PBL Sessions: Immunologic Diseases


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Page 4

History of Present Illness:

Jack comes to see you and relates that he has noted "lumps in his neck" for the past year. During this time he seems to have had less energy. He has lost about 5 kg. He has had no major medical problems. He has kept working in the past regardless of minor medical problems, such as the flu, because he needed the income. However, he is worried because the lumps don't go away, and if he keeps getting more and more tired, he will not be able to continue working.

Physical Examination (Jack): The spleen tip is palpable. There is nontender cervical and axillary lymphadenopathy. You note the presence of a 7 cm long well-healed oblique scar in the right upper quadrant. The abdominal exam is otherwise unremarkable, and his stool is negative for occult blood. The neurologic exam is normal.


Sarah is brought to the ED that evening after developing severe shortness of breath. On physical examination she is in moderate distress. Her temperature is 37 C, pulse 103/minute, respirations 20/minute, and blood pressure 110/70 mm Hg. She has blotchy areas of skin erythema on her trunk and extremities.

Tasks

  • What do these findings indicate?

  • What hypotheses explain these findings?

  • Explain your reasoning for the hypotheses you choose.

  • Explain the pathophysiologic mechanisms.

  • What learning issues are being identified?

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