diarrhoea with bloody mucous

A couple of ages 23 and 22 arrive at your clinics this morning reporting severe abdominal cramps, gross bloody diarrhea with mucous, nausea and fever for 48 hours. On further questioning, they said that they recently come back from their village and drinking raw water from the well.

1)What is the most likely bacteria that can cause above symptoms

2)What is the possible route of infection

3)What investigation that you would like to perform?

4)Outline the pathogenesis of above symptoms.

5)Outline the treatment




Anwer


1)What is the most likely bacteria that can cause above symptoms

a)Bacillary dysentry
-Shigella species (S. dysenteriae, S. flexneri, S. boydii, S. Sonnei)
-Campylobacter jejuni
-Enteroinvasive E.Coli
-Yersinia enterocolitica

b)Amoebic dysentry
-Entamoeba hystolytica

Dysentry

- frequent passage of stools containing blood& mucous accompanied with painful straining and defecation

2)What is the possible route of infection
-Faecal-oral route (crowded population, poor quality water supply, inadequate sewage disposal)


3)What investigation that you would like to perform?
-Stool microscopy
-Stool culture (Mac Conkey, DCA agar- colorless)
-Serological test (serotyping with O Ag)
-Gram stain (shigella and campylobacter is both gram negative rod)
-Stool culture on Campy agar (to exclude campylobacter)

4) Click on the image for the larger view




5)Outline the treatment
-Fluid and electrolytes replacement
- Antimicrobial (ampicillin/amoxacillin, Ciprofloxacin, Co trimoxazole, Cephalosporin)

mood disorder that gradually relieve on evening

A 40 Years old woman who has lost interest in her work and social life and lack of energy, motivation and appetite for two weeks of duration comes to your clinic. She tells you that although she feels hopeless and helpless most of the time, she seems to feel a bit better in the evening than in the morning [taken and modified from Page 65, Pathology Recall, Anikar Chhabra MD, Lorne H. Blackbourne MD, Lippincott Williams&Wilkins, 2002]

1)What other question you would like to ask this patient and give your judgement
2)Give three biological symptoms that usually present in depress patient
3)Outline the pharmacological treatment for depression.

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change of mood in 20 years old female students

A 20 years old female college student which previously quiet presented with history of being excessive talkative and active for two weeks of duration. She always gives mini lectures to her friends and become extrovert. Currently she enjoys shopping and spent RM250 for unnecessary item. She starts to wear bright clothes. During your interview, she said that she may become a lecturer as she is very cleaver. She mention that she sleeps for 1-2 hours per night but still very active at days for busying making plans on how to improve the ministry of education. During the interview, she mentioned that she was left by her boyfriend two years ago after giving her virginity and admits that she was depressed with this condition and cries a lot. Sometimes she thought about taking her own life

1)List four differential diagnosis
2)Give four further questions you would like to ask
3)Elicit the current symptoms of this patient
4)Outline the drugs treatment for this patient

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Anxiety in 21 years old boy

DZ is a 21 years old student of USM who has been troubled by feeling of nervousness, excessive worries, heart beating fast, sweating and trembling of hands. This problem has affecting his studies and personal relationship. He could not identify what causes this problem and as far as he concerns, he did not have this symptoms while he was in school. He finally come to your office after can not cope with this problems.

1)State the questions you would ask DZ to come to a provisional and differential diagnosis.

2)What lab investigation you would order to rule out the medical diagnosis and justify the reason for the test

3)What is your psychological and medical differential diagnosis

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