CASE STUDIES QUESTIONS AND
ANSWERS
Influenzazx
Influenzazxiszxazxcommunicablezxdiseasezxwhichzxiszxcausedzxbyzxinfluenzazxvirus.
Thiszxwillzxaffectszxthezxnosezx,zxpharynxzxandzxlungs.zxPatientszxmayzxsufferzxfromzxrunnyzx
nose,zxcoughzx,zxfever,zxmusclezxpain,zxfatigue,cheatzxconvention,zxchestzxpain,zxheadach
ezxetc.zx-zxanswer--ChiefzxComplaint
"IzxfeelzxlikezxIzxgotzxhitzxbyzxazxtruck.zxMyzxbodyzxacheszxintensely,zxI'mzxweak,zxIzxhavezxazxf
ever,zxI'mzxlyingzxunderzx3zxblanketszxandzxcan'tzxgetzxwarm,zxandzxIzxcan'tzxstopzxshivering.
"
HistoryzxofzxPresentzxIllness
AWzxiszxazx34-year-oldzxfemalezxpresentingzxtozxthezxemergencyzxdepartmentzxwithzxazx2-
dayzxhistoryzxofzxmyalgia,zxchills,zxandzxfeverzxtozx102°Fzxforzxwhichzxshezxhaszxbeenzxusing
zxover-the-
counterzxacetaminophen.zxShezxreportszxazxrapidzxonsetzxofzxsymptoms,zxincludingzxnasal
zxcongestionzxandzxcoughzxassociatedzxwithzxchestzxpain.zxShezxdenieszxazxsorezxthroat,zxb
utzxcomplainszxofzxnauseazxandzxvomitingzxthatzxbeganzxazxfewzxweekszxagozxandzxhaszxwo
rsenedzxacutely.zxShezxreportszx3zxepisodeszxofzxemesiszxthiszxmorningzxpriorzxtozxcomingz
xtozxthezxemergencyzxdepartment.zxShezxstateszxshezxhaszxneverzxreceivedzxthezxinfluenz
azxvaccine,zxbutzxallzxofzxherzxfamilyzxmemberszxarezxvaccinatedzxannually.
PastzxMedicalzxHistory
Asthma,zxHTN,zxHLD,zxhypothyroidism
SurgicalzxHistory
Appendectomyzx6zxyearszxago
FamilyzxHistory
FatherzxhaszxazxhistoryzxofzxMI;zxmotherzxhaszxHTN;zxsisterzxhaszxazxhistoryzxofzxbreastzxcan
cer.
Tineazxpedis/zxAthlete'szxFootzx/zxRingwormzx
-zxrednesszxandzxextremezxitchingzxbetweenzxtoeszx
-zxWellzxdemarcatedzxraisedzxborderzxandzxareazxofzxcentralzxclearingzx-zxanswer--
ChiefzxComplaint
"Izxhavezxanzxitchyzxrashzxonzxmyzxstomachzxandzxfeetzxthatzxwon'tzxgozxaway."
HistoryzxofzxPresentzxIllness
RPzxiszxazx16-year-
oldzxmalezxwhozxpresentszxtozxhiszxprimaryzxcarezxprovider'szxcliniczxatzxhiszxmother'szxinsis
, tencezxbecausezxofzxazxpersistentzxpruriticzxrashzxonzxhiszxtrunkzxandzxfeet.zxHezxiszxazxhighzx
schoolzxsophomorezxandzxazxmemberzxofzxthezxwrestlingzxteam.zxHezxreportszxhavingzxtwo
zxareaszxonzxhiszxtrunkzxthatzxarezxcircular,zxred,zxandzxitchy.zxHezxsayszxtheyzxhavezxincreas
edzxinzxsizezxsincezxhezxfirstzxnoticedzxthemzxaboutzx3zxweekszxago.zxHezxsayszxhiszxfeetzxha
vezxalwayszxsmelledzxbad,zxbutzxhezxfirstzxstartedzxtozxnoticezxrednesszxandzx"extremezxitch
ing"zxbetweenzxhiszxtoeszxonzxbothzxfeetzxaboutzx2zxweekszxago.zxHezxhaszxusedzxover-the-
counterzxhydrocortisonezxcreamzxonzxthezxrashzxonzxhiszxtrunkzxwithoutzximprovement.zxH
ezxalsozxstartedzxapplyingzxdeodorizingzxsprayzxtozxhiszxfeetzxazxweekzxagozxwithoutzximpro
vement.
PastzxMedicalzxHistory
Seasonalzxallergies;zxasthmazxaszxazxyoungzxchildzx(asymptomaticzxforzx10zxyears)
community-acquiredzxpneumoniazx-zxanswer--ChiefzxComplaint
"Izxhavezxbeenzxcoughing,zxhavezxchestzxpain,zxandzxcannotzxbreathezxforzxaboutzx2zxdayszx
now."
