Clinical details
Date ______Oct 3rd 2010___
Dear ____Dr. Scott___________________________________
I would be grateful for your opinion and advice with regard to
(Name) _____GREEN, Peter___________________________
URGENT Please indicate in the boxes □
A brief outline of history, symptoms and signs and present therapy is given below
Peter Green, a 7-year-old boy, had a severe pain in the chest and a high temperature.
During the physical examination there were abnormal bubbling, râles that signalled the presence of thick liquid. Chest X-ray examination confirmed the presence of pneumonia and determined the extent and location of the infection. Abscesses in the lung were thick-walled, pus-filled cavities. Abscesses caused hemorrhage in the lung, but antibiotics that targeted them could not have reduced the inflammation.
I refer him to you for further assessment.
Diagnosis: aspiration pneumonia?
Thank you for your seeing him.
Yours sincerely,
If transport required please state: Yes □ No □
Stretcher / sitting case □
Sitting case – two man lift □
Signature___Mary Chapman, resident___
Exercise 3.
Fill in the gaps in the text using the following words:
should in is and cases legs any remain on of the other be appears progressing majority number case weeks that dry back acute how contagious the
Chicken-pox is a very c__________(1) disease of children. The disease occurs in epidemics, especially in children under the age of ten years. Children o__________(2) the first four years of life are the most susceptible. There is an incubation period of 14-21 days, most frequently 17 days.
The first symptoms are the following: a slight fever and sometimes pains in the b__________(3) and l__________(4). Almost at the same time (within twenty four hours) a characteristic eruption a__________(5) o__________(6) different parts of the body. It is found very frequently on the scalp (the hairy part of t__________(7) head).
The eruption consists of red macules quickly p__________(8) to papules and vesicles. Soon they become crusted. The brownish crusts d__________(9) up and fall off in two - three w__________(10). The child remains infectious until the scabs scale.
The n__________(11) of vesicles i__________(12) very variable. In a slight c__________(13) there may only be eight or ten of the vesicles, but sometimes i__________(14) severe cases their number may amount to six or seven hundred.
In the vast m__________(15) of cases there is no difficulty in making a diagnosis, but a doctor must learn h__________(16) to differentiate it from other skin disorders especially from smallpox.
Chicken-pox is one of the mildest of a__________(17) infectious diseases of children. Children r__________(18) feverish for 2-3 days, while new vesicles still appear a__________(19) after t__________(20) feel well. The recovery is usually complete. Complications are rare. Encephalitis may occur in uncommonly severe c__________(21).
In the majority of cases no o__________(22) treatment beyond isolation is required. The child should be kept in bed during the eruptive stage and as long as there is a__________(23) fever. The lesions s__________(24) b__________(25) treated with a disinfective solution.
(12)
Exercise 1.
Guess the diagnosis and prove your choice:
PATIENT: How do you do, doctor.
DOCTOR: How do you do. Take your seat, please. What’s brought you along today? What do complain of?
PATIENT: I have a sore throat, bad headache, vomiting, occasional attacks of quite sharp pain in the area of neck lymphatic nodes and I feel very hot, doctor. Last night I was on the point of calling for urgent medical aid.
DOCTOR: Did you take your temperature?
PATIENT: This morning it was 38ºC.
DOCTOR: When did you feel the onset of the disease?
PATIENT: It was 3 days ago. I’ve been having trouble getting started and I seem to have to get up two or three times at night to try to comfort myself. I wake up at night and I’m drenched in sweat. Paracetamol gives some relief but doesn’t solve the problem completely.
DOCTOR: I see you are quite ill. I understand you’re in some pain. Why didn’t you apply for medical help as soon as your malaise began?
PATIENT: I thought it was a common cold and I took some tablets of aspirin. But this morning I felt some difficulty in swallowing. It’s a sort of dull and throbbing kind of pain. It is so bad I couldn’t breathe. I became anxious and went to the polyclinic. Well, what do you think, doc?
DOCTOR: I must examine you. At first, I’ll do a physical examination according to the present problem. Well, open your mouth. Stick out your tongue, please. Your throat is red and inflamed… Now let me check your neck… Enlarged lymphatic nodes… Let me feel your pulse… accelerated pulse rate…
PATIENT: Is it dangerous?
