present. Rash is
usually present in 80–90% of patients. The rash usually begins as a blanching maculopapular
lesions. And in half of the patients the rash becomes petechial or ... Show more content on
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The most concerning diagnosis would be Kawasaki disease because of coronary artery aneurysm.
Approximately 15%–25% of children with untreated Kawasaki disease will develop coronary
aneurysm. Aneurysm may occur up to 6 months after the illness. Other complication may include,
massive myocardial infarction, CHF, myocarditis, pericarditis or pericardial effusion (Burns, Dunn,
Brady, Starr & Blosser, 2013).
What additional diagnostic tests will you recommend? Why?
Diagnostic test would include, CBC with differential, ESR, platelet count, CRP, liver transaminases,
gamma–glutamyltransferase (GGT), and urinalysis. CRP will be elevated but ESR is sometime
normal. Blood, urine, cerebrospinal fluid, and group A beta–hemolytic streptococcus pharyngeal
cultures may be collected to identify other sources of fever. Diagnostic test would be done to
confirm or rule out the diagnosis of Kawasaki disease (Burns, Dunn, Brady, Starr & Blosser, 2013).
What would be your focus for caregiver

HLH Case Studies
INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is an incompletely understood
condition resulting in uncontrolled and ineffective immune activation. HLH is classified as genetic
HLH (primary) or acquired (secondary) and presents with a fulminant picture of non–remitting high
fever, pancytopenia, hepatosplenomegaly, lymphadenopathy, liver dysfunction, coagulopathy, and
neurological symptoms. Acquired causes of HLH include infection associated hemophagocytic
syndrome (IAHS), macrophage activating syndrome(MAS), and malignancy–associated HLH.
CASE REPORT: BS, a 6 yo Caucasian male at the time of presentation, was admitted to a pediatric
hematology service with a 3 week history of fever of unknown origin, fatigue and joint pain. His
past ... Show more content on Helpwriting.net ...
BS was sent to a larger center for nephrology consult and renal biopsy. The renal biopsy was
diagnostic for focal lupus nephritis (class 3) and the patient was started on mycophenolate.
DISCUSSION: HLH and SLE are both challenging diagnosis in the pediatric population and can
have significant morbidity and mortality. Ultimately, our patient had "reactive" HLH secondary to
underlying SLE, an extremely rare diagnosis in pre–school aged caucasian males. CONCLUSION:
Systemic lupus erythematosus (SLE), an autoimmune disease characterized by multiple–organ
involvement, female dominance, and rapid progression affects patients from infancy to old age. The
reported yearly incidence of SLE in children ranges between 0.36 and 0.9 per 100,000, compared to
3.0 per 100,000 in adults [Zhu, 2013]. The incidence of SLE in a Caucasian male under age 10 is
extremely rare, with one study documenting lupus nephritis in Caucasian boys with an estimated
prevalence of 0.20% and an annual incidence of

Chest X Ray Essay
An 18 year old African American male presented for evaluation of a mediastinal mass seen on chest
x ray. He was initially seen in the ED with transient, stabbing, chest pain, which lasted for a few
seconds and self–resolved. This prompted evaluation with a chest radiograph. He had no shortness
of breath, night sweats, chills, loss of appetite, weight loss, hemoptysis or cough. His past medical
history was only significant for seasonal allergies. He had no prior surgeries and had no history of
smoking, alcohol or illicit drug use. He was on no medications. Complete physical examination
including vital signs and cardiopulmonary exam was normal. Laboratory testing showed a normal
complete blood count, biochemistry profiles and he was HIV negative.
A chest radiograph showed a rounded, well–defined soft tissue density measuring 4.5 x 4.2 cm
located in the inferior aspect of the left hilum at the level of the mid chest. The chest x–ray was
otherwise unremarkable. Computed tomography of the chest revealed a left hilar 3.2 x ... Show more
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It can be classified as unicentric (localized) or multicentric (systemic). Unicentric Castleman disease
(UCD) has an excellent prognosis, where as multicentric Castleman disease (MCD) is associated
with significant morbidity and mortality. MCD occurs most commonly in HIV infected individuals
and is associated with human herpesvirus 8 (HHV–8). Although the pathogenesis of CD is not
completely understood, interleukin (IL) 6 plays a central role in UCD and both IL–6 and HHV–8 in
MCD. Histologically, CD, is usually classified as either the hyaline–vascular (usually occurring in
UCD) or plasma cell variant (mostly present in MCD), with occasional cases with mixed features.
The diagnosis of CD is made by excisional biopsy or core needle biopsy of affected lymph node
tissue. Our patient was HIV negative and the specimen pathology was negative for

How Did Aids Affect People?
How Did AIDS Affect People?
Lissette Borgono
Honors Global Citizenship
April 29, 2016
The AIDS virus shook the world. It seemed to have appeared from nowhere. No one knew how to
deal with it. Thus, many people, even those affected by the disease, reacted with fear. This confusion
combined with the knee jerk reaction by the public towards AIDS has influenced many lives. But in
what ways? How were people affected by the AIDS disease and how the public reacted to it? In
order to understand why the public had such an intense reaction, one must look into what AIDS truly
is. In 1980, doctors find the presences of a new disease. At the very least, it seemed new. They
called it 'new' because they were forced to resort to ... Show more content on Helpwriting.net ...
Joel Weisman, a doctor known for his kindness towards homosexuals, realized an increase within
his patients of mononucleosis–like syndrome. Mononucleosis (mono) is also called the kissing
disease. The virus that induces mono is shared through saliva. Thus you can get infected by sharing
eating utensils and drinks, by kissing, and by being exposed to a cough or sneeze by someone who
has mono. Unlike the common cold, mononucleosis is not as contagious. Symptoms of
mononucleosis include but are not limited to, swollen lymph nodes in the neck and armpits, skin
rash, and swollen spleen. Within Weisman's patients, those with mononucleosis–like syndrome,
were also marked by weight loss, hectic fever, and swollen lymph nodes. There were other
similarities. The patients were young and from the growing California gay community. Another
doctor, Michael Gottlieb, realized that Weisman's peculiar cases seemed familiar. Together they
noticed that two of their patients were homosexual and had Pneumocystis Carinii Pneumonia (PCP),
which is a rare illness. By the beginning of 1982, there were two hundred reported cases. However,
the disease still lacked a name. Newspapers called the disease many things. All of them focusing on
the fact the majority of its victims were gay. Thus they called it 'gay cancer' or 'gay pneumonia' even
'gay plague.' The disease was not named

