CASE STUDIES Q AND S
G.P.,vbavb3vbyearvboldvbgirl,vbcomesvbtovbthevbfreevbclinic.vbAccordingvbtovbhervbmother,vbshevbhasvbsomevbbrig
htvbredvbmarksvbonvbhervbstomachvbandvbtrunkvbthatvbarevbpeelingvbandvbalmostvblookvblikevbburns.vbG.P.vbjust
vbreturnedvbfromvbavbtwovbweekvbvisitvbwithvbhervbfathervbandvbG.P.'svbmothervbisvbconcernedvbaboutvbabusevb
(theyvbarevbdivorced).vbYouvbalsovblearnvbthatvbG.P.'svbfathervbjustvbboughtvbhervbavbpetvbguineavbpigvbforvbher
vbbirthday.vb-vbanswer---Probablyvbringvbworm-fromvbpet
-usevbClotrimazole-topicalvblamosil
Avb66vbyearvboldvbmanvbpresentsvbtovbclinicvbforvbavbpainfulvbrash.vbStatesvbhevbstartedvbtovbhavevbleftvbsidedvbr
ib/
chestvbpainvbthatvbwasvbavbburningvbsensationvbforvbtwovbdays,vbthenvbavbpainfulvbrashvbappearedvbonvbthevbri
ghtvblateralvbsidevbofvbthisvbchest.vbThevbareavbisvbveryvbtendervbwhenvbhevbtouchesvbitvbandvbhevbisvbreluctantv
btovbwearvbclothing.
PhysicalvbExam:vbleftvbsidevbofvbchestvbtherevbarevberythematousvbpopularvbandvbvesicularvbrashvbinvbavbder
matomalvbdistributionvbthatvbdoesvbnotvbcrossvbmidline.vb-vbanswer--
Whatvbisvbthevbvirusvbmostvblikelyvbcausingvbthisvbinfection?vbVaricellavbZoster
Whatvbisvbthevbmostvblikelyvbdiagnosis?vbShingles
Whatvbisvbthevbrecommendedvbtreatmentvbplan?
vbsupportivevbcarevbandvbpainvbmanagement,vbmaybevbantivirals,vb
Howvbcanvbthisvbbevbprevented?vbVaccine
Avb27vbyearvboldvbmanvbcomesvbinvbtovbclinicvbwithvbcomplaintsvbofvbsorevbthroat,vbfever,vbandvbfatigue.vbHevbst
atesvbsorevbthroatvbhasvbpresentvbforvb4vbdays,vbandvbthevbpainvbmakesvbitvbdifficultvbtovbeat.vbHisvbfatiguevbisvb
extremelyvbprofound.vbHevbalsovbhasvbnoticedvbswollenvblymphvbnodesvbinvbhisvbneck.vbHevbhasvbassociated
vbgeneralizedvbachiness.vbNovbrespiratoryvbsymptoms.vb
Exam:vbPosteriorvbpharyngealvberythemavbwithvbbilateralvbtonsillarvbenlargementvbwithvbexudate.vbPosterio
rvbcervicalvblymphadenopathyvbpresent.vb-vbanswer--
Whatvbisvbthevbvirusvbmostvblikelyvbcausingvbthisvbinfection?vbEBV-vbmaybevbCMV
Whatvbisvbthevbmostvblikelyvbdiagnosis?vbMononucleosus
Whatvbisvbthevbrecommendedvbtreatmentvbplan?vbSupportivevbCare,vbnovbcontactvbsports
Howvbcanvbthisvbbevbprevented?vbGoodvbHygiene
Avb4vbyearvboldvbboyvbpresentsvbtovbclinicvbwithvbmothervbavb1vbdayvbhistoryvbofvbavbrash.vbMothervbstatesvb4vbd
aysvbthevbchildvbstartedvbtovbhavevbavblowvbgradevbfevervbandvbwasvbactingvb"notvblikevbhisvbnormalvbself,vbmor
, evbtired"vbandvbavbrunnyvbnose.vbThenvbyesterdayvbavbdiffusevbrashvbofvbhisvbback,vbchestvbandvbfacevbthatvbisv
