PBL Sessions: Immunologic Diseases


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Physical examination (James): he has vital signs with T 37.1 C, P 71/min, RR 14/min, and BP 125/80 mm Hg. He is 166 cm tall and weighs 71 kg. The appearance of the skin is shown in the figure. His heart rate is regular with no murmurs. The lungs are clear to auscultation. Palpation of the abdomen reveals no masses or areas of tenderness, and active bowel sounds are present. The rectal examination reveals no masses, and the stool guaiac is negative. Pulses in the extremities are 2+ bilaterally. Motor strength is not decreased. Reflexes are normal. Cranial nerves II through XII are intact and there are no localizing neurologic signs. Funduscopic examination is unremarkable.

Figure 1: Gross appearance of the skin

Physical examination (Sarah): she has vital signs with T 37 C, P 80/min, RR 18/min, and BP 100/70 mm Hg. She is 134 cm tall and weighs 30 kg. Her heart rate is regular with no murmurs. The lungs are clear to auscultation. There appears to be mild swelling in the posterior oral cavity, but no erythema. Palpation of the abdomen reveals no masses or areas of tenderness, and active bowel sounds are present. The rectal examination reveals no masses, and the stool guaiac is negative. Pulses in the extremities are 2+ bilaterally. Motor strength is not decreased. Reflexes are normal. Cranial nerves II through XII are intact and there are no localizing neurologic signs. Funduscopic examination is unremarkable.

Tasks

  • What problems can you identify?

  • What hypotheses can you suggest that might be causing these problems?

  • Explain your reasoning for the hypotheses you choose.

  • What learning issues are being identified?

  • What additional information might you request?

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