Questions: A 36-year-old person enters the hospital in an extremely debilitated condition. They appear to have purple-brown skin lesions apparent on their neck and chest and a persistent cough with a 39°C temperature. A physical examination reveals swollen lymph nodes in all areas of their body, and laboratory tests find a very high Basophil and T-lymphocyte WBC counts. Information taken during the personal history reveals the spouse and child are also not feeling well. A) What test(s) might you immediately order next? B) What other step(s) might you do while waiting for the results to come back?

A 36-year-old person enters the hospital in an extremely debilitated condition. They appear to have purple-brown skin lesions apparent on their neck and chest and a persistent cough with a 39°C temperature. A physical examination reveals swollen lymph nodes in all areas of their body, and laboratory tests find a very high Basophil and T-lymphocyte WBC counts. Information taken during the personal history reveals the spouse and child are also not feeling well. A) What test(s) might you immediately order next? B) What other step(s) might you do while waiting for the results to come back?
Transcript text: A 36-year-old person enters the hospital in an extremely debilitated condition. They appear to have purple-brown skin lesions apparent on their neck and chest and a persistent cough with a $39^{\circ} \mathrm{C}$ temperature. A physical examination reveals swollen lymph nodes in all areas of their body, and laboratory tests find a very high Basophil and T-lymphocyte WBC counts. Information taken during the personal history reveals the spouse and child are also not feeling well. A) What test(s) might you immediately order next? B) What other step(s) might you do while waiting for the results to come back?
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Solution

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Solution Steps

Step 1: Identify the patient's symptoms and initial findings
  • The patient is a 36-year-old with purple-brown skin lesions on the neck and chest.
  • They have a generalized cough and a 39°C temperature.
  • Physical examination reveals swollen lymph nodes.
  • Laboratory tests show a very high WBC count.
  • Personal history indicates that the spouse and child are also unwell.
Step 2: Determine immediate next tests
  • Given the symptoms and findings, immediate tests should include:
    • Blood cultures to identify any bacterial infection.
    • Chest X-ray to check for any lung involvement.
    • Skin biopsy of the lesions to determine the cause.
    • Complete blood count (CBC) with differential to further analyze the WBC count.
Step 3: Consider additional steps while waiting for results
  • Isolate the patient to prevent potential spread of infection.
  • Start empirical antibiotic therapy to cover possible bacterial infections.
  • Monitor vital signs and provide supportive care (e.g., antipyretics for fever).
  • Take a detailed history to identify any recent travel, exposure to sick individuals, or other risk factors.

Final Answer

  1. Immediate tests: Blood cultures, chest X-ray, skin biopsy, CBC with differential.
  2. Additional steps: Isolation, empirical antibiotics, supportive care, detailed history.
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