Week 5 Discussion Group – Case Study #1 A full term female neonate was born to

Week 5 Discussion Group – Case Study #1

A full term female neonate was born to a 21-year-old woman. The baby was found to have icterus at 4 hr. after birth. Upon noticing this, several laboratory tests were ordered.

The patient Patient’s blood smear

Normal Blood smear for comparison

 

Laboratory Test Results:

The neonate’s red cells typed B, Rh+, while the mother’s red cells typed O, Rh=.

A blood smear showed changes typical of hemolysis.

A screen for fetomaternal hemorrhage was negative.

The baby’s G6PD activity was normal.

Sickle cell test had negative results.

An infectious disease evaluation was completed reported as negative.

Day 1 Serum Bilirubin was 10mg/dl. Day 2 Serum Bilirubin was 12 mg/dl Day 3 Serum Bilirubin was 14 mg/dl

Explain fully the following questions:

     What is the diagnosis of the neonate’s condition?

     What is the treatment for this condition?

     What needs to be done for the mother?

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Case Study #2

Clinical history: Over the course of 1 week, a 6-year-old boy develops 0.5- to 1.0-cm pustules on his face. During the next 2 days, some of the pustules break, forming shallow erosions covered by a honey-colored crust. New lesions then form around the crust. The boy’s 40-year ­old uncle develops similar lesions after visiting for 1 week during the child’s illness.

Laboratory Findings:

• 

Lesions on patient Growth on blood agar Coagulase test results

 

Gram stains of exudate from lesions from both patient and patient’s uncle.

The Gram stain from a skin pustule are shown above. The organism grew on sheep blood agar (SBA) and was catalase positive. Which of the following organisms do you think is responsible for this pathology?

1. Staphylococcus aureus
2. Staphylococcus epidermidis
3. Streptococcus pyogenes Lancefield Group A
4. Streptococcus pyogenes Lancefield Group B
5. Streptococcus pneumonia

 

1. What is the MOST LIKELY diagnosis?
2. How will you attend to this patient? List your steps in proper order. What do you tell the mother about home care after they leave the office?
3. What pharmaceutical intervention is warranted, if any? List specific drugs you might prescribe. Or should we wait?
4. The uncle is not present. Should he be treated too, or does it matter since he is an adult?

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CASE STUDY #3

An 2 year-old boy comes to your physician’s office with his mother who reports he has redness in both eyes with greenish-yellow discharge x 2 days. When he awakens in the mornings, his left eye is swollen, and he says that it feels like there is “something stuck” in the eye. The mother reports his eyes are both itchy, crusty, and hard to open in the morning. Patient keeps rubbing both eyes and seems uncomfortable while sitting in the exam room. Patient states he has just returned from his day care.

Physical Exam: Reveals an 2 year old boy in good health except for ophthalmic symptoms as noted by the patient. Patient history is unremarkable. Mother states he has no known allergies or chronic illnesses.

1. List the steps in proper order of how you will attend to this patient.
2. What do you believe is the diagnosis? Which microorganisms are the most likely pathogens in this case?
3. How is this disease transmitted?
4. What tests do you wish to be completed to confirm your diagnosis?
5. If you believe pharmaceutical intervention is warranted at this time, which agent(s) will you prescribe and in what format?  
6. What do you tell the mother?

Laboratory tests you ordered will take 48 hours to complete – so stay tuned for additional information later.