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Have fever, dry cough, muscular pain, anorexia, abdominal discomfort. Diagnosis?

hello,iam abubakr osman ,medical student ,from sudan can you help me to resove the following problem: A 22-year-old English woman living in Kenya complained of a constant frontal headache with fever which had been present for ten days. Treatment with chloroquine (600 mg base orally) had not produced any improvement. On enquiry she complained of anorexia , abdominal discomfort and constipation. She had a dry cough and muscular aches and pains. On physical examination she looked ill and had a rather sunken facies. Vital signs: temperature 40.5C; pulse rate 92/min; blood pressure 120/70 mmHg; respiratory rate 18/min. On auscultation, scattered rhonchi were heard throught both lung fields. On abdominal palpation there was generalized abdominal tenderness, but no rigidity or guarding. Bowel sounds were present. Her spleen was palpable at 2 cm below the left costal margin. Investigations: Haemoglobin 11.0 g dl-1; total leucocyte count 3.5 x 1091-1. Thick and thin blood films did not show malaria parasites. Chest radiograph , and urine microscopy and culture were all normal. Questions: Q1: What is the likely diagnosis? Q2: How would you confirm this diagnosis? Q3: What is the correct treatment? Q4: The patient initially made a favourable response to therapy. On the fourth day, however, her condition suddenly deteriorated; she was sweating and restless, pulse rate had increased to 120/min and blood pressure had fallen to 90/60 mmHg. What are the possible explanations and what would now be your management?
Asked On : Mon, 25 Mar 2013
Answers:  1 Views:  59
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Psychiatrist 's  Response
Jun 2013
Hi there ~

I am glad you have come up with the right questions. I do not think she has malaria, especially if the sampling was done at the right time. Although you may have to repeat a blood film, I think she has anorexia as her primary problem. You would have to confirm the diagnosis by doing a complete physical exam and asking her a good psychiatric history. You may also want to consult the DSM (Diagnostic and Statistical Manual) for psychiatric disorders and its latest version is IV-TR but the 5th version is about to be released. Treatment is by doing cognitive behavioral therapy although you may also treat her with a starting dose of Prozac (Fluoxetine) at 60 mg after the nightime meal and give her a sedative hypnotic like clonazepam for anxiety. The sudden fall in blood pressure may be attributable to poor hydration which is the most likely cause, however an electrolyte check may be in place as she may have started to purge after treatment as they start getting better. Regular (daily is ideal) check up is recommended.

I hope this helped. Take care and have a lovely day !
Answered: Wed, 27 Mar 2013
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