The Recent Onset Of Regional Lymphadenopathy
Discussion
When evaluating the recent onset of regional lymphadenopathy in a teenager, there are various
etiologies that should be explored. Lymphadenopathy is often a benign entity that is self–limiting
but can also be the presenting sign of a more serious illness. Our patient had several signs and
symptoms that were concerning for both a malignant etiology as well as an infectious cause for his
acute, painful lymphadenopathy. Due to the commonality and potentially serious causes of
lymphadenopathy, it is important for physicians to be able properly differentiate the more commonly
benign causes from the potentially serious illnesses.
When evaluating any patient with lymphadenitis a detailed history is paramount to finding the cause
of the lymphadenitis, which can help guide treatment. Our patient has several elements in his history
that point us to an infectious cause of his lymphadenopathy: exposure to pets, potential sexual
activity, and skin flora exposure to an open wound. Our patient plays roughly with his kitten who
scratches him on his legs. Bartonella henselae is a gram negative bacterium that can cause cat–
scratch disease, which is characterized by tender regional unilateral lymphadenopathy. In this
disease, inguinal lymphadenopathy is present 18% of the time, which warrants its consideration in
our differential diagnoisis1. Given his age, sexually transmitted infection or infectious
mononucleosis should always be contemplated as a cause of his

Diagnosing Disorders: A 23-Year-Old Patient
10. A 23–year–old male presents with 5 days of tender, bilateral tonsillar and anterior cervical chain
lymphadenopathy. He has a low–grade fever of 100.2°F and has noticed a sore throat with trouble
swallowing for 1 day. There are no cough or cold symptoms, although he does feel achy all over.
Exam reveals enlarged tonsils with whitish exudate. What is the best next step in management?
A. Conservative management with antipyretic/analgesic for viral cause of illness
B. Obtain a monospot and complete blood cell count (CBC)
C. Obtain a rapid strep test
D. Treat empirically with penicillin for 10 days
E. Refer to ENT for a second opinion
Answer: C
Explanation: Strep throat is a common condition afflicting both children and adults. Diagnosing this
condition is usually straightforward, especially if using the validated Centor Criteria or modified
Centor Criteria. Count these criteria, adding 1 for the presence of each of the following: ... Show
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Our patient has a total of 3 per the modified Centor criteria, providing a positive predictive value of
roughly 33% for having strep throat. Treating empirically with antibiotics is not universally
recommended unless the (modified) Centor Criteria score is 4 or more. Thus, obtaining a rapid strep
test, also known as a rapid antigen detection test (RADT), is strongly recommended, along with a
throat culture should the RADT be negative. Infectious mononucleosis, although potentially a
diagnosis given the patient's age, is not likely as fatigue is generally a common complaint and the
onset if more insidious. Referring the patient to an Ear, Nose and Throat (ENT) physician is
premature given there is no urgent need and does not assist the

Signet-Ring Cell Adenocarcinoma Case Summary
A Case of Signet Ring Cell Adenocarcinoma–Unique presentation with Concurrent Non–
gastrointestinal Malignancy.
Authors: Sandar Linn1, Hernan A. Lopez–Morra1, Sofia Nigar1, Juan Tejada1, Nami S Haeri1,Shah
Giashuddin2,Jonathan Chow2, Mahesh K. Krishniah1, Sury Anand1.
1 Division of Gastroenterology, Department of Internal Medicine, the Brooklyn Hospital Center,
Brooklyn, NY.
2 Department of Pathology, the Brooklyn Hospital Center, Brooklyn, NY.
Abstract:
Background: Signet–ring cell adenocarcinoma (SRCC), the histological variant of ampullary
carcinoma, is an extremely uncommon malignancy. To our knowledge, this report is the first case of
SRCC with concurrent non–gastrointestinal malignancies.
Case Report: A 66 year old male with history of prostate cancer, anglioblastoma multiforme
presented with jaundice and abdominal pain. Endoscopic retrograde cholangiopancreatography
(ERCP) and Endoscopic Ultrasound (EUS) suggested a duodenal tumor at ... Show more content on
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90% of SRCC take place in the stomach [1]. SRCC is extremely uncommon in the ampulla of Vater,
and only 32 previous cases have been described in the literature [3].
Because of its uncommon entity, the histological genesis of SRCC is still mysterious. While
previous authors suggested that the tumor came from the ectopic gastric mucosa located at the
ampullary region since most of SRCC are found in stomach [9, 10], others declared that SRCC
occurs from the gastric–type metaplastic epithelium [1] which appeared possibly due to the elevated
acidity since the metaplastic changes were are usually observed at the duodenal bulb in peptic ulcer
patients [10]. However, Our case did not support both theories like the other case because it did not
show any gastric mucosa around the tumor nor peptic ulcer found in EGD

Rheumatoid Leukemia Case Study
(Choice A) ↑ blood viscosity, ↓ blood flow and presence of blast cells in blood smear are features of
leukemia. Hyperleukocytosis and leukostasis are common in leukemias, in which blast cells are
large and poorly deformable (e.g., acute myeloid leukemia). Leukemia usually manifests with
combinations of symptoms of anemia (e.g., pallor, fatigue), thrombocytopenia (e.g., mucosal
bleeding) and leukopenia (e.g., recurrent infections).
Choice (B): ↑ blood viscosity, ↓ blood flow and presence M–spike with immunoglobulin G are
features of multiple myeloma. Excess production of immunoglobulin G can induce hyperviscosity
syndrome. Multiple myeloma usually manifests as high Calcium, Renal failure, Anemia and Bony
lesions (lytic lesions or osteoporosis). ... Show more content on Helpwriting.net ...
In this type of anemia, heme synthesis is decreased, renal production and/or response to
erythropoietin is decreased, liver synthesis of hepcidin is increased and serum ferritin is increased
(in contrast to iron deficiency anemia, in which serum ferritin is low). Chronic severe anemia (e.g.,
hemoglobin less than 5 g/dL) is a risk factor for high–output heart failure, in which cardiac output is
high, but still insufficient to meet metabolic demands of the body.
Choice (D): ↑ blood viscosity, ↓ blood flow and presence M–spike with immunoglobulin M are
features of Waldenström macroglobulinemia. Hyperviscosity syndrome may occur in this disease
due to increased immunoglobulin M. Unlike multiple myeloma, Waldenström macroglobulinemia is
characterized by generalized lymphadenopathy, hepatosplenomegaly and absence of lytic lesions,
renal disease or amyloidosis.
Learning Objectives
Hematocrit is the main factor which determines blood viscosity. Diseases which decrease hematocrit
(e.g., anemia) will lower blood viscosity and diseases which increase hematocrit (e.g.,
polycythemia) will elevate blood

