,Part 1: Case Study with Answers
Part 2: Critical Thinking Questions
Part 3: Lecture Notes
,Part 1: Case Study with Answers
Case 1
A 24-year-old female automotive technician presents herself at the doctor’s office. She
complains of fever and of pain in her left hand.
On physical examination, the patient had a deep wound on her left palm that was
oozing pus. She had purplish, red streaks running up her left arm. She had enlarged
lymph nodes at the elbow and under her arm. The patient’s skin was warm and dry.
In her history, the patient had punctured her left palm with sharp metal from the
undercarriage of a "real cherry" 1977 Malibu about a week earlier. She said the wound
had bled for a few minutes and she thought that she had washed it "real good" with
soap and water. She had covered the wound with a large "band-aid" and gone back to
work. She developed a fever about three days later. For the past couple of days, she
"did not feel so good" and had vomiting and diarrhea.
1. What type of infection do you believe she has in this hand?
a. Streptococcus pyogenes
b. Staphylococcus aureus
c. Clostridium
d. Pseudomonas
e. Pasteurella multocida
2. From complaint and physical examination, which of the symptoms lead you
to your choice of agent?
a. the fever and pain in the hand
b. the fever, wound with oozing pus and enlarged lymph nodes
c. the lymph nodes and red streaks
d. the warm dry skin
e. the pain, red streaks and enlarged lymph nodes
3. From the history, which of the information confirmed your choice?
a. The wound had bled for a while.
b. The wound was cleaned with soap and water.
c. The wound had been covered and had perhaps become anaerobic.
d. She had diarrhea and vomiting.
e. The cut was from a rusting car frame.
4. Which of the following is most likely to follow this infection?
a. gangrene and amputation
b. toxic shock syndrome
c. muscle spasms
d. neurological dysfunction of the hand
e. arthritis
, Case 2
A 27-year-old white female presented at the walking clinic of her local physician on August
15. On physical exam, the patient had a fever of 38.5C. She appeared fatigued, had
tender joints, and complained of a headache, a stiff neck and a backache. The
physician noticed a circular "rash" about 5 inches in diameter, with a bright red leading
edge and a dim center in the form of a "bull’s eye". The physician noted an irregular
heartbeat. The patient complained of lack of ability to concentrate.
The patient gave the following history: She is a graduate student in the wildlife program at
the university in town. She was in the field for three weeks in Wisconsin during the
months of May and June. She tracks small mammals in the field and studies their
behavior. It had been a warm, wet spring and she complained of a large number of
biting flies, mosquitoes and ticks in the area. She felt well until about 2 weeks after
returning to her home. Since that time, many of her symptoms had progressed. She
finally found that she could take it no more.
1. What is your best diagnosis of this case?
2. What features are critical to your diagnosis?
3. What further steps should be taken to clear up the problem?
Part 2: Critical Thinking Questions
Part 3: Lecture Notes
,Part 1: Case Study with Answers
Case 1
A 24-year-old female automotive technician presents herself at the doctor’s office. She
complains of fever and of pain in her left hand.
On physical examination, the patient had a deep wound on her left palm that was
oozing pus. She had purplish, red streaks running up her left arm. She had enlarged
lymph nodes at the elbow and under her arm. The patient’s skin was warm and dry.
In her history, the patient had punctured her left palm with sharp metal from the
undercarriage of a "real cherry" 1977 Malibu about a week earlier. She said the wound
had bled for a few minutes and she thought that she had washed it "real good" with
soap and water. She had covered the wound with a large "band-aid" and gone back to
work. She developed a fever about three days later. For the past couple of days, she
"did not feel so good" and had vomiting and diarrhea.
1. What type of infection do you believe she has in this hand?
a. Streptococcus pyogenes
b. Staphylococcus aureus
c. Clostridium
d. Pseudomonas
e. Pasteurella multocida
2. From complaint and physical examination, which of the symptoms lead you
to your choice of agent?
a. the fever and pain in the hand
b. the fever, wound with oozing pus and enlarged lymph nodes
c. the lymph nodes and red streaks
d. the warm dry skin
e. the pain, red streaks and enlarged lymph nodes
3. From the history, which of the information confirmed your choice?
a. The wound had bled for a while.
b. The wound was cleaned with soap and water.
c. The wound had been covered and had perhaps become anaerobic.
d. She had diarrhea and vomiting.
e. The cut was from a rusting car frame.
4. Which of the following is most likely to follow this infection?
a. gangrene and amputation
b. toxic shock syndrome
c. muscle spasms
d. neurological dysfunction of the hand
e. arthritis
, Case 2
A 27-year-old white female presented at the walking clinic of her local physician on August
15. On physical exam, the patient had a fever of 38.5C. She appeared fatigued, had
tender joints, and complained of a headache, a stiff neck and a backache. The
physician noticed a circular "rash" about 5 inches in diameter, with a bright red leading
edge and a dim center in the form of a "bull’s eye". The physician noted an irregular
heartbeat. The patient complained of lack of ability to concentrate.
The patient gave the following history: She is a graduate student in the wildlife program at
the university in town. She was in the field for three weeks in Wisconsin during the
months of May and June. She tracks small mammals in the field and studies their
behavior. It had been a warm, wet spring and she complained of a large number of
biting flies, mosquitoes and ticks in the area. She felt well until about 2 weeks after
returning to her home. Since that time, many of her symptoms had progressed. She
finally found that she could take it no more.
1. What is your best diagnosis of this case?
2. What features are critical to your diagnosis?
3. What further steps should be taken to clear up the problem?