HistoryzxofzxPresentzxIllness
WAzxiszxazx40-year-
oldzxCaucasianzxmalezxwhozxpresentszxtozxthezxemergencyzxdepartmentzxwithzxazxfever,zxc
ough,zxchestzxpainzx(worseningzxwhenzxbreathingzxorzxcoughing),zxandzxshortnesszxofzxbre
ath.zxNormally,zxhezxhaszxazxfairlyzxactivezxlifestylezxaszxhezxtrainszxforzxmarathons.zxHezxha
szxnotzxtraveledzxoutsidezxthezxUnitedzxStateszxrecently.zxHezxstateszxhezxhaszx"beenzxtakin
gzxcoughzxmedicinezxatzxnight"zxforzxthezxpastzx4zxdayszxtozxhelpzxhimzxsleep,zxbutzxitzxhaszxn
otzxbeenzxgettingzxbetter.zxAlso,zxhezxreportszxthatzxhezxhaszxbeenzxwakingzxupzxatzxnightzxd
uezxtozxheavyzxsweating.zxHezxstateszxallzxhiszxsymptomszxhavezxgottenzxworsezxinzxthezxla
stzx2zxdays.zxAfterzxbeingzxassessedzxinzxthezxED,zxWAzxiszxadmittedzxtozxthezxmedicinezxuni
tzxforzxfurtherzxworkup.
PastzxMedicalzxHistory
Diabetes:zxTypezx1
cystitiszx
causedzxbyzxE.zxcolizx
-zxpainfulzxandzxfrequentzxurination
-zxdysuriazx(discomfortzxwhenzxpeeing)zx
-zxpolyuria:zxabonrmallyzxlargezxamountszxofzxurinezxpassedzxthroughzx-zxanswer--
ChiefzxComplaint
"Izxhavezxpainfulzxandzxfrequentzxurination."
HistoryzxofzxPresentzxIllness
VZzxiszxazx19-year-oldzxHispaniczxfemalezxwhozxpresentszxtozxthezxurgentzxcarezxwalk-
inzxcliniczxwithzxdysuriazxandzxpolyuriazxforzx3zxdayszxduration.
PastzxMedicalzxHistory
Seasonalzxallergies
SurgicalzxHistory
None
ANSWERS
Influenzazx
Influenzazxiszxazxcommunicablezxdiseasezxwhichzxiszxcausedzxbyzxinfluenzazxvirus.
Thiszxwillzxaffectszxthezxnosezx,zxpharynxzxandzxlungs.zxPatientszxmayzxsufferzxfromzxrunnyzx
nose,zxcoughzx,zxfever,zxmusclezxpain,zxfatigue,cheatzxconvention,zxchestzxpain,zxheadach
ezxetc.zx-zxanswer--ChiefzxComplaint
"IzxfeelzxlikezxIzxgotzxhitzxbyzxazxtruck.zxMyzxbodyzxacheszxintensely,zxI'mzxweak,zxIzxhavezxazxf
ever,zxI'mzxlyingzxunderzx3zxblanketszxandzxcan'tzxgetzxwarm,zxandzxIzxcan'tzxstopzxshivering.
"
HistoryzxofzxPresentzxIllness
AWzxiszxazx34-year-oldzxfemalezxpresentingzxtozxthezxemergencyzxdepartmentzxwithzxazx2-
dayzxhistoryzxofzxmyalgia,zxchills,zxandzxfeverzxtozx102°Fzxforzxwhichzxshezxhaszxbeenzxusing
zxover-the-
counterzxacetaminophen.zxShezxreportszxazxrapidzxonsetzxofzxsymptoms,zxincludingzxnasal
zxcongestionzxandzxcoughzxassociatedzxwithzxchestzxpain.zxShezxdenieszxazxsorezxthroat,zxb
utzxcomplainszxofzxnauseazxandzxvomitingzxthatzxbeganzxazxfewzxweekszxagozxandzxhaszxwo
rsenedzxacutely.zxShezxreportszx3zxepisodeszxofzxemesiszxthiszxmorningzxpriorzxtozxcomingz
xtozxthezxemergencyzxdepartment.zxShezxstateszxshezxhaszxneverzxreceivedzxthezxinfluenz
azxvaccine,zxbutzxallzxofzxherzxfamilyzxmemberszxarezxvaccinatedzxannually.
PastzxMedicalzxHistory
Asthma,zxHTN,zxHLD,zxhypothyroidism
SurgicalzxHistory
Appendectomyzx6zxyearszxago
FamilyzxHistory
FatherzxhaszxazxhistoryzxofzxMI;zxmotherzxhaszxHTN;zxsisterzxhaszxazxhistoryzxofzxbreastzxcan
cer.