Understanding The Pathophysiology Of Sepsis
This leads us to the next step in the pathophysiology of Sepsis. Stage 2 of sepsis, which is when
SIRS plus the confirmation of an infection has been made. At this stage, the patient's body has been
continuously fighting something in their body and it is starting to have an effect on the patient. Signs
and symptoms of sepsis are often nonspecific and include the following: Fever, chills, or rigors,
Confusion, Anxiety, Difficulty breathing, Fatigue, malaise, Nausea and vomiting. It is important to
identify any potential source of infection. Localizing signs and symptoms referable to organ systems
may provide useful clues to the etiology of sepsis and are as follows: Head and neck infections:
Severe headache, neck stiffness, altered mental

Medical Case Study: Over-The-Counter Coughy
CC Sore throat, cough. S The patient is a 22–year–old female who does tell me she graduated from
Dartmouth College recently, will be going to Europe, leaving in two days for a three week tour. She
states she wanted to make sure she is okay prior to leaving. She does tell me one week ago she
began having a sore throat, which then developed into rhinorrhea and a cough, which is productive
of yellow sputum. She does tell me the sore throat has now gone away. She denies any sinus pain or
pressure, no ear pain, she has not had any fevers and overall feels fairly well. She is not waking
because of the cough, she is taking an over–the–counter cough syrup. She also thinks she might
have a component of allergies, as she was having some sneezing

Essay On Fungal Scalp Infections
Fungal scalp infections
What are fungal scalp infections?
Tinea capitis and seborrheic dermatitis (dandruff) are scalp disorders characterized by scaling and
itchiness related to fungal infection. Tinea capitis usually affects children and is spread by direct
contact. The skin lesions appear as scaly patches on the scalp that are often associated with hair loss
(alopecia). Lymph nodes in the head or neck may enlarge as a reaction to scalp infection, but usually
resolve with clearance of infection.
Seborrheic dermatitis (dandruff), although technically not a fungal scalp infection, may produce
symptoms that are similar to tinea capitis. This condition often affects infants, adolescents, and
adults. Dandruff is implicated to be indirectly ... Show more content on Helpwriting.net ...
The condition is most frequency seen in African–American children. There appears to be a higher
prevalence in males compared to females.
Seborrheic dermatitis can be seen in infants as well as adolescents and adults. Its prevalence is about
3% and peaks at age 30–40. Men are affected more than women. The condition also has a high
prevalence in individuals infected with HIV.
What are the symptoms and signs of fungal scalp infections?
Symptoms of tinea capitis often include scaly patches with areas of hair loss (alopecia). Hair loss
often appears as black dots which represent broken hairs. Patients often have itchiness (pruritus) of
the scalp and may develop enlarged tender lymph nodes (cervical lymphadenopathy) as a reaction to
fungal scalp infection.
Seborrheic dermatitis typically causes a fine, white, scales on the scalp. In severe cases, the skin can
be inflamed, with red plaques covered in yellow, greasy scales. These can be itchy and irritating.
Other conditions that are sometimes mistaken for tinea capitis or seborrheic dermatitis include
psoriasis and eczema.
How are fungal scalp infections

Lung Ultrasonography
Lung ultrasonography is a fast, non–expensive, widely available bed–side diagnostic tool which is
useful for quick and early diagnosis of respiratory diseases. The aim of the work was to evaluate the
role of the chest ultrasound in the assessment of intensive care unit patients. Our prospective study
was carried out on 24 ICU patients with different chest symptoms. Fifteen males and nine females
with a mean age of 53.83±14.63 years (range 14–75 years), with clinical presentation such as
dyspnea (17 patients), chest pain (15 patients), cough and expectoration (15 patients). All patients
had real time gray scale ultrasound with a 3.5–5 MHZ (curvilinear) and 5–8 MHZ (linear) probes.
M–mode (motion mode) was utilized as an adjunctive imaging modality in all patients. ... Show
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We found that sensitivity, specificity and accuracy of lung US in the diagnosis of thoracic non
pulmonary lesions were: pleural effusion (100%, 100%, 100%), pleural masses (83%, 78%, 80%),
pneumothorax (80%, 95%, 91.66%), mediastinal lymphadenopathy (75%, 70%, 70.8%) and chest
wall lesions (95%, 91%, 94%). In conclusion, Chest US offers a noninvasive diagnostic study at the
bedside for evaluation of critically ill patients. US has many advantages, including examination in
multiple planes, absence of ionizing radiation, less expensive, high sensitivity in detection of many
chest lesions. The main limitations of chest US, it is personal dependent. Also, it is difficult to use
this technique on obese patients and in patients lying in positions that limit the exploration of lung
areas. The presence of drains and catheters can interfere with the appropriate placement of the

Spleen
A number of anomalies have been found in the cat through out the dissection sessions. The
anomalies were an enlarged spleen, enlarged thymus and enlarged lymph nodes.
3.1 The Spleen
The spleen is an organ of the immune system (lymphatic system). It function is filter the blood and
maintain it in a healthy way. The spleen produces two types of pulp to perform its function, the red
and the white pulp (Goodenough & McGuire, 2014). The red pulp filters the damaged blood cells,
palates and foreign materials in the blood, so it recycles the blood. On other hand, the white pulp is
composed from lymphocytes, macrophages and plasma cells that help clean the blood. These two
pulps work interchangeably to make sure the blood is filtered completely from any foreign materials
and dead cells.
Splenomegaly, which is the enlargement of the spleen, could happen due to four main causes, which
were cancer, infection, liver or blood diseases (Kuntz, 2006). An enlarged spleen causes
hypersplenism; it is a process where the spleen increases the filtration process of the blood cells.
This causes the spleen to recycle more blood and consider it to be a foreign material. Consequently,
more RBCs, WBCs and palates in the blood plasma are ... Show more content on Helpwriting.net ...
After witnessing the enlarged spleen, thymus gland and lymph nodes, it was evident the cat had
undergone some dilemmas with its lymphatic and immue system. With the first discovery, which
was the spleen, the following discussion was presented: the chances that the cause of splenomegaly
is a liver or blood diseases are low, because of the normal appearance of cat's liver and the blood of
the cat was drained. The chances are higher with the other causes, which are more related to the
lymphatic system. There might have been an infection, lymphoma or inflammation of the nodes in
the

