Case 1:

M.G. is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104ºF, lethargy, headache and stiff neck. Laboratory analysis of a spinal tap illustrates increased white blood cells in the cerebrospinal fluid (CSF).

problems:

1) What is the most probable cause of M.G.'s signs and symptoms?
2) What are general complications of this disorder, and how would one evaluate for their occurrence?
3) What is the usual treatment for this disorder? What are the most present guidelines and point out your citation(s)?

Case 2:

J.Y. is a 43-year-old woman who has detected a lump in the upper outer quadrant of her left breast while performing her monthly self-breast examination. She is examined by her primary physician who finds out a single mobile, painless lump. A biopsy is done which shows probable malignancy. J.Y. is scheduled for surgery. There is no evidence of regional lymph node involvement. J.Y.'s tumor is thought to be responsive to estrogen.

problems:

1) Based on the above information, what kind of breast surgery is pointed out for J.Y.?
2) What treatment besides surgery is J.Y. likely to receive?
3) What implications does J.Y.'s breast cancer have for the use of estrogen therapy when she becomes menopausal?
4) How frequently should J.Y. have mammography done? Comprise the most recent guidelines and comprise your citation(s).

Case 3:

D.W. is a 47-year-old man being evaluated for complaints of fatigue, loss of appetite and abdominal fullness. Upon examination the skin is noted to be jaundiced and the liver enlarged. D.W. denies important alcohol or drug use. He denies any known exposure to hepatitis and has never been vaccinated for hepatitis. He is taking no medication. Laboratory tests reveal the following and a diagnosis of acute hepatitis B is made:

AST                    142 IU/L
ALT                    120 IU/L
GGT                   42 IU/L
AlkPhos             84 IU/L
Total bilirubin    1.0 mg/dl
Albumin             4.3 g/dl
HBsAg                positive
Anti-HBS             negative
Anti-HCV             negative
HIV                     negative

problems:

1) Review and examine the laboratory data. Which findings support the diagnosis of acute hepatitis B?
2) What are the usual modes of hepatitis B transmission? What further risk factor evaluation is indicated to identify the source of infection?
3) What precautions must D.W. take to avoid transmitting the disease to others?
4) How must the disease be managed and monitored? Comprise your citation (s).