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Clues To Case-Based Questions-1

1. Anaphylaxis presents with dyspnea, hypotension, and shock following exposure to allergens like foods, drugs, or insect stings. 2. Rheumatoid arthritis commonly affects women and presents with arthritis of small joints, morning stiffness, positive rheumatoid factor and anti-CCP antibodies. 3. Acute rheumatic fever develops after a streptococcal infection and presents with migratory joint pains, heart murmurs, chorea, nodules, macular rashes and increased antistreptolysin O titers.

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Ali Haider
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33 views

Clues To Case-Based Questions-1

1. Anaphylaxis presents with dyspnea, hypotension, and shock following exposure to allergens like foods, drugs, or insect stings. 2. Rheumatoid arthritis commonly affects women and presents with arthritis of small joints, morning stiffness, positive rheumatoid factor and anti-CCP antibodies. 3. Acute rheumatic fever develops after a streptococcal infection and presents with migratory joint pains, heart murmurs, chorea, nodules, macular rashes and increased antistreptolysin O titers.

Uploaded by

Ali Haider
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Diagnosis Features

Anaphylaxis – type 1 Dyspnea, hypotension, vascular collapse/shock following exposure to


hypersensitivity reaction sea food, nuts, bee sting, penicillin,etc.
Rheumatoid arthritis Female, arthritis of small joints, morning stiffness, raised RF, anti-
CCP
Acute rheumatic fever Following a few weeks of an episode of streptococcal infection (sore
throat) – migratory joint pains, heart murmurs, chorea, nodules,
macular rashes. Raised ASO
Fever (stepladder pattern), headache, abdominal pain,
Enteric fever/ typhoid hepatosplenpmegaly, coated tongue, relative bradycardia, rashes on
trunk (rose spots), mild leukopenia
Scrub typhus History of exposure to mites/travel to areas with scrub vegetation,
eschar at site of mite bite, fever with rash, myalgia,
later - encephalitis

Brucellosis Fever (undulating pattern), night sweats, arthralgia,


hepatosplenomegaly, exposure to animals (abattoir worker/ vet/
farmer), consumption of unpasteurized milk/milk products
Leptospirosis Fever, conjunctival suffusion, myalgia. Jaundice, renal failure,
haemorrhagic features in Weil’s disease. Exposure to rodents,
stagnant water (floods, rice fields)
HIV/AIDS Fever, persistent diarrhea/recurrent pneumonia, emaciation/
progressive loss of weight, generalised lymphadenopathy. History of
unprotected sex/ intravenous drug abuse/ needle stick
injury/transfusion

Dengue Fever, retro-orbital pain, myalgia, rash,positive tourniquet test/


bleeding manifestations/petechiae, shock. Thrombocytopenia

Malaria Fever, chills, rigors, sweating, fever every 48/72 hours, anemia,
splenomegaly, peripheral blood smear showing abnormal forms in
RBC, altered sensorium/coma in cerebral malaria (falciparum)
Visceral leishmaniasis/ Fever, hyperpigmentation (kala azar), pancytopenia, massive
Kala azar splenomegaly, hypergammaglobulinemia, travel to or from endemic
area
Lymphatic filariasis Fever, lymphangitis, lymphadenitis, lower limb edema (non-pitting
in later stages), elephantiasis, hydrocele/scrotal swelling.
Candidiasis Immunosuppressed patient (HIV-AIDS, post-transplant etc)/ patient
on broad-spectrum antibiotics/ neonate/elderly with white patches on
oropharyngeal mucosa (thrush)/ lesions in intertriginous areas.
Budding yeast cells on microscopy, creamy white/pasty colonies on
culture
Shigellosis/ bacillary Fever, diarrhea, bloody/ mucopurulent stools, tenesmus, abdominal
dysentery cramps. No parasites seen on stool wet mount

