CASE 3:
A 55 year old patient presents with the second episode of a swollen hard area in his (L) submandibular area. The patient initially had a mass in this area which was treated with ampicillin for one week. The mass resolved, but recurred on month later. In addition, the patient has had an intermittent toothache in his lower molars on that side, (for the last 5 days). PMHx. ETOH abuse, drug detox.
Physical examination: T. 99.8°, Skin: 3cm x 4cm swollen red-bronze area at angle of the jaw on (L) woody induration. Mouth: poor dentition, (L) lower molar decayed with surrounding gingivitis.
Laboratory: Aspirate of the neck lesion revealed branching gram-positive organisms, Ziehl-Nielsen stain negative.
QUESTIONS:
1. Create a problem list from the history. Answer
2. Identify and explain the significance of each pertinent physical finding. Answer
3. Review the lab data and explain the findings. Answer
4. What is diagnosis based on History, physical and lab data. Answer
5. Describe succinctly, the disease each case represents Answer6. Describe the offending organism, its morphological, cultural characteristics and their normal habitat. Answer
7. How do these organisms gain access to humans? Answer
8. Who are susceptible to develop this infection? Answer
9. How do they invade and spread in humans? Answer10. What defenses humans have against these organisms? Answer
11. How do these organisms able to overcome human defenses? Answer
12. What is the end result of this battle between organisms and humans? Answer
13. How do you diagnose this infection? Answer
14. What will be your therapeutic strategy? Answer
15. How can you prevent it from spreading to others? Prevent its occurrence?
Answer
16. What are other clinical infections with these organisms? Answer
17. Which disease do you have to differentiate it from? Answer