DRESS Syndrome Research Paper
DİSCUSSİON Dress syndrome was diagnosed because after Trimebutin maleate use was seen fever,
skin rash, high transaminase values and eosinophilia detected in the peripheral blood smear. DRESS
syndrome is an acute, severe and life–threatening disease with a mortality rate of about 10%, which
is frequently associated with systemic organ involvement involving liver dysfunction, renal
impairment and interstitial pneumonitis. It is not clear incidence of DRESS syndrome known as
hypersensitivity reactions. More than 50 drugs that caused the notification is made DRESS
syndrome. DRESS syndrome is more common in adults and rarely seen in children. Aromatic
anticonvulsants, allopurinol, and sulfonamides are the main drugs that cause the most common.
Anticonvulsants and sulfonamides for the drug that causes frequent 1000–10000 drug exposure is
estimated that developed DRESS syndrome (1.13). Fever, rash, lymphadenopathy and internal organ
involvement with progresses and accompanied by eosinophilia. Liver, lymph nodes and internal
organs, the kidneys are the most common involvement, respectively. Heart and lung involvement,
but it may also occur to a lesser ... Show more content on Helpwriting.net ...
The use of antihistamines is recommended almost for the treatment Dressler's syndrome. Patients
with internal organ involvement are recommended use of systemic corticosteroids and intravenous
immunoglobulin (IVIG), but are still insufficient number of studies on this issue(10). Trimebutin
Maleate treatment was stopped firstly in our patient. Antihistamines began and methylprednisolone
added to treatment for liver involvement. Clinical and laboratory findings regressed without IVIG
therapy. In some publications, hyperbaric oxygen, N–acetylcysteine, pentoxifylline, levamisole,
plasmapheresis treatment has been reported. However, the benefits of these agents are not
conclusive

A Case Study Of Castleman's Disease
3) The signs and symptoms of Castleman's Disease can be rather vague, usually presenting as flu
symptoms in the beginning. How can the nurse educate the families on what to look for and when to
come to the hospital for a child that is potentially immunocompromised and experiencing massive
inflammation such as E.B.?
Thanks for using this patient. I Can't imagine how challenging it was for this child and her family
prior to her diagnosis, as well as after. The family of this child probably never imagined flu like
symptoms that were expected to resolve, would turn out to be this disease. Coming from a parents
perpective I would educate families about the ovbiuos nonspecific symptoms such as the nausea,
vomiting, fever, loss of appetite. Like

Differential Diagnoses Paper
Differential diagnoses are developed by a clinician upon learning of the chief complaint. One must
begin to develop the possibility of potential diagnoses mentally to guide the care provided to the
patient. These potential diagnoses are developed by the care provider and are often based on one's
past clinical experiences, awareness of the illness and a clear understanding of the patient's
complaint (Goolsby & Grubbs, 2014). The care provider with experience may develop these
diagnoses independently and others with less experience may utilize evidence–based resources and
clinical guidelines to aid in this process (Goolsby & Grubbs, 2014). The process for reaching a final
diagnosis requires further investigation and use of physical assessment ... Show more content on
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Acute tonsillitis is inflammation of the tonsils secondary to an infectious process causing painful
swallowing and is more commonly attributed to a viral cause rather than bacterial (Shepherd, 2013).
A physical assessment of the tonsils may reveal an increase in size with edema and erythema. This is
often associated with upper respiratory symptoms like, headache and cough (Shepherd, 2013).
Another diagnosis is pharyngitis. Pharyngitis is also a sore throat which is secondary to
inflammation noted at the back of the throat and associated with complaints of pain when
swallowing (Shepherd, 2013). Viral pharyngitis is the most common and can be contributed to the
rhino or coronavirus which lasts between 5–7 days and presents with associated symptoms like
cough, headache, fatigue and mild fever (Ruppert & Fay, 2015). Finally, GABHS or more
commonly noted as strep throat is a potential diagnosis. This bacterial infection is most common in
children and adolescents. Often individuals present with symptoms including throat pain, fever,
chills, headache, cervical lymphadenopathy and exudate noted to tonsils or in the pharyngeal
(Ruppert & Fay, 2015). This infectious process in younger children may also present with
gastrointestinal symptoms like nausea, vomiting and abdominal pain but is not accompanied by
cough or nasal

Cat Scratch Disease Essay
Treatments for cat scratch disease By Jonas Wilson, Ing. Med. Transmitted by the bite or scratch of
a cat and occasionally by fleas or ticks, cat scratch disease (CSD) is a common bacterial infection. It
is caused by Bartonella henselae and has a high prevalence in humid and warm climates. Children
and adolescents are more likely than adults to have a higher risk of exposure. People who become
infected present within 1 – 2 weeks with mild infection at the site of inoculation, which is followed
by proximal lymphadenopathy and possible systemic symptoms such as fever, anorexia and malaise.
Diagnosis is made on the grounds of clinical history and symptoms in addition to serology (best
initial test) and is supported by other investigations, such as hematology and lymph node biopsy, if
necessary. CSD is usually a self–limiting disease and as such generally only requires symptomatic
and conservative treatment in patients with a mild or moderate presentation. Analgesics and
antipyretics may be administered as necessary and applying localized heat to the affected lymph
nodes may also be done. Patients with more severe presentations of CSD and ... Show more content
on Helpwriting.net ...
Those who are immunocompetent with any signs of systemic disease may be followed up in an
outpatient clinic with a scheduled appointment several weeks later to ensure that resolution of CSD
lymphadenopathy has been achieved. However, a patient should seek medical attention if
neurological complications occur or if the lymphadenitis progressively enlarges. The latter could be
a sign of something more sinister, such as a neoplasm. In preventing CSD parents should instruct
children to always exercise caution to avoid scratches and bites. Proper pet hygiene is also
recommended to prevent flea and tick infestations. Treating cats with antibiotics may also be done,
but has not shown to reduce the risk of transmission to

