Case 5

Gap-fill exercise

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  • Medical Setting:Hospital; A 29 year-old woman with acute myelocytic leukemia is in hospital seven days after induction chemotherapy. An indwelling central catheter has been in place for one-week. There is significant mucositis
  • Chief Complaint/History:
    • Fever (40 degrees) with cough
    • Abdominal pain
    • Loose stools
  • Physical Exam:
    • Patient appears quite ill, with significant alopecia
    • Temperature: 40
    • BP: 90/40 mm Hg
    • Pulse: 120
    • Pharynx-significant, painful mucosal ulcerations
    • Lungs-clear
    • Chest-clear
    • Catheter site-no fluctuance (fluid/air under the skin)
    • Abdomen-soft, non-tender
  • Laboratory values:
    • Chest x-ray-normal
    • Urine-esterases -
    • Blood and urine culture is sent
    • white blood cell count: 200/ml

       
The differential diagnosis is and fever-the source could be from the lungs, gastrointestinal tract,genitourinary tract, skin, catheter, etc.