bitchy.vbMothervbreportsvbchildvbisvbnotvbupvbdatevbonvbhisvbchildhoodvbvaccinesvbandvbhasvbskippedvbvaccine
svbsincevbhisvb6vbmonthvbvaccines.vb
Exam:vb*Diffusevberythematousvbvesicularvbrash*vbofvbthevbchestvbandvbbackvb-vbanswer--VaricellavbZoster
ChickenvbPox
Supportivevbcare,vbwatchvbforvbcomplicationsvbsuchvbasvbPNA,vbOM
Vaccine
Avb22vbyearvboldvbmanvbpresentsvbtovbclinicvbwithvbhistoryvbofvbpainfulvblesionsvbonvbhisvb"groin."vbHevbreportsv
bhevbhasvbskinvbburningvbforvbonevbdayvbandvbgeneralizedvbbodyvbachinessvbandvbfeelingsvbofvbfever.vbThenvb
thevbburningvbskinvberuptedvbintovbavbpainfulvbrashvbonvbhisvbpenilevbshaftvbandvblowervbpubicvbarea.vbHevbhas
vbnevervbhadvbthesevbsymptomsvbbefore.vbHevbisvbsexuallyvbactivevbwithvbmultiplevbpartners,vbandvbwearsvbc
ondomsvbforvbcontraception.vb
Exam:vbtherevbarevbscatteredvberythematousvbvesicularvblesionsvbinvbclustersvbatvbthevbbasevbofvbthevbpubisvb
andvbpenilevbshaftvbthatvbarevbtendervb-vbanswer--HerpesvbSimplexvbVirusvb2
GenitalvbHerpes
Supportivevbcare,vbantivirals-acyclovir,vbValacyclovir.vbpotentiallyvbsuppressivevbtherapy
Ptvbeducation,vbspreadvbriskvbmanagement
Avb31vbyearvboldvbwomanvbcomesvbinvbtovbclinicvbduevbtovblipvbsores.vbShevbstatesvbshevbremembersvbhavingvb
thesevbsoresvbasvbavbchild,vbbutvbresolvedvbinvbadolescence.vbShevbstatesvbforvbthevbpastvb2vbmonthsvbshevbh
asvbhadvbaboutvb7vboutbreaks.vbShevbfeelsvbavbtinglingvbsensationvbinvbhervblipvbforvbonevbdayvbandvbthenvbanvb
"uglyvbsore"vbappears.vbShevbreportsvbnovbothervbskinvbrashesvborvblesions.vb
Exam:vbTherevbisvbavbclustervberythematousvbbasevbvesicularvblesionsvbofvbthevbuppervblip.vb-
vbanswer--...ColdvbsorevbcausedvbbyvbHSV-
1,vbherpesvblabialis,vbsupportivevbcare,vbantiviral,vbsuprressivevbtherapy,vbgoodvbhygene
Avb29-year-
oldvbwomanvbwithvbnovbsignificantvbpastvbmedicalvbhistoryvbcomesvbintovbclinicvbforvb3vbdaysvbofvbcoughvbandv
bnasalvbcongestion.vbShevbreportsvbsymptomsvbstartedvbwithvbavbmildvbsorevbthroat,vbandvbprogressedvbtovbsi
gnificantvbnasalvbcongestion,vbandvbavbnon-
productivevbcough.vbShevbhasvbhadvbassociatedvbheadachevbandvbfatigue.vbShevbreportsvbsymptomvbreliefvb
withvbibuprofenvbandvb"AlkavbSeltzer"vbcoldvbmedicine.vbShevbdeniesvbfevers,vbchills.vbShevbhasvbnovbwheezi
ng,vbproductivevbsputum,vborvbchestvbpain.
Vitalvbsigns:vbBP:vb120/80vbP:vb72vbT:vb98.6FvbO2%:vb99%
HEENT:vbTMsvbpearlyvbgreyvbwithoutvbsignsvbofvberythemavborvbbulging.vbSwollenvbandvberythematousvbnas
alvbturbinatesvbwithvbrhinorrheavbpresent.vbPharynxvbwithvbmildvbposteriorvberythema.vbTonsilsvbarevbnon-
erythematousvbandvbwithoutvbexudate.