Cat Scratch Disease Essay
Introduction
Cat–scratch disease is a slowly progressive, chronic lymphadenopathy that typically more prevalent
in young children and immunocompromised individuals. Cat–scratch fever is just as the name
suggest is passed to humans by being either being scratched or bitten by a cat that has been infected
with Bartonella henselae. B henselae is the rod–shaped gram–negative bacteria that causes cat–
scratch disease. When looking at this disease it will important to discuss the Epidemiology, the
incubation and duration, signs and symptoms, diagnosis as well as treatment as well as case studies.
The Epidemiology There is roughly 25,000 cases of cat–scratch disease recognized each year. Most
of the cases tend to occur during the summer and first part of winter. Of all the reported cases eighty
to ninety percent of them occur in subjects younger than twenty one. The cats that have been
exposed to B henselae can still be considered contagious since the ... Show more content on
Helpwriting.net ...
It is recommended to use a warm compress applied against the swollen lymph nodes to help reduce
the sharp pains associated with CSD. The majority of all CSD cases physician's advice against
antibiotic treatment. The exception to this is when CSD infected individuals are
immunocompromised, then the antibiotics help eliminate the bacteria and by doing so reduce the
possible The list of possible complications is broad and be found in almost every organ system. .
Such as encephalopathy (coma), pneumonia (respiratory problems), osteroyelthis (bone pain),
neuroretinitis (possible blindness) otic neuralgia (hearing loss), and hepatitis (abdominal pain). .
That being said there is no certain antibiotic that is proscribed to treat CSD even though it is
resistant to several penicillin based antibiotics it is entirely left up to the treating physicians to
choose what he feels will work best for the

Chronic Fatigue Syndrome
CHRONIC FATIGUE SYNDROME (CFIDS) Overview Chronic fatigue syndrome (CFS) is a
weakening disease that characterized by the intense weakness that can not be cured with sleep. It
makes you feel so tired that you can not complete normal daily activities Physical and mental
activities can cause symptoms to worsen. When your work can not be related to a specific cause,
your doctor may classify your condition as CFS. Causes The genuine cause of CFS is unknown. The
Researchers speculate that hypotension(abnormally low blood pressure), viral infection, a weakened
immune system, immune wound, and hormonal problems (imbalance) might all be included factors.
Symptoms The symptoms of CFS differ from patient to patient and depends on upon the harshness
of the ... Show more content on Helpwriting.net ...
As per the CDC, only twenty percent of the expected 1 to 3 million Americans with CFS have been
identified. There are no specific lab tests are available and its symptoms are also common to many
diseases. Many patients with CFS do not look obviously sick, so doctors can not diagnose that they
are ill. In order to be analyzed with CFS, you need to have at least four of the above symptoms
listed. You also must have unexplained fatigue, severe that can't be cured with bed rest. The
weakness and other symptoms must longer for six months. Treatment There is no proven curing for
CFS. But there are various home Remedies that helps you to treat your syndrome Create proper
sleeping routine (go to bed and wake up same time) Try to avoid napping during the day. Limiting
or eliminating your caffeine intake and alcohol intake too. Medication and yoga To consult with
psychological to help you cope with CFS and improve your mindset

CAT: Tracial Infection Disease (CSD)
CAT–SCRATCH DISEASE Overview Cat scratch fever is also called cat scratch disease (CSD), it
is a bacterial infection. The infection takes its name because most of the people get from cats
infected with Bartonella Hensel ae, which is one of the most common bacteria in the world that
mostly spread by the cat. Causes CSD is a bacterial infection spread which occurs by the bite and
scratch by the cat but sometimes Dog and monkey bites also have been implicated, as well as thorns,
pins, and splinters. Nerves, bites and human–to–human transmission also have been supposed as
possible sources but none has been clearly proved. Symptoms The most common symptoms you can
see after 3–10 days of the site of the scratch that are following: Most common

Flv Case Studies
Mesentery, Mesenteric Lymph Nodes, Kidneys, and Heart: Multicentric Lymphoma
Liver: Hepatic Lipidosis
Etiology:
The etiology of lymphoma in cats is, for the most part, not very well understood. Historically,
lymphoma went hand in hand with Feline Leukemia Virus (FeLV), but in recent years the
prevalence of FeLV has decreased due to vaccinations and antigen screening tests. Thus the FeLV
associated mediastinal and/or multicentric T–cell lymphocyte lymphoma, mostly seen in FeLV
positive young cats ages (2–3 years old), has decreased in incidence, and instead there has been a
rise in cases of non–FeLV associated alimentary lymphoma seen in older cats (9–10 years). Feline
Immunodeficiency Virus (FIV) positive cats have a 6x increase in developing ... Show more content
on Helpwriting.net ...
The World Health Organization has developed a staging system (chart below), that can contribute
but not solely be used for prognosis. Prognosis must be made using overall patient condition,
disease stage, FeLV/FIV status, clinical signs, and response to treatment. Positive prognosis factors
that have been noted in cats include complete response to therapy, negative FeLV status, early
clinical stage, no clinical signs (substage a), and addition of Doxorubicin to treatment protocol.
Chemotherapy is currently the gold–standard for treatment, but response to therapy depends on the
anatomic presentation of the lymphoma. For animals with lymphoma that do not undergo
chemotherapy treatment, the mean survival time is 4–6 weeks. For multicentric lymphoma in cats,
several different Chemotherapy protocols exist but the COP based protocol with the addition of
Doxorubicin is recommended. Chemotherapy for multicentrc lymphoma has a 50–80% response
rate and a mean survival time of 6

Essential Lymphoid Disease
The lymphoid tissues and organs are the basis of our immune system that helps us fight infections
and is our body's defense against disease. Essential lymphoid organs are the lymph nodes. The
lymph nodes are along the lymphatic vessels located throughout the body in clusters, especially in
the armpit, neck, chest, abdomen and groin areas and are sources of immune cells that help fight
disease and infection (2015). Our body contains about 500–600 relatively small lymph nodes. The
lymph nodes are encased by a fibrous capsule, which surrounds the cortex and medulla. The outer
layer of the cortex is packed with B cells that assist with humoral immunity. The inner layer
contains T cells that play a role in cell–mediated immunity and are also known