DOCTOR: All the vital signs: temperature elevation, pulse rate, respiration picture, character and time of vomiting, enlarged lymphatic nodes, inflamed throat make me suppose it’s some infectious eruptive disease.
PATIENT: Oh, doctor, but I have not got any eruptions.
DOCTOR: You see, adults may have only sore throat without the rash characteristic of this infection...That’s quite normal for the course of this disease. We must have some laboratory tests done to prove this fact and then we’ll decide how to treat you.
PATIENT: Oh, thank you, doctor. I hope I’ll recover soon.
DOCTOR: Sure, if you follow my prescriptions.
Exercise 2.
Study the letter from a GP to a consultant. Write down the questions, which a doctor might have asked to obtain the information marked in the letter:
The hospital consultant made these notes of her interview with Mr. Green. Fill in as many of the gaps as you can with the help of the previous letter:
Exercise 3.
Fill in the gaps:
Whooping cough is a common acute infection of childhood, highly contagious. It is (1)__________ by the Bordutellia Pertussis. The illness is characterized by a catarrhal period of nonspecific respiratory symptoms progressing to the stage of (2)__________ cough, accompanied by the typical inspiratory whoop and vomiting. It may be complicated by potentially serious (3)__________ of the respiratory tract and the central nervous system.
Epedimiologic Factors. The disease may (4)__________ at any time of the year. Although no age is exempt from pertussis, most people have the disease in early life. (5)__________ is likely to occur by direct contact with an infected person (coughing, sneezing, talking). The disease is communicable from its very first days to four weeks after onset of typical paroxysms.
Clinical Manifestaions. The (6)__________ period is about 7 days, seldom shorter — from 2 to 4 days, or longer — up to 21 days.
The clinical (7)__________ of whooping cough is divided into 3 stages — catarrhal, paroxysmal and convalescent. The catarrhal stage lasts for about 1 or 2 weeks. It begins with the symptoms of an upper respiratory infection or common cold. The child may appear (8)__________ and irritable. Sometimes the only (9)__________ is a dry hacking cough. After about a week the cough, instead of (10)__________, gradually becomes more severe and it begins to occur in paroxysms. The paroxysmal stage lasts, as a rule, 4 to 6 weeks. The cough now comes in explosive bursts. A series of 5 to 10 short, rapid coughs are given on one expiration, followed by a sudden inspiration, associated with a characteristic sound or (11)__________. During the attack the child's face becomes red or cyanotic, the eyes bulge, the tongue protrudes. Vomiting frequently follows the attack. In severe cases young unimmunized infants may stop breathing during an attack (apnea).The attacks occur more (12)__________ at night and in a stuffy room than in one well aired or out of doors.
The convalescent stage is marked by (13)__________ of whooping and vomiting. Little by little the number and severity of paroxysms decrease.
Diagnosis. The clinical diagnosis is made by the paroxysmal nature of the cough, the red or cyanotic (14)__________ of the child during an attack and the associated vomiting. During the catarrhal stage it is usually impossible to (15)__________ pertussis on clinical grounds from the common cold, bronchitis or acute respiratory disease. At this time Bordutellia Pertussis can be isolated from the nasopharynx. The white blood test may also help the diagnosis. High white blood counts with a (16)__________ of lymphocytes are characteristic of whooping cough.
Treatment. There is no (17)__________ drug to stop the attacks. Modern cough suppressing remedies may be administered in severe cases.
Whooping cough can be effectively treated with (18)__________. The sooner one of the antibiotics is used, the better the results. The course of antibiotics treatment averages 8-12 days. Rest in bed is (19)__________ as long as fever is present. The room should be well (20)__________. It is important to maintain proper nutrition. The diet must be adequate, rich in (21)__________, especially vitamin C. The patient should be separated from other people.
Complications. The commonest and usually the most severe (22)__________ is pneumonia. Stop of breathing during an (23)__________ is very dangerous in young children. Otitis media, atelectasis may often occur.