Question

Patricia felt like almost everything in her life was charmed, golden, perfect. She had gotten back from a lazy trip to see friends in the Dominican Republic last week, had a job interview last Monday and now they had called to say she was hired! Finally, some health insurance! She decided to go shopping with her sister for new work clothes to celebrate As she changed in the dressing room, Patricia told her sister all about the three new boyfriends she picked up in the DR. Her sister was so jealous! Maybe that's why she made that face when Patricia came out of the dressing room in a skirt that was maybe a bit too short for work. Continuing the judging, her sister asked "hey, Pat, what's up with your leg?" Patricia looked in the mirror and saw those super gross sores she had gotten probably after some bug bite in DR There were LOT's of bugs. Ugh. But the sores did seem kind of infected or something. "Guess long skirts or pants for a bit. l'll put some Neosporin on them, and they'll go away." She was super happy with the new job, but the hours they wanted were a little crazy. After just the first week, she began to feel tired more frequently. She noticed her fingers felt tingly sometimes. Then later it was her toes. Her throat felt tight and strange and she had trouble swallowing. Three weeks after she started the new job, her new healthcare plan kicked in so she went to see the doctor As the PA on duty, you ask Patricia about herself, her diet, habits, medical history, sexual partners and travel history. You conducted the physical exam and there was no doubt that she had peripheral neuropathy What are the five most likely causes (pathogens) of Patricia's illness and why are they likely/unlikely based on current information alone? (justify... maybe make a chart...)-15 1. 2. You ordered an ECG that came back with ST-T wave changes, variable heart block, and dysrhythmia. Blood work revealed a creatinine of 12.4 mg/dl, a blood urea nitrogen of 214 mg/dl, a white blood cell count of 26,500 /mm with 92% polymorphonuclear cells, and a platelet count of 10,000/mm. Does this change your diagnosis, eliminate or support any particular pathogens? (justify.. maybe make a char...) 10 pt. The chest X-ray you ordered based on her ECG abnormalities is to the right. Does this change your diagnosis, eliminate or support any particular pathogens? (justify maybe make a chart...) 10 pt. 3.

Answer 1

1. In the present scenario, Patricia had gotten back from a lazy trip to see friends in the Dominican Republic (DR) last week, had a job interview last Monday and now they had called to say she was hired $\rightarrow$  She had gotten probably after some bug bite in the Dominican Republic (DR) $\rightarrow$ There were LOT’s of bugs. But the sores did seem kind of infected or something $\rightarrow$ After just the first week, she began to feel tired more frequently $\rightarrow$ She noticed her fingers felt tingly sometimes. Then later it was her toes. Her throat felt tight and strange and she had trouble swallowing $\rightarrow$ Three weeks after she started the new job, her new healthcare plan kicked in so she went to see the doctor.

2.  Here the ECG of the patient shows ST-T wave changes, variable heart block, and dysrhythmia. Blood work revealed a creatinine of 12.4 mg/dl, a blood urea nitrogen of 214 mg/dl, a white blood cell count of 26,500 /mm with 92% polymorphonuclear cells, and a platelet count of 10,000/mm. shows that the patient is having a Lyme disease. The patient is having the variations in the ECG with ST-T wave changes and as well as there is an increased creatinine level and BUN, that shows that the infection affects the kidney and some times with the Lyme there may be an elevation or normal WBC count and changes in the platelet count.

The pathogen may affect the heart, kidney and changes in the lab values.

3. The chest X-ray showing infiltrates here I am confused that the patient is having Pulmonary tuberculosis and lepromatous leprosy co-infection that shows infiltration and sputum accumulation in the lung.

To confirm the diagnosis we need more blood test.

In the history, she said regarding a bug bite thus confused with the Lyme disease. Then also she is very tired and feeling lethargic and as well as shows multiple skin lesions and later she developed the tingling and numbness over the fingers, later toes throat felt tight and strange and she had trouble swallowing. and as well as she had peripheral neuropathy.