Anatomy Carcinoma Of Lung / Skull Metastasis
Case Study–Anatomy–Carcinoma of lung w/ skull metastasis
Abstract
Squamous cell carcinoma represents 30% of all lung carcinomas. A carcinomas is cancer that
appears in the epithelial tissue. Epithelial tissue is mostly found in the lining of your organs, like the
esophagus. Squamous cell carcinoma, or SqCc for short, is known to produce malignant tumours in
the brain parenchyma.
There has been a case of SqCc that has impacted the parietal bone. An 80 year old Australian man
was admitted with a rare form of metastatic carcinoma of the lung. After a physical examination, it
was conclude that there was an extensive amount of bone destruction. The authors were unable to
find a past case with this same problem. It is an unusual disease with very limited resources and
background knowledge.
Introduction
Squamous cell carcinoma is an uncontrollable growth of abnormal cells stemming from the
epithelial tissue of the lungs. It is a slow–grown lung cancer that is caused by smoking, a majority of
the time. There are less than 200,000 cases in the United States alone per year; about 85%–90% of
lung cancers are non–small cell lung cancer, but squamous cell carcinoma makes up for 30% of it.
Although there can be other causes of squamous cell carcinoma, it is mostly associated with
cigarette smoking. Cigarette smoking can lead to lung cancer which can soon get out of control. As
the cancer cells develop, they become tumors and soon spread to other areas of the body. Typically,
small

Monkeypox Virus Orthopox Paper
Human monkeypox is a rare disease caused by monkeypox virus. Monkeypox virus comes from the
genus Orthopoxvirus in the family Poxviridae. This disease portrays similar symptoms as seen in
smallpox patients. This was first discovered in 1958 when two patients had pox–liked symptoms on
their skin. This disease has been seen in Western and Central Africa where it originated (Center for
Disease Control and Prevention, 2015). Due to small number of cases of monkeypox, little is known
about this disease.
Incidence Globally/Locally
Any new cases of human monkeypox is still unknown. It was mentioned by the centers of disease
control and prevention (CDC) that the latest case of monkeypox was in Sierra Leone in 2014 with
one person having this infectious disease (2015). There are no other records of people having
monkeypox in 2016. The places where monkeypox are more likely to happen are countries in
Central and West Africa (Center for Disease Control ... Show more content on Helpwriting.net ...
However, it is believed to have originated from Africa. The source of the virus has also been
believed to be many different types of mammals. Some of these mammals include rope squirrels,
tree squirrels, Gambian rats, striped mice and primates. The exact reservoir and the nature of virus
have yet to be discovered (World Health Organization, 2014).
Signs and Symptoms Human Monkeypox resemble similar symptoms to small pox. The initial signs
and symptoms are fever, headache, muscle aches, and exhaustion. The cardinal symptom of
monkeypox is lymphadenopathy (swelling of the lymph nodes). This symptom is what differentiates
monkeypox from small pox. The incubation period is usually 7 to 14 days or longer like 5 to 21
days. Lesions usually progress after the fever has occurred. People will have lesions like macules,
papules, vesicles, and pustules. The illness usually last 2 to 4 weeks on average (World Health
Organization, 2014).
Nurse's role in

Hiv And Its Effects On Children
HIV
What is HIV?
HIV stands for human immunodeficiency virus. Infection by this virus frequently leads to AIDS –
acquired immunodeficiency syndrome. Viral infection initially causes a flu–like illness characterized
by fever, sore throat, headache, rash, gastrointestinal discomfort, and body aches (mylagias). The
virus tends to stay dormant for months or years while it is slowly killing immune cells – especially
CD4 cells.
Individuals with high viral loads and low CD4 cell counts have high viral infectivity and tend to
develop opportunistic infections – atypical infections that generally affect immunocompromised
hosts. AIDS is a common cause of death worldwide, buts its medical treatment in developed
countries has led to a significant ... Show more content on Helpwriting.net ...
The virus tends to lie dormant for months or years, slowly and progressively killing immune cells.
Patients eventually develop opportunistic infections as their CD4 counts decrease below 200.
How common is HIV infection?
HIV is relatively common in the United States and responsible for a fair amount of deaths. This
condition is a frequent cause for referral to an infectious disease specialist.
In 2015, worldwide – approximately 37 million adults and children had HIV or AIDS, 2 million
were newly infected that year, and 1 million people died of the condition. Sub–Saharan Africa
makes up about 75% of the word's HIV–infected population. Approximately 3.3 million children
have HIV/AIDS in the world – most of these patients are born in sub–Saharan Africa and Southeast
Asia.
The prevalence of HIV seems to be stabilizing overall, however some countries are still
demonstrating an increase. Since 2001, there has been about a 38% decrease in the incidence of HIV
infection.
What are the symptoms and signs of HIV infection?
Symptoms of acute HIV infection are flu–like and typically include:
Fever
Enlarged and painful lymph nodes – lymphadenopathy
Rash
Sore throat
Body aches
Headache
Weight loss
Night sweats
Anorexia – loss of appetite

These typically subside and the virus then hibernates in the lymphatic system. Months or years later,
the CD4 cells become significantly depleted

Swollen Lymph Node Case Study
CHIEF COMPLAINT Swollen lymph node. SUBJECTIVE A 29–year–old male comes from
segregation and is shackled. Patient is seen today for concerns about swollen lymph node on left–
side of his neck. He said it is painful with turning his neck and with palpation. He denies having
pain with swallowing. Has not had chills, fever, change in appetite. Says he has partially been
baseline due to his anxiety. He also continues to complain of generalized rash. He states that he has
had this rash and swelling for the past four weeks. Rash kind of moves around different spots of his
body. Currently, the only spot that the rash is present in is on the tip of his penis. Currently, does not
have any swelling but states he has had swelling of joints

Lemierre Syndrome: A Case Study Essay
We report a 20–year–old Caucasian female with no significant past medical history presents with
sore throat, body aches and high–grade fevers for two weeks. On examination, she is febrile,
tachycardic and noted to have slight induration around anterior aspect of the neck, and cervical
lymphadenopathy. She had elevated white cell count with left shift and thrombocytopenia. Chest x–
ray showed multifocal nodular infiltrates suspicious for septic emboli (image 1). She was treated for
presumed sepsis with broad–spectrum antibiotics.
CT scan of the neck, which showed mild non–specific thickening of the left tonsillar pillar and a
thrombus in left internal jugular vein (image 2, image 3). On day three, her chest CT scan showed
multiple cavitatory lesions bilaterally consistent with septic emboli in both lung fields. (image 4,
image 5) Echocardiogram didn't reveal any obvious vegetation's. Later blood cultures were positive
for Fusobactrim necrophorum and her antibiotic course was changed to ampicillin–sulbactam.
Patient was discharged few days later in stable condition. ... Show more content on Helpwriting.net
...
The syndrome is characterized by super infection with Fusobacterium necrophorum, jugular vein
thrombosis and septic emboli.[1] Healthy young adults are at a higher risk for this infection and
have a significant mortality rate. Infection spread locally by breakdown of mucosal barrier at
pharyngeal and para pharyngeal space and extend to carotid sheath. This will lead to formation of
septic thrombophlebitis in internal jugular vein[2] and cause distant septic emboli. Early antibiotic
with anerobic coverage would prevent significant morbidity but duration of antibiotic therapy is not
clearly

