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Review the various conjunctivitis cases and determine the most likely cause, including pathogen and mode of transmission. Discuss data that supports your decision and treatment strategies. Part 1 Case 1 A 5-year-old girl has had a cough and runny nose (yellowish discharge) for the past 3 days. Her mother brought her for an evaluation as her left eye became pink and the right eye is also starting to get pink. Her daughter keeps rubbing them. The mother says there was a little discharge that was like mucus, but she wiped it away before coming to get checked. The physical examination reveals an active, alert girl. Her ears and lungs are within normal limits (WNL). Yellowish discharge is noted from the nose, and her oropharynx is mildly erythematous; however, there is no tonsillar enlargement or exudate. Her eyes have conjunctival erythema and mild edema—the left eye greater than the right eye. Mild crusting at the lid but no discharge is noted. Provide responses to the items below. Most likely cause including pathogen – Mode of transmission – Discuss data that supports your decision – Treatment strategies – Case 2 A 15-year-old is complaining of right ear pain and a feeling of fluid in his right ear for the past 3 days. He feels likes it is getting worse. He says his hearing is slightly decreased in the right ear in comparison to the left. He stated these symptoms started after he came back from a camping trip where he went swimming in a lake several times. Physical exam reveals a left ear that is WNL. His right ear is painful when the auricle is tugged. The ear canal is edematous and erythematous. Whitish exudate is present in the right ear, and due to the amount of exudate, the tympanic membrane was only partially visible. The portion seen was intact and nonerythematous. Provide responses to the items below. Determine whether the disorder causes a conductive, sensorineural, or combination of both types of hearing loss. Explain the part of the ear that is affected and describe the disorder. Part 2: Abnormal uterine bleeding is a common gynecologic complaint. Review the following scenarios and determine a likely cause and describe the mechanism that leads to the abnormal bleeding pattern. Case 1: Scenario 1: A 13-year-old girl is having episodes of amenorrhea and infrequent menses. Her menarche was at the age of 12, she denies being sexually active, and a urine pregnancy test is negative. Case 2: Epididymitis and testicular torsion are both causes of scrotal pain. Testicular torsion requires prompt recognition and surgical intervention to avoid testicular damage. Epididymitis is easily managed with antibiotics. Differentiation between the two disorders is important. Review the case and answer the questions. A 15-year-old presents to the emergency department complaining of sudden onset of right-sided scrotal and groin pain. He states the pain is constant and extreme. He said it started about 2 hours ago during basketball practice at school, but he denies any trauma to the scrotum. He is worried that he has a sexually transmitted infection as he just started having sexual intercourse with his girlfriend and he did not use condoms. He says he feels nauseated and thinks he is going to vomit. He said he noticed this same pain once before, but it went away within a few seconds and he did not tell anyone. Physical examination reveals a healthy-appearing adolescent who is anxious and grimacing. The patient has edema and erythema of his right scrotum. His scrotum is tender, and the patient only tolerated superficial palpation. Vital signs: temperature 98.9°F; pulse 100 beats per minute; respirations 20 per minute; blood pressure 120/70 mmHg. Answer the following questions or provide responses based on this case. 1. The most likely diagnosis based on his history is: Epididymitis Testicular torsion 2. Erythema and edema of the scrotum are only present with epididymitis. True or False 3. Which clinical manifestations are consistent with epididymitis, and which are consistent with testicular torsion? Positive Prehn sign Negative cremasteric reflex Testis elevated on affected side Fever 4. Which diagnostic test is most appropriate to confirm the suspected diagnosis? A complete blood count with differential An MRI of the scrotum A Doppler ultrasound of the scrotum A urine culture and sensitivity 5. Discuss the treatment plans for testicular torsion and epididymitis.
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