EMQs in Clinical Medicine.pdf - Peshawar Medical College

172 The abdomen and surgery
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A 23-year-old man presents with a week’s history of fever and sore
throat. He developed a macular rash after being prescribed ampicillin
by his GP. On examination he has enlarged posterior cervical nodes,
palatal petechiae and splenomegaly.
Infectious mononucleosis is more commonly known as glandular fever
and results from primary infection with Epstein–Barr virus (EBV). The
appearance of a faint morbilliform eruption or maculopapular rash after
the patient is treated with ampicillin is a characteristic sign of EBV infection.
There is a T-cell proliferation, with the presence of large atypical
cells that can be observed on the blood film. There is no antiviral therapy
and the patient is simply advised to rest for uncomplicated infection.
Complications are rare but include thrombocytopenia, aseptic meningitis
and Guillain–Barré syndrome.
A 21-year-old female backpacker returning from India presents with
flu-like symptoms followed by a periodic fever. She is anaemic,
jaundiced and has moderate splenomegaly.
The fever of malaria is classically periodic, e.g. peaking every third day.
This is caused by rupture of infected erythrocytes releasing matured
merozoites and pyrogens. This classic paroxysm may not necessarily be
present in early infection.
Thick and thin blood smears are required for diagnosis. Resistance to the
traditional quinine-based drugs is now widespread and newer drugs are
in development.
A 28-year-old woman presents with abdominal pain, vomiting and
jaundice. On examination she has tender hepatomegaly and ascites.
She has a history of recurrent miscarriages.
Budd–Chiari syndrome is a condition characterized by obstruction to
hepatic venous outflow. It usually occurs in a patient with a hypercoagulative
state (e.g. antiphospholipid syndrome, use of oral contraceptive
pill, malignancy) but can also occur as a result of physical obstruction,
e.g. tumour. The venous congestion can lead to enlargement of the
spleen as well as the liver. The history of recurrent miscarriages suggests
that there may be an underlying disorder, e.g. antiphospholipid
syndrome, and this should be investigated thoroughly.
59 Jaundice
Answers: C A J L M
A 24 year old presents with nausea, malaise and jaundice. He
returned 3 weeks ago from a holiday abroad. On examination he has a
moderate hepatosplenomegaly and tender cervical lymphadenopathy.
He has dark urine and pale stools.