Tineazxpedis/zxAthlete'szxFootzx/zxRingwormzx
-zxrednesszxandzxextremezxitchingzxbetweenzxtoeszx
-zxWellzxdemarcatedzxraisedzxborderzxandzxareazxofzxcentralzxclearingzx-zxanswer--
ChiefzxComplaint
"Izxhavezxanzxitchyzxrashzxonzxmyzxstomachzxandzxfeetzxthatzxwon'tzxgozxaway."
HistoryzxofzxPresentzxIllness
RPzxiszxazx16-year-
oldzxmalezxwhozxpresentszxtozxhiszxprimaryzxcarezxprovider'szxcliniczxatzxhiszxmother'szxinsis
, tencezxbecausezxofzxazxpersistentzxpruriticzxrashzxonzxhiszxtrunkzxandzxfeet.zxHezxiszxazxhighzx
schoolzxsophomorezxandzxazxmemberzxofzxthezxwrestlingzxteam.zxHezxreportszxhavingzxtwo
zxareaszxonzxhiszxtrunkzxthatzxarezxcircular,zxred,zxandzxitchy.zxHezxsayszxtheyzxhavezxincreas
edzxinzxsizezxsincezxhezxfirstzxnoticedzxthemzxaboutzx3zxweekszxago.zxHezxsayszxhiszxfeetzxha
vezxalwayszxsmelledzxbad,zxbutzxhezxfirstzxstartedzxtozxnoticezxrednesszxandzx"extremezxitch
ing"zxbetweenzxhiszxtoeszxonzxbothzxfeetzxaboutzx2zxweekszxago.zxHezxhaszxusedzxover-the-
counterzxhydrocortisonezxcreamzxonzxthezxrashzxonzxhiszxtrunkzxwithoutzximprovement.zxH
ezxalsozxstartedzxapplyingzxdeodorizingzxsprayzxtozxhiszxfeetzxazxweekzxagozxwithoutzximpro
vement.
PastzxMedicalzxHistory
Seasonalzxallergies;zxasthmazxaszxazxyoungzxchildzx(asymptomaticzxforzx10zxyears)
community-acquiredzxpneumoniazx-zxanswer--ChiefzxComplaint
"Izxhavezxbeenzxcoughing,zxhavezxchestzxpain,zxandzxcannotzxbreathezxforzxaboutzx2zxdayszx
now."
HistoryzxofzxPresentzxIllness
WAzxiszxazx40-year-
oldzxCaucasianzxmalezxwhozxpresentszxtozxthezxemergencyzxdepartmentzxwithzxazxfever,zxc
ough,zxchestzxpainzx(worseningzxwhenzxbreathingzxorzxcoughing),zxandzxshortnesszxofzxbre
ath.zxNormally,zxhezxhaszxazxfairlyzxactivezxlifestylezxaszxhezxtrainszxforzxmarathons.zxHezxha
szxnotzxtraveledzxoutsidezxthezxUnitedzxStateszxrecently.zxHezxstateszxhezxhaszx"beenzxtakin
gzxcoughzxmedicinezxatzxnight"zxforzxthezxpastzx4zxdayszxtozxhelpzxhimzxsleep,zxbutzxitzxhaszxn
otzxbeenzxgettingzxbetter.zxAlso,zxhezxreportszxthatzxhezxhaszxbeenzxwakingzxupzxatzxnightzxd
uezxtozxheavyzxsweating.zxHezxstateszxallzxhiszxsymptomszxhavezxgottenzxworsezxinzxthezxla
stzx2zxdays.zxAfterzxbeingzxassessedzxinzxthezxED,zxWAzxiszxadmittedzxtozxthezxmedicinezxuni
tzxforzxfurtherzxworkup.
PastzxMedicalzxHistory
Diabetes:zxTypezx1
cystitiszx
causedzxbyzxE.zxcolizx
-zxpainfulzxandzxfrequentzxurination
-zxdysuriazx(discomfortzxwhenzxpeeing)zx
-zxpolyuria:zxabonrmallyzxlargezxamountszxofzxurinezxpassedzxthroughzx-zxanswer--
ChiefzxComplaint
"Izxhavezxpainfulzxandzxfrequentzxurination."
HistoryzxofzxPresentzxIllness
VZzxiszxazx19-year-oldzxHispaniczxfemalezxwhozxpresentszxtozxthezxurgentzxcarezxwalk-
inzxcliniczxwithzxdysuriazxandzxpolyuriazxforzx3zxdayszxduration.
PastzxMedicalzxHistory
Seasonalzxallergies
SurgicalzxHistory
None
