Clinical Case: Differential Diagnosis (Gap-Fill Exercise)

 

Fill in all the gaps, then press "Check" to check your answers.

  • Medical Setting:Hospital; A 29 year-old woman with acute myelocytic leukemia is in hospital seven days after induction chemotherapy. An indwelling central catheter has been in place for one-week. There is significant mucositis

  • Chief Complaint/History:

    • Fever (40 degrees) with cough

    • Abdominal pain

    • Loose stools

  • Physical Exam:

    • Patient appears quite ill, with significant alopecia

    • Temperature: 40

    • BP: 90/40 mm Hg

    • Pulse: 120

    • Pharynx-significant, painful mucosal ulcerations

    • Lungs-clear

    • Chest-clear

    • Catheter site-no fluctuance (fluid/air under the skin)

    • Abdomen-soft, non-tender

  • Laboratory values:

    • Chest x-ray-normal

    • Urine-esterases -

    • Blood and urine culture is sent

    • white blood cell count: 200/ml

       

The differential diagnosis is and fever-the source could be from the lungs, gastrointestinal tract,genitourinary tract, skin, catheter, etc.