Tuesday, 6 February 2007

History and Physical Quiz: I need your Answers!!!!

Today I am going to do something different. I am setting you all a quiz!

I will give you a short history and show you the physical signs that I picked up on this patient and please send me your answers to the questions I have posed at the end of this blog.


This is a 41 year old male computer worker who developed bloody diarrhoea of up to 10 times per day. The diarrhoea was non-painful and he experienced no abdominal pain. He had these symptoms for 2 months prior to coming to the hospital.

He had recently developed a fever prior to admission and in fact, that was the reason for him seeking medical intervention on this occasion. He denied any shivers or shakes. He noticed the skin on his legs had become discoloured but they were not painful.

He had no chest pain, dyspnoea, cough, sputum or haemoptysis. No genitourinary, joint, throat, or cranial symptoms.

He denied eating raw or poorly cooked foods and he denied any foreign travel. He had no pets at home. He had a similar episode of this in the recent past and was taking some medication but he could not remember the name of his diagnosis or treatment when he was admitted to hospital.

He had no recent weight loss, night sweats or loss of appetite. He was taking no anti-coagulant drugs or Non-Steroidal Anti-Inflammatory Drugs. He denied any previous peptic ulcer disease and he drank no alcohol. He had experienced no haematemesis and had no symptoms of gostroesophageal reflux disease (GERD).

There was no family history of bowel disease or cancer.

On examination: He looked relatively well. BP and Pulse were stable. Temp 38.0 degrees C. Resp Rate 14/min and O2 sat 98% on room air.

No Jaundice, Anaemia, Clubbing, Cyanosis, Oedema, Lymphadeopathy (No JACCOL)

CVS: pulse 80/min, regular. BP 120/80 mmHg. JVP was not raised. Heart sounds 1 + 2. No added sounds or murmurs. No evidence of DVT in the lower extremities.

RESP: Trachea central. No tracheal tug. Expansion normal bilaterally. Percussion resonant throughout and Auscaultation revealed Vesicular breath sounds.

ABDO: Soft, non-distended, non-tender, no organomegally. Bowel sounds normal. No signs of chronic liver disease. Rectal examination: fresh red blood, no obvious discharging fistula orifices.

JOINTS: Normal range of movement. Non-tender and no swelling.

EYES: See Photograph

SKIN: See Photograph


Question 1:

What is the eye sign?

Question 2:

What is the lower extremity skin signs and what are the possible causes of it?

Question 3:

With the history and examination in mind, what is the likely diagnosis or at least, provide some differential diagnoses?

Question 4:

What investigations should be done e.g. radiological / microbiological, etc...?

Question 5:

What treatments should be commenced on admission for this patient?

I will publish all answers and I will provide you the answers in one week from today!!

Good Luck!!!