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Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:52 pm

amc clinical exam

A 23 year old young man was brought in to a country small hospital by friends as he becomes disorientated while watching football match. He had convulsion too.
CT brain was done- NAD
LP result as follows
Pressure- Increased ( I don’t remember the numbers )
Cells- WBC very high ( Lymphocytes 90% )
Gram stain- Negative
Some other examination findings are give and I can’t remember at all now.

Task- Talk to the concerning parent regarding the patient and initial management.

Me- Is my patient stable now?
Examiner- Yes, no more convulsions. Talk to the parent.

Me- Hello Mrs X, I know you are very concerned for your son. It is true that he was brought in by friends cos he has confusion and he has had fits but he doesn’t have any more fits now. Let me explain the problem and some results from investigations.

Results say there is increased pressure in the brain and it is due to an infection of the brain substance with a virus with subsequent inflammation and swelling of the cells.

RP- Oh, it seems so serious doctor! Is he going to die?
Me- Yes, it is serious but he is stable at the moment and he is going to be transferred to the hospital where specialists are available after initial treatments here.

Me- Do you want me to explain what we are going to do here?
RP- Of course, I am very worried.

Me-First of all, I have given oxygen and inserted a cannula and drawn bloods for testing already.
We will do some measures to reduce his pressure in the brain such as giving glucose , medications like Steroid and Mannitol after discussing with Emergency Physician in the hospital I am going to refer.
And depending on the advice, we might give intravenous Acycloivir which is antiviral medication.
After that , he will be transferred with helicopter to the hospital . There will be doctor in the flight who is very specialized in managing such emergency situations. He will treat him in case he gets another fits with some Diazepam.

RP- What will they do when he reached the hospital?
Me- They are going to test bloods for infection, liver function, renal function , inflammatory markers, blood cultures and CXR.
By the way, do you mind if I ask you some private questions about your son?
RP- That’s alright doc.

Me- Are you aware that he uses any recreational drugs
RP- Not at all . He is such a clever boy .

Me- Is he on stable relationship ?
RP- Yes.

Me- Does he smoke? Does he drink alcohol ? Does he have any other significant medical issues in the past such as Epilepsy , head injury , meningitis ? Any family history of Epilepsy? Any recent travel to somewhere? Does he have any herpes infection before?
RP- No to all .

Me- That’s really good. So, to summarise, he will get better once the pressure in the brain gradually falls and he will remember you too.

Do you have any further questions ?
RP- How does he get this virus ?

Me- Umm, it is hard to say now. There are a lot of viruses that can cause such infection. Don’t worry he will be in the experienced hand and they will do all the investigations to find out what viruses cause this infection. We are going to send PCR of his fluid from the spine which is a specialized test to find the virus.

Bell Rang.
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