A 5 Month Old Baby With Fussiness

A couple presents to the emergency department with their 5-month-old son. The parents report that their son has never been fussy. However, last night he began to cry incessantly and neither changing his diapers nor feeding was able to calm him. This morning he had become very lethargic and warm, and his temperature reached 39.4° C (103° F).
The physician examines the baby and notices some rigidity in his nuchal region. The emergency department physician becomes extremely concerned and orders a lumbar puncture which reveals an elevated opening pressure, elevated protein level, decreased glucose level, and numerous polymorphonuclear cells.
What is the most likely cause of this patient’s symptoms?

Discussion:

Folic Acid Deficiency Anemia

Essentials Of Diagnosis:

• Macrocytic Anemia
• Macro ovalocytes and hypersegmented neutrophils on peripheral blood smear
• Normal serum vitamin B12 levels
• Reduced folate levels in red blood cells or serum.

Introduction:

Folic acid is present in most fruits and vegetables ( especially citrus fruits and green leafy vegetables) and daily requirements of 50-100 mcg/d are usually met in the diet. 

Causes Of Folic Acid Deficiency: By far the most common cause of folic acid deficiency is inadequate dietary intake. Alcoholic or anorexic patients who do not eat fresh fruits and vegetables , and those who over cook their food are candidates for folate deficiency. Reduced folate absorption is rarely seen , since absorption occurs from the entire gastrointestinal tract. However certain drugs may lead to decreased folic acid absorption resulting in folate deficiency. 

Folic acid requirements are increased in pregnancy, hemolytic anemias and exfoliative skin diseases and the increased requirements may sometimes not be met by regular diet. The causes are summarized below:

A Patient Presents With Maculopapular Rash Of Penicillin Allergy

A 22 Year old patient presents with community acquired pneumonia and was reported to have allergy to penicillin. How would you approach this patient?

Clinical Approach To  Case Of Penicillin Allergy:

History Of Presenting Complaints:

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.