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Diagnostic Challenge at Ben Taub Hospital From: Geffrey Klein, MD (gklein@bcm.tmc.edu) Sat Oct 28 12:56:29 1995 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joshua Copel: "Diagnostic Challenge at Ben" Previous message: MNudel@aol.com: "Re: tocolysis vrs irritable uterus" Next in thread: Charlie Chambers: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Charlie Chambers: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Dr. Carlos Chase: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Arthurfree@aol.com: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Patrick S. Pevoto: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: David Nagey: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: DoctorJoe@aol.com: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Charlie Chambers: "Re: Diagnostic Challenge at Ben Taub Hospital" I would like to enlist the readership's assistance for this diagnostic dilemma. I admitted this patient last night and would like suggestions: -- _______ This patient is a 28 y/o G4P3 mexican female at 13 6/7 wks who's chief complaint is recurrent fevers for 2 weeks. She complains of chills and night sweats, fatigue, anorexia, and dark urine during this time. She presented to clinic with a fever of 102.9. She denies any other symptoms.. No headache, neck pain, sinus pain, earache, sore throat, lymphadenopathy, photophobia, chest pain, shortness of breath, cough, abdominal pain, nausea, vomiting, diarrhea, rectal pain, constipation, skin lesions, or muscle aches... There are no sick contacts. Her past medical and surgical history are unreamarkable She is on no medication and has no known drug allergies Her social history is remarkable for recent immigration from central Mexico. She lived on a farm, but denies exposure to farm animals or birds. She is married and does not work outside the home. Obstetrical history is remarkable only for 3 spontaneous vaginal deliveries at term without complication. Physical examination notes a non-toxic appearing well developed and well nourished appearing female. VS 96/60 pulse 120 Temp 102.9 RR 20 99% sat on RA Only pertinent postives on exam are mild tenderness to palpation of the liver and a grade 1-2/6 systolic flow murmur at the aortic site. Pertinent negatives incluse the lack of scleral icterus, normal oropharynx, no cervical lymphadenopathy, clear lungs, soft abdomen with normoactive bowel sounds, no CVAT, normal pelvic exam with a 12-14 wk uterus which is non-tender, and the absolute lack of any skin lesion. Lab Data: Heme: H/H: 10/33 (on 10/3) which decreased to 8/24 (on 10/27) MCV 85 WBC ct 4.6 with diff 59 segs, 37 lymphs, and 0 eos PT/PTT 12/32 (nl) UA only sig for 2+ protein Chemistries: Creatinine 0.6 K 3.7 Alb2.7 ALT/ST elevated 123/122 LDH 458 Amylase 241 Serologies: HBsAg(-) HBsAb(-) anti-HBc(-) anti-HAV IgM(-) anti-HCV(-) HIV(-) RPR 1:2 MHATP NR Rubella Immune Blood type O positive. Genital cultures negative for GC and Chl Pending labs: ANA, CMV IgG and IgM, 24 hour urine for protein, PPD, Cultures of blood, urine, feces, and oral cavity for bacteria and viruses, smear for malaria, and brucellosis titers. Chest xray was negative except for mild thoracic scoliosis. RUQ U/S pending She spiked to 104 last night, but does not feel unwell... Thanks for any help you can give.. (maybe if the answer is a good zebra, Dr. Nagey will let me present it at stump the professor......) Geff Klein, MD Baylor College of Medicine, Dept OB-GYN 1 Baylor Plaza Houston, Texas 77030 Tel # 713 798 7500 e-mail: gklein@bcm.tmc.edu http://www.bcm.tmc.edu/obgyn/obgyn-ce/geff.html listowner: OB-GYN-L Next message: Joshua Copel: "Diagnostic Challenge at Ben" Previous message: MNudel@aol.com: "Re: tocolysis vrs irritable uterus" Next in thread: Charlie Chambers: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Charlie Chambers: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Dr. Carlos Chase: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Arthurfree@aol.com: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Patrick S. Pevoto: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: David Nagey: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: DoctorJoe@aol.com: "Re: Diagnostic Challenge at Ben Taub Hospital" Maybe reply: Charlie Chambers: "Re: Diagnostic Challenge at Ben Taub Hospital"

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