PBL Sessions: Hematology Organ System - 2

Page 4

History of Present Illness:

She presents to the emergency department a month later with sudden onset of severe headache accompanied by generalized convulsions. On examination she is drowsy and confused. She is afebrile and her blood pressure is 130/80 mm Hg. No papilledema is noted. A urine specimen is obtained and appears dark. On the urine dipstick there is no glucose or protein noted, but blood is present.

A lumbar puncture is performed. The opening pressure is 200 cm H20. Clear fluid is obtained. The gram stain of the CSF shows no organisms. The cell count shows 1 RBC/microliter and 2 WBCs/microliter (both mononuclear cells).

A head CT scan is performed that shows no intracranial hemorrhage. Angiography is performed and reveals thrombosis involving the superior sagitatal sinus.

Her skin surfaces over the anterior left upper chest and lower right leg demonstrate focal swelling with hemorrhage and ulceration.

Tasks

• What do these findings indicate?

• What hypotheses explain these findings?

• Explain your reasoning for the hypotheses you choose.

• What learning issues are being identified?

Stop !! Complete discussions and tasks before moving to the next page.