GENERAL

CASE NO. 3 (DEC 2013)

1. Most likely diagnosis :

Anaphylactic shock due to :

 History of no regular medication but just recently received intramuscular

Penicillin injection for presumed Streptococcal Pharyngitis.
 Developed facial edema & shortness of breath 20 minutes prior to the
injection, most probably anaphylactic reaction as a result of allergic towards
specific antigen which is Penicilllin in this case (hypersensitivity type 1).

 O/E - heart rate 130 bpm(tachycardia)

- blood pressure 90/47mm Hg (hypotension)
- edema on face and lips, swelling on eyes
- diffuse wheezing on chest
- multiple raised urticarial lesions on skin

2. Other clinical manifestations :

- bronchospasm and laryngeal edema
- itching
- sweating
- diarrhoea
- vomiting

3. Other causes that cause the reaction :

- atopic eczema
- allergic rhinitis
- asthma(extrinsic)
- food allergies
- urticaria and angioneuritic edema
4. Management :

 Diagnostic test : skin prick test leading to wheal within 5-10 minutes

 Treatment :
- Adrenaline 1/1000, 0.5-1ml IM and repeat after 10-20 minutes if shock
persists.
- Hydrocortisone IV100-300mg IV
- Antihistaminics
- Aminophyline IV with bronchospasm
- IV fluids if hypotension persists and O2 therapy or assisted ventilation if
Hypoxia is severe
CASE NO. 9 (JUN 2003)

1. Most likely diagnosis :

Infectious Mononucleosis (Glandular Fever) due to :

 History of malaise & anorexia for 1 week followed by fever & sore throat
due to generalized viremia
 O/E : - inflamed throat without exudates
- palatal petechae : petechae at junction of
hard and soft palate
- cervical lymph node enlargement : firm, discrete & slightly tender
- hepatosplenomegaly : there maybe mild jaundice
 Investigations :
a) –ve culture for Group A Streptococci
b) CBC : lymphocytosis
c) serum total bilirubin : increase (N = 0.2-1 mg/dl)
d) SGOT : increase (N = 0-35 U/L)
e) SGPT : increase (N = 0-35 U/L)
f) Serum ALP : normal (N = 30-150 U/L)
g) Hepatitis A, B, C are –ve

2. One differential diagnosis :

Cytomegalovirus (CMV) infection

3. 2 important investigations :
a) Paul Bunnel Test
b) Monospot Test (rapid sensitive)
c) ELISA for IgG & IgM antibodies
CASE NO. 27 (MAY 1986)

1. Additional signs with explanations :

- pin-pointed petechiae at junction of hard & soft palate.
- spleen moderately enlarged in 50%
- liver maybe enlarged with jaundice
- purpura & encephalitis as CMV infection is the differential diagnosis

2. Minimum number of test to reach definite diagnosis :

a) Paul Bunnel Test
b) Monospot Test

3. Prognosis :
Self-limiting disease with good prognosis except rupture spleen which is a
serious complication