Wednesday, October 19, 2016

A 30 year old man Presents with Acute Painful Swelling of the Right Parotid

A 30 year old man presents with acute painful swelling of the right parotid for 1 day.
Answer the following questions:
1. What 3 questions you would ask in history?
2. What examination would you conduct?
3. What will be your management plan?

( Question from MCPS paper October 19th 2016).

                                                   Acute swelling of the parotid . 


Solution:
1. What 3 questions you would ask in history?

Answer:


  1. h/o fever and malaise, pain and difficulty swallowing & chewing, any dental infection?  
  2. Any close contact having similar symptoms. ? ( viral Infection like Mumps can be spread easily from close contacts) 
  3. h/o mumps infection in past and either immunized for mumps? 
2. What examination would you conduct?

Answer: 

1. Examine the swelling as for any lump: 
  • Inspect the swelling and determine the extent ( involving the parotid region only or extending elsewhere) 
  • Look for facial asymmetry ( as facial nerve may be involved) 
  • Look for redness, any discharging fistula. 
  • Palpate the swelling and look for signs of tenderness. 
  • Check both sides and compare (swelling is either unilateral or bilateral) 
2. Check the cervical lymph nodes for enlargement and tenderness.  
3, Look inside the mouth and examine for any dental infection, and also examine the opening of the parotid duct opposite the 2nd molar tooth. 
4. Check for any ear infection. 
5. Check the cranial nerve 7 .
6. Look for any associated swelling of the testes. 


3. What will be your management plan?

Answer:  For acute parotitis secondary to viral infection (mumps) treatment is:  
  • symptomatic with analgesics and antipyretics to control fever and pain.
  • NSAIDs like ibuprofen to relieve pain and inflammation
  • Encourage good fluid intake to prevent dehydration
  • Topical application of cold or warm packs on the swollen parotid may provide relief from pain and inflammation. 
  • Advice soft diet for initial few days until the swelling resolves. 
  • If associated orchitis , provide bed rest with scrotal support. 

2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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  2. Nice blog
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    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
    Thanks so much for reading my article, you should share your testimony if you have cure as well
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