Pttm's Pathological Determortem Diagnosis
PTTM is a highly fatal, rare complication from metastatic carcinoma. Von Herbay et al. first
described the disease in 1990 after a review of 630 consecutive autopsy cases of carcinoma (8). Of
the 21 cases, gastric carcinoma was the most prevalent. Although less prevalent, malignancies of
lung, breast, prostate, and colon, among others were noted during the study (8). An antermortem
diagnosis is challenging due to the rapidly progressive pulmonary hypertension and right–side heart
failure. However, PTTM has pathological, radiological, and clinical characteristics that can help aid
an antermortem diagnosis. In order to assess PTTM's pathological characteristics antermortem, a
lung biopsy is required. A histological assessment from a lung biopsy is the most accurate method of
diagnosis; however, the patients' are usually too hypoxic upon discovery to perform a lung biopsy.
In which case, a pathological diagnosis can only be made postmortem. Although, antermortem and
postmortem investigations will inspect for the same determining factors histologically. PTTM is
defined by the activation of fibroceullular intimal ... Show more content on Helpwriting.net ...
Several cases of PTTM have shown distinct radiological imaging characteristics that should be used
to influence a diagnosis. The mediastinal views of a chest CT angiogram should indicate multiple
mediastinal and hilar lymphadenopathies, along with right–side heart failure displayed from the
flattening of the interventricular septum (4, 5). Centrilobular nodules and "tree–in–bud" images are
also radiological indicators of PTTM (4). Additionally, the chest CT angiogram should not show
signs of a pulmonary embolism, which is a common suspicion during the clinical investigation of
PTTM (2, 3). However, radiological characteristics are not as definitive as pathological aspects and
should be coupled with high suspicion from clinical characteristics

Bartonella Quintan Trench Fever
One of the main goals in society is to try to change and improve from the past. This is done through
technology, advancing medical practices, and even through education. However, when something
critical from the past starts introducing itself into society again, it is imperative that research is done
to figure out why it is happening. Bartonella quintana is a pathogen that is known to cause trench
fever. The pathogen is carried by the louse vector and is transmitted to humans only. This disease
was first found in soldiers from WWI in 1915 when it affected more than 1 million people and
reemerged again during WWII. Cases of a new B. quintana are showing up in homeless people,
people who live in low hygienic areas, people who suffer from excessive ... Show more content on
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As mentioned above, homeless people are more susceptible to trench fever because they don't have
the resources they need to bathe, wash their clothes, or even get new clothes. AIDS patients are also
at risk of infection because B.quintana is an opportunistic pathogen. Studies have given percentages
of homeless people from many different countries that have antibodies against B. quintana. Up to
20% was found in those tested in France and the United States and 57% was found in Tokyo, Japan.
(Bonilla, Kabeya, Henn, Kramer, and Kosoy, 2009). During WW1, most cases of B. quintana and
trench fever were focused on men because they were the soldiers. Urban cases in places like Peru,
Croatia, Greece, India, Australia, and the countries mentioned above are also primarily of middle–
aged men (Perloff and Balderia, 2015). In the past, the disease caused morbidity and even
disabilities but not mortality. However, "Contemporary descriptions of B. quintana endocarditis in
homeless alcoholic males have found mortality rate to be as high as 12%..." (Perloff and Balderia,
2015). These statistics are important because they show how deadly the disease can be. After
learning the geographical distribution of the disease, it is crucial to know how it can spread and how
it actually

Intrinsic Hepatoxins
Intrinsic hepatotoxins predictably cause dose–dependent hepatocellular necrosis and their effects are
reproducible. The period between onset and exposure is short, usually occurring within hours to
days and the pattern of injury is fairly consistent in most people and animal models. Several drugs
with intrinsic hepatotoxic potential are still widely used (eg, acetaminophen, iron sulfate and
ethanol). Idiosyncratic reactions cause the majority of DILI cases. These rare reactions occur in < 1
percent of individuals taking the drug [150]. The main characteristic of this type of reaction is the
unpredictability of the liver injury in humans. The period between exposure and the sensitivity
reaction is variable; approximately one to three months.

Acute Pulmonary Histoplasmosis Research Paper
Among the endemic mycosis in the United States, Histoplasmosis is the most prevalent and the most
common cause for hospitalization. For individuals requiring hospitalization, there is a mortality of
7.5 percent.7 There are five different types of Histoplasmosis disease including: acute pulmonary
histoplasmosis, chronic pulmonary histoplasmosis, progressive disseminated histoplasmosis, central
nervous system infection and African histoplasmosis. The most affected populations vary according
to the type. Acute pulmonary histoplasmosis affect infant and children, chronic pulmonary
histoplasmosis affect older patients with preexisting pulmonary disease and/or white, middle–aged
men, progressive disseminated histoplasmosis affects individuals with ... Show more content on
Helpwriting.net ...
It can also show patchy infiltrates or enlargement of the hilar and/or mediastinal lymph nodes.
Severe cases may show bilateral diffuse reticulonodular infiltrates, small or diffuse pulmonary
nodules. CT may show diffuse reticulonodular infiltrates. In severe disease, upper lobe infiltrates
and cavities may be present along with extensive fibrosis of the lower lung fields.1,2,4,8 The
diagnosis of acute pulmonary histoplasmosis can be difficult and many times is not even made due
to the patient's being asymptomatic.2 There are different traditions to diagnosis histoplasmosis.
These include: stains for fungi, cultures, antigen detection, and serologic tests for Histoplasma–
specific antibodies. All of these test have limitations. In addition, they have better sensitivity and
specificity for different types of histoplasmosis. This is important for one to recognize in order to
select the correct test. 2,5 The gold standard for diagnosis is culture. It requires one to obtain
multiple sputum samples or bronchoalveolar lavage. It is most useful in for chronic pulmonary
histoplasmosis because the sensitivity of respiratory cultures is much lower in localized disease or
acute disease. Another downside is that it can take anywhere from one to six weeks for results to
grow on standard mycological media. This can delay the diagnosis of a patient with acute severe
disease

