Approach To A Patient With Fever And Lymphadenopathy

A 57 year old woman comes to her family physician with the complaints of fever and lymphadenopathy in her neck.

How will you approach this case?

Clinical Approach:
There are a wide variety of causes of lymphadenopthy. Knowing theses causes helps in making a structured diagnosis. Majority of the causes for enlarged or swollen lymph nodes are benign and secondary to self limiting infectious causes. The probability for malignancy increases with age and should always be ruled out an any patient with lymphadenopathy.

Causes Of Lymphadenopathy: The important causes for lymphadenopathy include:

1. Infectious causes: 

Toxic Shock Syndrome In A Young Female

A 20 year old female university student presents to the emergency department with a 12 hour history of fever, chills and generalized body aches and pains. On arrival she is noted to be confused, breathless and hypotensive with a sinus tachycardia.

Palmar desquamation seen in the above patient.

What is the differential diagnosis?

Approach To A Patient With Chronic Diarrhoea

A 24 year old married man presents to his general physician with a history of watery diarrhea which has sometimes blood mixed in with the stools. He has lost some weight and also complains of arthralgia.. How would you approach this case ?

Clinical Approach:
The patient in this case is most likely suffering from idiopathic inflammatory bowel disease, but it is important to exclude chronic infection and to consider other causes of chronic diarrhea. Always make sure that the patient is actually having diarrhea that is increased daily stool volume.

History of Presenting Problem:

1. Character of the stool  knowing the character of the stool is very important for the appropriate diagnosis. The questions to be asked in history include:

• Frequency of passing the motion.
• Whether there is any urgency
• Any pain on defecation

2. Rectal Bleeding: If there is any rectal bleeding or blood in stool following should be clarified:

• is the blood passed freely per rectum without any stool?
• Is it mixed with stool
• is it only present on the toilet paper when the anus is wiped.