Part 1
Case 1
A 5-year-old girl has had a cough and runny nose (yellowish discharge) for the past 3 days. Her mother brought her for an evaluation as her left eye became pink and the right eye is also starting to get pink. Her daughter keeps rubbing them. The mother says there was a little discharge that was like mucus, but she wiped it away before coming to get checked. The physical examination reveals an active, alert girl. Her ears and lungs are within normal limits (WNL). Yellowish discharge is noted from the nose, and her oropharynx is mildly erythematous; however, there is no tonsillar enlargement or exudate. Her eyes have conjunctival erythema and mild edema—the left eye greater than the right eye. Mild crusting at the lid but no discharge is noted.
Provide responses to the items below.
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- Most likely cause including pathogen –
- Mode of transmission –
- Discuss data that supports your decision –
- Treatment strategies –
Case 2
A 40-year-old woman is complaining of itching, redness, and watery discharge in both her eyes. She feels like she has sand in her eyes. She also starting sneezing and has a clear nasal discharge. She thinks the symptoms started after petting a cat 2 days before at a friend’s house. She stated this reaction never happened before around animals, but she does get hay fever a few times a year. She has a past medical history of eczema. The physical examination reveals alert woman in no acute distress. Her ears, nose, throat, and lungs are WNL. There is evidence of bilateral stringy “ropelike” discharge and conjunctival erythema.
Provide responses to the items below.
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- Most likely cause including pathogen –
- Mode of transmission –
- Discuss data that supports your decision –
- Treatment strategies –
Case 3
An 18-month-old boy has a runny nose (yellowish discharge) and has been rubbing his left ear for 3 days. His parents kept him home from day care and brought him in for an evaluation as both his eyes became pink and were full of crust and yellowish discharge this morning. He has been fussy, not eating well, and had a temperature of 100°F. The physical examination reveals a fussy, alert boy. His throat and lungs are WNL. There is evidence of yellowish discharge from the nose, and his left ear canal is clear, but the tympanic membrane is bulging and red, and fluid is noted behind the tympanic membrane. His eyes have a yellowish discharge and conjunctival erythema bilaterally.
Provide responses to the items below.
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- Most likely cause including pathogen –
- Mode of transmission –
- Discuss data that supports your decision –
- Treatment strategies –
Part 2
Review the various hearing disorder cases and determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss. Once you identify the type of hearing loss, explain the part of the ear that is affected and describe the disorder.
Case 1
A 45-year-old woman noticed that she feels like her left ear is full and she cannot hear as well from her left ear as from her right. She states these symptoms started after she was cleaning the inside of her ears with a cotton-tip applicator. Physical exam reveals a right ear that is WNL. Her left ear canal has dark cerumen occluding her ear canal.
Provide responses to the items below.
- Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss.
- Explain the part of the ear that is affected and describe the disorder.
Case 2
A 15-year-old is complaining of right ear pain and a feeling of fluid in his right ear for the past 3 days. He feels likes it is getting worse. He says his hearing is slightly decreased in the right ear in comparison to the left. He stated these symptoms started after he came back from a camping trip where he went swimming in a lake several times. Physical exam reveals a left ear that is WNL. His right ear is painful when the auricle is tugged. The ear canal is edematous and erythematous. Whitish exudate is present in the right ear, and due to the amount of exudate, the tympanic membrane was only partially visible. The portion seen was intact and nonerythematous.
Provide responses to the items below.
- Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss.
- Explain the part of the ear that is affected and describe the disorder.
Case 3
An 80-year-old man states that he has been gradually having a harder time understanding what people are saying when he is with several people (e.g., like a party). He also states that he has a harder time understanding his grandchildren, and some words he hears well and other he does not. He states his hearing loss is equal in both ears. Physical exam is noncontributory and WNL.
Provide responses to the items below.
- Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss.
- Explain the part of the ear that is affected and describe the disorder.
- Part 3 scenarios
Abnormal uterine bleeding is a common gynecologic complaint. Review the following scenarios and determine a likely cause and describe the mechanism that leads to the abnormal bleeding pattern.
Scenario 1: A 13-year-old girl is having episodes of amenorrhea and infrequent menses. Her menarche was at the age of 12, she denies being sexually active, and a urine pregnancy test is negative.
