You are seeing a 7 year old in the ER, his dad brought him w…
You are seeing a 7 year old in the ER, his dad brought him with concerns of a diffuse, non-itchy, painless rash. He has never had a rash like this before and other than a recent cold that he has recovered from he has been feeling well without sick symptoms. His exam is only significant for multiple discrete, nonblanching pinpoint (1-2 mm) red-purple macules densely covering his face, chest and back, with a few seen on his arms and legs and several 3-4 cm areas of subcutaneous purplish discoloration on his shins and knees. His labs show: WBC 7.6 with normal differential, Hct 38, platelets 12,000, smear shows giant platelets (megakaryocytes) with otherwise normal cell morphology. PT 13.6 and PTT 37.5. What is the most likely diagnosis?
Read DetailsDuring his chemotherapy, your patient develops severe neutro…
During his chemotherapy, your patient develops severe neutropenia, with a total WBC count of 250 and an ANC of 100. Two days later he also develops a fever of 39.5. On examination, he has severely ulcerated, painful oral mucosa, and is pale with diffuse bruising and petechiae. After you ensure that his airway, breathing, and circulation are adequately supported your next steps include:
Read DetailsYou are caring for a patient admitted to the PICU with a dia…
You are caring for a patient admitted to the PICU with a diagnosis of sepsis. In discussion about which non-specific inflammatory markers will be monitored serially you order this test knowing that it is most likely to peak early in the disease process and resolve quicker than other markers as the patient clinically improves:
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