G.P.,vbavb3vbyearvboldvbgirl,vbcomesvbtovbthevbfreevbclinic.vbAccordingvbtovbhervbmother,vbshevbhasvbsomevbbrig
htvbredvbmarksvbonvbhervbstomachvbandvbtrunkvbthatvbarevbpeelingvbandvbalmostvblookvblikevbburns.vbG.P.vbjust
vbreturnedvbfromvbavbtwovbweekvbvisitvbwithvbhervbfathervbandvbG.P.'svbmothervbisvbconcernedvbaboutvbabusevb
(theyvbarevbdivorced).vbYouvbalsovblearnvbthatvbG.P.'svbfathervbjustvbboughtvbhervbavbpetvbguineavbpigvbforvbher
vbbirthday.vb-vbanswer---Probablyvbringvbworm-fromvbpet
-usevbClotrimazole-topicalvblamosil
Avb66vbyearvboldvbmanvbpresentsvbtovbclinicvbforvbavbpainfulvbrash.vbStatesvbhevbstartedvbtovbhavevbleftvbsidedvbr
ib/
chestvbpainvbthatvbwasvbavbburningvbsensationvbforvbtwovbdays,vbthenvbavbpainfulvbrashvbappearedvbonvbthevbri
ghtvblateralvbsidevbofvbthisvbchest.vbThevbareavbisvbveryvbtendervbwhenvbhevbtouchesvbitvbandvbhevbisvbreluctantv
btovbwearvbclothing.
PhysicalvbExam:vbleftvbsidevbofvbchestvbtherevbarevberythematousvbpopularvbandvbvesicularvbrashvbinvbavbder
matomalvbdistributionvbthatvbdoesvbnotvbcrossvbmidline.vb-vbanswer--
Whatvbisvbthevbvirusvbmostvblikelyvbcausingvbthisvbinfection?vbVaricellavbZoster
Whatvbisvbthevbmostvblikelyvbdiagnosis?vbShingles
Whatvbisvbthevbrecommendedvbtreatmentvbplan?
vbsupportivevbcarevbandvbpainvbmanagement,vbmaybevbantivirals,vb
Howvbcanvbthisvbbevbprevented?vbVaccine
Avb27vbyearvboldvbmanvbcomesvbinvbtovbclinicvbwithvbcomplaintsvbofvbsorevbthroat,vbfever,vbandvbfatigue.vbHevbst
atesvbsorevbthroatvbhasvbpresentvbforvb4vbdays,vbandvbthevbpainvbmakesvbitvbdifficultvbtovbeat.vbHisvbfatiguevbisvb
extremelyvbprofound.vbHevbalsovbhasvbnoticedvbswollenvblymphvbnodesvbinvbhisvbneck.vbHevbhasvbassociated
vbgeneralizedvbachiness.vbNovbrespiratoryvbsymptoms.vb
Exam:vbPosteriorvbpharyngealvberythemavbwithvbbilateralvbtonsillarvbenlargementvbwithvbexudate.vbPosterio
rvbcervicalvblymphadenopathyvbpresent.vb-vbanswer--
Whatvbisvbthevbvirusvbmostvblikelyvbcausingvbthisvbinfection?vbEBV-vbmaybevbCMV
Whatvbisvbthevbmostvblikelyvbdiagnosis?vbMononucleosus
Whatvbisvbthevbrecommendedvbtreatmentvbplan?vbSupportivevbCare,vbnovbcontactvbsports
Howvbcanvbthisvbbevbprevented?vbGoodvbHygiene
Avb4vbyearvboldvbboyvbpresentsvbtovbclinicvbwithvbmothervbavb1vbdayvbhistoryvbofvbavbrash.vbMothervbstatesvb4vbd
aysvbthevbchildvbstartedvbtovbhavevbavblowvbgradevbfevervbandvbwasvbactingvb"notvblikevbhisvbnormalvbself,vbmor
, evbtired"vbandvbavbrunnyvbnose.vbThenvbyesterdayvbavbdiffusevbrashvbofvbhisvbback,vbchestvbandvbfacevbthatvbisv