Scenario 2: A 60-year-old woman who has been in menopause for 5 years is having episodes of menstrual bleeding for the past 2 months. She said sometimes it is just spotting but at times she has worn a small sanitary pad. She is overweight and says despite her efforts she struggles to lose weight.
Scenario 3: A 21-year-old woman is having episodes of amenorrhea and infrequent menses. Her menarche was at the age of 14 and her menses have sometimes been regular. She is overweight and says despite her efforts to lose weight, she does not do so. She is generally very healthy otherwise and the only medication she is taking is doxycycline for acne, which she feels is getting worse. She said her mother’s menstrual pattern was the same and that her mother told her she had trouble getting pregnant (the patient is an only child). She is sexually active, her partner uses condoms consistently, and her urine pregnancy is negative.
Part 4
Epididymitis and testicular torsion are both causes of scrotal pain. Testicular torsion requires prompt recognition and surgical intervention to avoid testicular damage. Epididymitis is easily managed with antibiotics. Differentiation between the two disorders is important. Review the case and answer the questions.
Case
A 15-year-old presents to the emergency department complaining of sudden onset of right-sided scrotal and groin pain. He states the pain is constant and extreme. He said it started about 2 hours ago during basketball practice at school, but he denies any trauma to the scrotum. He is worried that he has a sexually transmitted infection as he just started having sexual intercourse with his girlfriend and he did not use condoms. He says he feels nauseated and thinks he is going to vomit. He said he noticed this same pain once before, but it went away within a few seconds and he did not tell anyone.
Physical examination reveals a healthy-appearing adolescent who is anxious and grimacing. The patient has edema and erythema of his right scrotum. His scrotum is tender, and the patient only tolerated superficial palpation. Vital signs: temperature 98.9°F; pulse 100 beats per minute; respirations 20 per minute; blood pressure 120/70 mmHg.
Answer the following questions or provide responses based on this case.
1. The most likely diagnosis based on his history is:
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- Epididymitis
- Testicular torsion
2. Erythema and edema of the scrotum are only present with epididymitis. True or False
3. Which clinical manifestations are consistent with epididymitis, and which are consistent with testicular torsion?
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- Positive Prehn sign
- Negative cremasteric reflex
- Testis elevated on affected side
- Fever
4. Which diagnostic test is most appropriate to confirm the suspected diagnosis?
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- A complete blood count with differential
- An MRI of the scrotum
- A Doppler ultrasound of the scrotum
- A urine culture and sensitivity
5. Discuss the treatment plans for testicular torsion and epididymitis.
Part 5
Most women at some point in their life will get a vaginal infection. Vaginal infection can be characterized by complaints of vaginal discharge. Three common causes of vaginal discharge are bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. Review the following case and answer the questions.
Case
A 40-year-old woman comes in complaining of an increased thin whitish vaginal discharge that started about 5 days ago. She said it is so much that she needs to wear a small sanitary pad. She also noted that she had a funny odor after having sexual intercourse, and she says the odor continues despite her attempts to control it with douching. Physical examination reveals a thin white discharge around the vaginal wall with no erythema. Examination of the discharge includes a positive KOH whiff test and a vaginal pH > 4.5. Vaginal microscopy reveals clue cells.
Answer the following questions or provide responses based on this case.
1. What is a likely cause of the vaginal discharge?
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- Trichomoniasis
- Bacterial vaginosis
- Vulvovaginal candidiasis
2. Which of the clinical manifestations confirms the diagnosis?
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- The thin white discharge
- Malodorous discharge
- Presence of clue cells on a saline wet mount slide
3. The cause of this vaginal discharge disorder is due to:
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- An alteration in the vaginal flora
- Overgrowth of yeast due to antibiotic use
- A sexually transmitted organism, T. pallidum
4. This item is optional. Which is the primary treatment of this vaginal discharge disorder?
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- Fluconazole
- Metronidazole
- Clindamycin
5. Describe the mode of transmission, common organism, clinical manifestations, and treatment of the other two diagnoses not chosen in question 1.
6-Professional Reflection ( 4-5 sentences )
