1. CASE 1.
A 4 year-old child complains of ear pain. He has a temperature of 38.9°C and has had a cold for several
days, but he has been eating well and his activity has been essentially normal.
What is the most likely diagnosis?
What is the best therapy?
CASE 2.
A 7 –month-old boy with respiratory difficulty is brought to the emergency department at 3 AM. His
mother reports that several family members have had “colds” over past week. He first developed cough
and coryza 3 days ago, and the cough has become “barky”. She reports that his immunizations are
current and that he has had no previous illness. On examination, he has an axillary temperature of 38°C,
respiratory rate 55 breaths/min, and heart rate 140bpm,. His pharynx is moderately inflamed; chest
auscultation reveals inspiratory stridor. His examination is otherwise unremarkable
What is the next step managegement of this patient?
What is the most likely diagnosis?
CASE 3.
A 19-year-old student to the University Montemorelos with several days of fever, sore throat, malaise,
and rash that developed today. She first started feeling ill 10 days ago with general malaise, headache,
and nausea. Four days ago she developed a temperature of 39.4°C that has persisted. She has worsening
sore throat and difficulty swallowing solid foods; she is drinking well. She denies emesis, diarrhea, or sick
contacts. She takes an oral contraconceptive daily and took two doses of ampicillin yesterday (left over
from a prior illness). On examination, she es well developed with a diffuse morbilliform rash. She
appears tiresd but no distress. Her temperature is 39°C. She has mild supraorbital edema; bilaterally
enlarged tonsils that are coated with a shaggy gray exudates; a few petechiae on the palate and uvula;
bilateral posterior cervical lymphadenopaty; and spleen that is palpable 3 cm below the costal margin.
Laboratory data include a white blood cell count of 17,000 cells/mm3 whit 50% lymphocytes, 15%
atypical lymphocytes, and platelet count of 100,000/mm3.
What is the most likely diagnosis?
What is the best tool quickly confirm this diagnosis?
What is the best management for this condition?
What is the expected course of this condition?
2. Masculino de 3 años de edad es traido al servicios de urgencias por dificultad para respirar. La madre
refiere que inicia hace 1 semana con tos, agregándose fiebre de 39.7°C hace 4 días, acudió con su
medico quien diagnostico una FAA e indico penicilina intramuscular, (le han aplicado una dosis). La
madre refiere que presento eritema en mejillas que desapareció al tercer día. No presenta vómitos, ni
diarrea, ni otra sintomatología. Antecedentes: no relevantes.
Exploración física: Se observa apático, polipneico.
SV: T 39°C, FC 169 lpm, FR 62 rpm. Saturación al ambiente con pulso oximetro 92%. Peso 20 kg.
Regular estado general. Leve palidez cutánea, bien nutrido e hidratado. ORL: amígdalas hiperemicas e
hipertróficas, sin exudados. No adenopatías. Otoscopia: membrana timpánica izquierda hiperemica.
Tiraje subcostal y supra esternal moderado.
Auscultación cardiopulmonar: hipoventilación bilateral moderada, con marcada hipoventilacion en
hemitorax derecho, con soplo tubarico en zona posterior. No se auscultan sibilancias.
Abdomen: blando, depresible y no doloroso.
SNC: normal.
Exámenes:
Procalcitonina: 16.6 ng/ml; glucosa 94 mg/dL, urea 38 mg/dL, creatinina 0.33 MG/Dl, Na 123 mEq/L, K
no reportado ( muestra hidrolizada), CL 88 mEq/L, PCR 29.5 mg/dL.
BH: globulos rojos 3.91 X10⁶/uL, MCHC 33 g/dL, Hb 10.4 g/dL, RDW 14.5%, Hcto 31,6%, MCH 26.6 pg,
MCV 80.7fL, plaquetas 233X10³/uL, leucocitos 9.8 X10³/uL, segmentados 81%, cayados 6%, linfocitos
9%, monocitos 4%.
¿Cuál es el diagnostico mas probable?
¿Cuál es el manejo inmediato?
¿Cuál es la fisiopatología?