USMLE PLAB Clinical Cases Questions 13 A patient of 16 year old presented to emergency department of your hospital in 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 afternoon. Temperature sometimes reached to 104-105 F. His tongue was coated at periphery. His abdomen was distended and tender in the right lower quadrant. He had constipation during the first week but in 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 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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