bitchy.vbMothervbreportsvbchildvbisvbnotvbupvbdatevbonvbhisvbchildhoodvbvaccinesvbandvbhasvbskippedvbvaccine
svbsincevbhisvb6vbmonthvbvaccines.vb
Exam:vb*Diffusevberythematousvbvesicularvbrash*vbofvbthevbchestvbandvbbackvb-vbanswer--VaricellavbZoster
ChickenvbPox
Supportivevbcare,vbwatchvbforvbcomplicationsvbsuchvbasvbPNA,vbOM
Vaccine
Avb22vbyearvboldvbmanvbpresentsvbtovbclinicvbwithvbhistoryvbofvbpainfulvblesionsvbonvbhisvb"groin."vbHevbreportsv
bhevbhasvbskinvbburningvbforvbonevbdayvbandvbgeneralizedvbbodyvbachinessvbandvbfeelingsvbofvbfever.vbThenvb
thevbburningvbskinvberuptedvbintovbavbpainfulvbrashvbonvbhisvbpenilevbshaftvbandvblowervbpubicvbarea.vbHevbhas
vbnevervbhadvbthesevbsymptomsvbbefore.vbHevbisvbsexuallyvbactivevbwithvbmultiplevbpartners,vbandvbwearsvbc
ondomsvbforvbcontraception.vb
Exam:vbtherevbarevbscatteredvberythematousvbvesicularvblesionsvbinvbclustersvbatvbthevbbasevbofvbthevbpubisvb
andvbpenilevbshaftvbthatvbarevbtendervb-vbanswer--HerpesvbSimplexvbVirusvb2
GenitalvbHerpes
Supportivevbcare,vbantivirals-acyclovir,vbValacyclovir.vbpotentiallyvbsuppressivevbtherapy
Ptvbeducation,vbspreadvbriskvbmanagement
Avb31vbyearvboldvbwomanvbcomesvbinvbtovbclinicvbduevbtovblipvbsores.vbShevbstatesvbshevbremembersvbhavingvb
thesevbsoresvbasvbavbchild,vbbutvbresolvedvbinvbadolescence.vbShevbstatesvbforvbthevbpastvb2vbmonthsvbshevbh
asvbhadvbaboutvb7vboutbreaks.vbShevbfeelsvbavbtinglingvbsensationvbinvbhervblipvbforvbonevbdayvbandvbthenvbanvb
"uglyvbsore"vbappears.vbShevbreportsvbnovbothervbskinvbrashesvborvblesions.vb
Exam:vbTherevbisvbavbclustervberythematousvbbasevbvesicularvblesionsvbofvbthevbuppervblip.vb-
vbanswer--...ColdvbsorevbcausedvbbyvbHSV-
1,vbherpesvblabialis,vbsupportivevbcare,vbantiviral,vbsuprressivevbtherapy,vbgoodvbhygene
Avb29-year-
oldvbwomanvbwithvbnovbsignificantvbpastvbmedicalvbhistoryvbcomesvbintovbclinicvbforvb3vbdaysvbofvbcoughvbandv
bnasalvbcongestion.vbShevbreportsvbsymptomsvbstartedvbwithvbavbmildvbsorevbthroat,vbandvbprogressedvbtovbsi
gnificantvbnasalvbcongestion,vbandvbavbnon-
productivevbcough.vbShevbhasvbhadvbassociatedvbheadachevbandvbfatigue.vbShevbreportsvbsymptomvbreliefvb
withvbibuprofenvbandvb"AlkavbSeltzer"vbcoldvbmedicine.vbShevbdeniesvbfevers,vbchills.vbShevbhasvbnovbwheezi
ng,vbproductivevbsputum,vborvbchestvbpain.
Vitalvbsigns:vbBP:vb120/80vbP:vb72vbT:vb98.6FvbO2%:vb99%
HEENT:vbTMsvbpearlyvbgreyvbwithoutvbsignsvbofvberythemavborvbbulging.vbSwollenvbandvberythematousvbnas
alvbturbinatesvbwithvbrhinorrheavbpresent.vbPharynxvbwithvbmildvbposteriorvberythema.vbTonsilsvbarevbnon-
erythematousvbandvbwithoutvbexudate.
