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A 39 yearold woman comes to the clinic complaining of diarrhea and abdominal pain. “I feel so weak.” She reports having four to five loose, occasionally bloody stools per day for the past two weeks, with abdominal cramping beginning over the past 48 hours. She has been self-treating with occasional other-the-counter (OTC) antidiarrheals without success. She denies recent antibiotic use. She complains of severe fatigue. She gave birth to her third child 6 weeks ago. She is not breast feeding.
A complete blood count, blood chemistry (including electrolytes, renal function tests and blood glucose) and serum iron is ordered along with stool cultures, colonoscopy and upper gastrointestinal (UGI) endoscopy with small bowel follow-through.
Lab Data:
| Sodium | 140 mmol/L |
| Potassium | 3.5 mmol/L |
| Chloride | 105 mmol/L |
| Urea | 3.57 mmol/L |
| Serum creatinine | 115 µmol/L |
| Glucose | 7.8 mmol/L |
| Iron | 4.3 µmol/L |
| Hb | 132 g/L |
| Hct | 0.39 L/L |
| WBC | 7.68 x 109 with normal differential |
She is diagnosed with Crohn’s disease and prescribed prednisone 40 mg PO daily for one week, then prednsione 35 mg PO daily for one week. The dosage will be tapered slowly by 5 mg per week until she is receiving 5 mg/day for one week and then the drug will be completely discontinued.
How does prednisone work to address this patient’s pathologic condition?
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- Mr. Jones is a 69-year-old man who was admitted to the hospital 10 days earlier with a diagnosis of acute diverticulitis. He was given intravenous fluids and empiric antibiotic coverage with ceftriaxone and metronidazole. His antibiotics were stopped after 7 days, and he continued to do well until today, when he developed abdominal pain, fever, and diarrhea. A diagnosis of Clostridium difficile colitis was made, and antibiotic treatment was initiated. Discuss the following questions: What diagnostic test would confirm the diagnosis? What risk factors did Mr. Jones have to acquire a Clostridium difficile infection? Why is oral but not intravenous vancomycin a potential treatment option for this infection? One person from each group should respond to this discussion with a link to their group’s recording and a summary of the discussion that took place.A 22 year old black woman present with complaints of burning and frequency of urination for the past 2 to 3 days. It is getting worse. She feels she has to void, rushes to the bathroom and then is only able to void a small amount. it is painful. There is no sign of blood in the urine. She denies fever, chills, diarrhea, nausea, vomiting or vaginal discharge. " I have to rush to the bathroom, and it hurts when I urinate". Physical Ex: Essentially unremarkable. Negative suprapubic tenderness: negative costovertebral angle tenderness. Negative abdominal pain and benign abdominal exam. Negative back pain. Afebrile. Vital signs normal. No complaints of vaginal discharge. Uranalysis shows+ WBCs, trace RBCs. What additional data are important to factor into this picture? Do you do vaginal ex and why? Should you do urine culture and sensitivity? What are things in the medical history that may provide clues to the possible cause of dysuria? What are the possible differential diagnoses for…Chief Complaint: Rajesh Kumar presents to the village health worker complaining of persistent fatigue, weakness, and occasional abdominal pain. He reports feeling increasingly tired despite getting adequate rest and experiencing discomfort in his abdomen. Rajesh describes his symptoms as ongoing for several weeks. He mentions that many other villagers have been experiencing similar symptoms, and there has been talk of a "strange illness" spreading throughout the community. He denies any recent travel or changes in diet. Social History: Rajesh is married with three children. He works as a farmer, tending to crops and livestock on his family's farm. The village is situated in a remote area with limited access to modern amenities. Rajesh mentions that he often walks barefoot around the farm and occasionally experiences minor cuts and scrapes on his feet. Physical Examination: Vital Signs: Temperature 37°C (98.6°F), Blood Pressure 120/80 mmHg, Heart Rate 80 bpm, Respiratory Rate 16 bpm…
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- a 23-year-old male presented to the er with a 5-day history of fever, headache, sore throat, muscle pain, nausea, and diarrhea. he described his headache as a 10/10 on a pain scale, and was worsened by bright lights, movement, or noise. He had migraines in the past but stated this felt different. He said there was not a prior history of head injury, chest pain, or ear pain. He does not have abdominal pain, dysuria, or a skin rash. No recent alcohol or illicit drug use, travel, or exposure to ticks. Upon physical exam, he had right-sided tonsillar exudates and swelling. Even though neck pain was described with his headache, the neck was supple. Following lumbar puncture, 4 nucleated cells and 87% lymphocytes were shown. CSF protein and glucose were within normal limits. He had a normal white blood cell count but a low blood lymphocyte count of 720 cells/uL (normal is 1500 - 5000/uL). Chest radiograph came back normal. CSF was sent for herpes simplex virus (HSV) PCR and for bacterial…A 74-year old woman with history of rheumatic fever (in her twenties) presented to her physician with complaints of increasing shortness of breath (dyspnea) upon exertion. The typical swelling she’s had in her ankles for years has started to get worse over the past two months. In the past week, she’s had a decreased appetite, some nausea and vomiting and tenderness in the right upper quadrant of the abdomen. On physical examination, the patient’s jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra “S3” heart sound. (i) Examination of the patient’s ankles reveals significant “pitting oedema”. Explain this finding. (ii) What is the general term describing this condition?Male, 50 years old, was admitted to the emergency department with abdominal pain for 7 hours The patient overate 8 hours before and felt discomfort in the upper abdomen after drinking alcohol. 7 hours ago, there was sudden severe pain under the xiphoid process, accompanied by nausea and vomiting of stomach contents several times. 5 hours ago, abdominal pain spread to the right lower abdomen with onset of fever. The patient refused to press the abdomen due to pain, irritable, and had cold sweats. Physical examination: T38.6 °C, P104 /min, R24 /min, BP100/60mmHg. Acute painful appearance, irritability, no obvious lesions in cardiopulmonary examination, flat abdomen, no gastrointestinal and peristaltic waves, extensive abdominal muscle tension, tenderness in the subxiphoid area and right middle and lower abdomen, obvious rebound pain. The most prominent undershoot, liver and spleen are not reached, Murphy sign (-), shifting dullness (-). dullness (-). Bowel sounds are heard occasionally,…