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USMLE Question: Clinical Case - 13

A patient of 16-year-old presented to the emergency department of your hospital in a severely dehydrated state. He had been suffering from fever since last two weeks. The pattern of temperature was variable during the first week but became continuous during the second week and temperature usually raised in the afternoon. Temperature sometimes reached to 104-105 F. His tongue was coated at the periphery. His abdomen was distended and tender in the right lower quadrant. He had constipation during the first week but in the second week he started complaining of diarrhea. He lost significant weight and he looked dull. On auscultation of chest, basal crepitations were heard. His abdominal ultrasound revealed hepatomegaly and splenomegaly. Complete Blood count Showed the following picture.
RBCs: 5.8 x 106
WBCs: 5994 (reference range = 5000 – 11000)
Platelets: 100 x 103 (reference range = 150x103 – 350 x 103)
Hb: 15 g%
Blood Sugar: 90mg/dl
Blood pressure: 100/60 mm of Hg
Pulse: 80 bpm
Temperature: 102 F
Respiratory Rate (RR): 22 per minute.
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