Cholera Watery diarrhea (usually painless), rice water stool, mucous flakes
in stool, signs of dehydration (thirst, loss of skin turgor, dry
lips/tongue, sunken eyes, decreased urine output)
Amoebic dysentery Bloody diarrhea, abdominal pain, flask-shaped ulcers in large
intestine, no pathogens grown in bacterial culture of stool.
Amoebic liver abscess Pain abdomen (right upper quadrant), hepatomegaly, fever, drainage
of abscess showing anchovy sauce pus.
Hepatitis B/C Jaundice ( may progress to liver cirrhosis/hepatocellular carcinoma
over many years), other symptoms like arthritis, rash. History of
needle stick injury/ tattoo/ shared needles/razors, unprotected sex,
transfusions, etc
Hydatid cyst/ Abdominal mass, hepatomegaly, USG showing water-lily sign,
echinococcosis exposure to dogs, person from sheep-rearing areas

Gas gangrene Road traffic accident/ crush injury with edema, pain, crepitus.
Gram positive bacilli on smear
Herpes Simplex Virus Vesicular lesins over lips/buccal mucosa or skin, Multinucleate giant
infection cell on Tzanck smear
Chickenpox/Varicella Fever with rashes at various stages of evolution, vesicular, centripetal
in distribution

Unilateral rash usually over a single thoracic/lumbar dermatome in


Herpes Zoster/ Shingles a middle-aged/elderly/ immunocompromised patient with history of
chickenpox years before.
Measles Fever, grey/bluish spots over buccal mucosa near the molars, rash
behind the ears, spreading to face, arms, trunk.
Congenital rubella Deafness, cataract, congenital heart disease (patent ductuc arteriosus)
syndrome in child. History of fever with rash in mother during first trimester of
pregnancy.
Dermatophytosis Annular pruritic scaly lesions of skin with raised edges.
Mycetoma Swelling ( usually over foot) with sinuses discharging granules
Sporotrichosis Ulcerative/ nodular skin lesions distributed along the lymphatics.
History of abrasion/ thorn prick.
Diphtheria Fever, ulcerative lesions covered by greyish white leathery
membrane over the throat and tonsils. Tonsillar swelling, edema
over the neck. Uncertain/ no history of immunization.
Pulmonary tuberculosis Low-grade fever, chronic cough (hemoptysis +/-), significant weight
loss, night sweats
COVID Fever, dry cough, sore throat, loss of smell / taste, myalgia
Rhinocerebral Patient with diabetic ketoacidosis/ uncontrolled diabetes or patient
mucormycosis with recent history of COVID or immunosuppressed patient

Fever, purulent nasal discharge, facial pain, orbital cellulitis,


blackening/ necrosis of tissues in nasal/palatal mucosa
Pyogenic meningitis Fever, neck stiffness, vomiting, altered sensorium, seizures
or acute bacterial CSF cell count showing plenty of cells, predominantly neutrophils.
meningitis Low CSF glucose, elevated CSF protein
Tetanus Following injury/ dirty wound, person develops trismus/ lockjaw,
muscle spasms/ stiffness.
Poliomyelitis Child with acute flaccid paralysis.

Rabies Complaint of inability to swallow liquids, restlessness, history of


being bitten/licked/scratched by dog/cat
Primary amoebic Fever, neck stiffness, positive Kernig’s sign, loss of smell, headache,
meningoencephalitis photophobia, seizures. Rapid deterioration. History of swimming in
fresh/warm water (lake,river, pond)
Toxoplasmosis Immunosuppressed patient (HIV, CD4 count <100) with seizures,
altered sensorium/ chorioretinitis
Or
Immunocompetent person with fever, cervical lymphadenopathy,
malaise, pharyngitis, splenomegaly

C-shaped/ crescent-shaped tachyzoites seen in patient samples


Neurocysticercosis Recent-onset seizures/ hydrocephalus/ focal neurological deficits
Cystic lesions in brain seen on imaging
Cryptococcal meningitis Fever, malaise, headache, neck stiffness. Slow onset of symptoms.
HIV positive/ immunosuppressed patient with low CD4 count. CSF
cell count, if mentioned, shows more lymphocytes.
Urinary tract infection Dysuria/ burning micturition, frequency, urgency, fever (+/-)

Primary syphilis Painless indurated genital ulcer (hard chancre) with painless
inguinal lymphadenopathy. History of unprotected sex

Secondary syphilis Skin rashes involving palms and soles, mucosal patches,
lymphadenopathy, previous history of genital lesions.
History of unprotected sex

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