The Principle Of The Glandular Fever Test
1) What is the organism responsible for the occurrence of IM? What patient group is mainly
affected?
The organism responsible for the occurrence of IM is the Epstein–Barr virus (EBV). This virus
belongs to the Herpes group and was first identified in cultured cells from biopsies of Burkitt's
Lymphoma.
The patient group that is mainly affected are 15 to 25 year olds. Infants and younger children have
been affected, but the virus is very rarely found in middle aged or elderly people.
2) Explain the principle of the glandular fever test.
A patient sample is added to an absorbent pad on the test strip which contains bovine erythrocyte
glycoprotein. The patient sample mobilises the blue microspheres that are contained in the test strip
and they move up the strip. The test strip contains a region of immobilised bovine erythrocyte
glycoprotein in the result window. If any IM heterophile antibodies are present in the specimen, then
a blue line should appear in the result window. The Clearview IM test strips used in the laboratory
provides an integrated control feature.
3) What is a heterophile antibody?
A heterophile antibody is an antibody produced in one species that reacts with the cells from another
unrelated species. These antibodies, which are IgM in nature, are not specific for sheep red cells but
also react with horse and ox, but NOT human, red cells.
4) What are atypical lymphocytes and how do they appear on: a) blood film, b) graphics plot?
a) On a blood

Kawasaki Disease Case Study
Based on the patient's history and symptoms some differential diagnose for the patient can be Fifth
Disease from Parvovirus B19 (slapped cheeks), scarlet fever, Kawasaki disease, and measles. Fifth
disease was a differential because the condition may cause a fever and a red rash on the patient's
cheeks, but it can also appear on the chest, back buttocks, or arms and legs. Scarlet fever is
condition that is caused by group A Streptococcus. Presenting symptoms can be a fever, a red rash
with a sandpaper feel, a strawberry tongue, and headache/body aches. Next, Kawasaki disease
presents with symptoms of a high fever, conjunctiva injection, a strawberry tongue, cervical
lymphadenopathy, peripheral edema, polymorphous rash, and tachycardia ... Show more content on
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The criteria for diagnosis entails a child that has a fever for 5 days plus four out of five of the other
criteria: bilateral conjunctiva injection without exudate, polymorphous rash, inflammatory changes
in the lips and oral cavity, changes in extremities (peripheral edema, erythema of palms and soles),
and cervical lymphadenopathy that is usually unilateral, anterior cervical (Burns, Dunn, Brady,
Starr, Blosser, 2013). Since the ER already performed cultures, a urine study, CBC, and CMP, which
were all negative, the next blood work that would be beneficial is a CRP and ESR to check the
extent of inflammation. The results of the CRP and ESR can help guide the management of the
patient to see if treatment is necessary. The condition may only need to be monitored with a series of
echocardiograms, or treatment with IVIG may become necessary depending on the results of the
echocardiogram. No matter if IVIG treatment is needed, an echocardiogram should be performed as
soon as a diagnosis is made, and at two weeks and six to eight weeks after the onset of the fever to
evaluate coronary, myocardial, and pericardial inflammation (Burns, Dunn, Brady, Starr, Blosser,

Autoimmune Lymphoproliferative Syndrome ( Alps ) Essay
Autoimmune Lymphoproliferative Syndrome (ALPS), Type 1A
Disease
Autoimmune Lymphoproliferative Syndrome (ALPS) is a heritable genetic disease, marked by mis–
regulated lymphoproliferation, due to an inoperative FAS/FASL apoptotic pathway in lymphocytes
(Sneller et al.1992). An immune response generates large amounts lymphocytes, to contend with
pathogen insults, and the subsequent dispatch of the pathogen. The immune response then requires
suppression of the activated lymphocytes, terminating the immune response. This suppression is
facilitated by the cell–mediated process of apoptosis. During the suppression of the immune
response, T lymphocytes express FAS and other B and T lymphocytes generate FASL (Nagata &
Golstein 1995). The expression of FAS and FASL are the prerequisite components of FAS/FASL
apoptosis, and any dysfunction of this pathway negates the ability of the immune system to regulate
the suppression of activated lymphocytes. Mis–regulatiuon, of the activated lymphocytes, causes an
inordinate population of T lymphocytes, which inappropriately target host tissues leading to ALPS.
There are several subcategories of the ALPS disease, each is distinguished by an individual gene
mutation, producing several diverse proteins that constitute the FAS/FASL apoptotic pathway. This
brief synopsis will focus on the ALPS attributed mutation of the FAS gene, classified as ALPS 1A,
which constitutes 75% proportion of ALPS cases (Bleesing et al. 2005).
Pathology
ALPS is

Ct Scan Essay
Thank you very much for referring Gerard along for further investigation of his haemoptysis in the
setting of his abnormal CT scan of his chest. As you are aware, about ten days ago, he noticed that
he was bringing up a little bit of sputum with some blood. It was bright red blood and only a small
amount in the morning and a little bit throughout the day, but no more than 10ml overall. This has
persisted over that time and is in the absence of any symptoms of infection. He has not noticed any
shortness of breath nor any wheeze and has not had any loss of weight. On reflection he has noticed
some night sweats.
He is an ex–smoker and in his previous work as an electrician, he does believe that he was exposed
to asbestos.
As you are ... Show more content on Helpwriting.net ...
His lung fields were clear without any wheezes of crackles and cardiovascular examination was
normal. His heart rate was 60 and regular and his blood pressure today was slightly elevated at
170/110.
Thank you very much for organising the CT scan. Looking at the images today, there is an
abnormality in the right upper lobe of concern. It is 5cm x 3cm x 3cm and it is speculated with some
ground glass opacities and some air bronchograms. There is also an enlarged 2cm right pretracheal
lymph node but no other significant abnormalities.
Blood tests show a normal blood cell count with a normal CRP and there is an ESR of 1. His
calcium is normal as are his LFTs and his kidney function.
Impression/Management:
Given the absence of any obvious infection, the right upper lobe changes are of concern for
underlying malignancy. As such I have organised a bronchoscopy with +/– EBUS sampling of the
node and lesion for Monday. We will then perform a PET scan on Tuesday and I will see him on
Thursday to follow up on the results and management moving forward and we will also try to
organise some lung function tests in the

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