Quote:
Originally Posted by ender18d
Any gingival hyperplasia/gum hypertrophy?
Negative.
Abdomen - any organomegaly or mass?
Negative.
GU/Testicular exam?
Unremarkable.
Any other abnormal skin findings?
No.
Cranial nerve, mentation, motor and sensory examination? DTRs?
CN II-XII intact to confrontation (CN I not tested, but PT denies changes in olefaction). Mini mental status exam unremarkable. Motor 5/5 in all extremities. Light touch, pain, vibration intact in all extremities bilat. Biceps, triceps, brachioradialis, patellar, achillies DTRs 2+ bilat. Negative babinksi.
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As you conduct your exam, you notice two other soldiers have shown up and are waiting for sick call....
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Given the location and the PFC's symptoms and exam, I'm worried about Typhoid. I assume he received his vaccination, but his drinking the local water supply is concerning and if he drank enough he may still become sick.
I believe ciprofloxacin is still the first line therapy for this, but if he fails cipro I would consider a switch to azithromycin or ceftriaxone on the assumption he has a drug restitant bug. I would treat on presumption without confirmation of the diagnosis given my limited ability to confirm the infection and knowing the natural course of this infection without intervention.
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"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
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