Author Question: A 15-year-old male presents to the clinic with fatigue, weakness, and sore throat for 4 days. The ... (Read 80 times)

Sportsfan2111 · **on:** Jun 25, 2018

A 15-year-old male presents to the clinic with fatigue, weakness, and sore throat for 4 days. The patient has no significant medical or surgical history.

On physical examination, there is fever of 102, erythematous pharynx and tonsilar enlargement, and prominent cervical lymphadenopathy. Heart has regular rate and rhythm. Lungs are clear to auscultation. Abdomen exam demonstrates left upper quadrant tenderness to deep palpation and splenomegaly. Extremities show no significant findings. No neurological deficits. These signs and symptoms are characteristic of:
A. Beta-hemolytic streptococcal infection
B. Scarlet fever
C. Infectious mononucleosis
D. Human immunodeficiency viral infection

Question 2

A 32-year-old morbidly obese male complains of excessive fatigue, snoring, and awakening in the middle of the night, which prevents restorative sleep.

He is sluggish during the day due to the lack of sleep and feels like he is going fall asleep at the wheel when driving to work. Occupation: dishwasher. Medical history includes hypertension and type 2 diabetes. Current medications include ACE inhibitor and metformin. Denies use of alcohol, tobacco, or drugs. On physical examination, the patient is afebrile, pulse 88, resps 20/min, BP 178/95. BMI is 45. These are signs and symptoms of:
A. Obstructive sleep apnea
B. Primary insomnia
C. Heart failure
D. All of the above

paavo · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: C
Mononucleosis is a viral infection that typically occurs in adolescence and early adulthood and is caused by the Epstein-Barr virus. Fatigue is a common complaint. Fever, sore throat, prominent cervical lymphadenopathy, and splenomegaly are characteristic of infectious mononucleosis.

Answer to Question 2

ANS: A
With the obesity epidemic, the incidence of obstructive sleep apnea (OSA) is also increasing. Besides obesity, other predisposing and risk factors include narrowed upper airways, macroglossia, tonsillar hypertrophy, sleep medicines, alcohol, smoking, nasal obstruction, and hypothyroidism. It occurs more in middle-aged men. A thorough medication history, respiratory history, neurologic history, and mental health assessment should be performed. One of the more common symptoms of OSA is snoring, usually reported by the spouse. The patient may complain of frequent nighttime awakening, morning drowsiness, headache (caused by carbon dioxide buildup in the brain), cognitive impairment, as well as impotence and weight gain, which can be both a cause and an effect. Systemic hypertension is a complication of OSA but often resolves when the cause of the apnea is corrected.