Case II

Gap-fill exercise

Fill in all the gaps, then press "Check" to check your answers. Use the "Hint" button to get a free letter if an answer is giving you trouble. You can also click on the "[?]" button to get a clue. Note that you will lose points if you ask for hints or clues!
Medical Setting: A 28 year-old male IV drug abuser, having recently received his unemployment check, seeks medical attention at the University emergency department.
Chief Complaint/History:
Fever for the last six hours
Perfused sweating & palpitations
Last used IV heroin about a day before coming to the emergency department
Physical Exam:
Unkempt male with multiple tattoos, perspiring profusely.
Temperature: 40
BP: 100/50 mm Hg
Pulse: 120
Fundi- without lesions
Pharynx-normal
Lungs-clear
Cardiovascular-3/6 systolic murmur at the apex radiating to the base and extremities; a right-sided 2/6 diastolic rumble.
Fingernails-no splinter hemorrhages
   cotton wool      endocarditis      Enterococcus faecalis      pneumonia      Pseudomonas aeruginosa      Staphylococcus aureus   
The differential diagnosis could include (1) (acute, right-sided, with septic emboli to the lungs), (2) , or (3) fever. If this is an infectious disease, the three most likely pathogens would be (1) , (2) , (3) .