Case scenario 1
Problems in the description for levels of dehydration:
• Number of stools/day not indicated
• Sunken eyes: moderate dehydration or severe dehydration
• Dry eyes: severe dehydration
• Breathing rapidly: (faster) moderate dehydration (fast/deep) severe dehydration
• Irritable: moderate dehydration
Three signs suggest moderate and three signs suggest severe dehydration.
Intended diagnosis: moderate dehydration (5%)
• Oral rehydration fluids (ORF) 180ml every hour (12 × 15) by mouth until fluid deficit corrected, then 100ml after every stool.
• ORF 4 or 5 packets
• 1st 1-2 hours give 1/4 of 425ml, or 850ml over 6-8 hours, then last 1/4 or 425ml over 14 hours or remainder over 24 hours, then reassess.
Intended diagnosis: severe dehydration (10%)
• intravenous fluids or ORF by nasogastric tube
• ORF 4 packets or 1200ml
• 1st 1-2 hours 575ml, 1150ml over 6-8 hours, the 575ml over remainder of 24 hours and reassess condition of child before further prescription.
Case scenario 2
Intended diagnosis: gonorrhoea (no indications of complications or previous treatment)
• probenicid 250mg, ii stat #2, wait 30 minutes and give procaine penicillin 4.8 million units IM divided between two sites or
• probenecid 250mg, ii stat #2, wait 30 minutes and give amoxicillin 250mg PO, 12 tablets stat, #12 (some people give #15 stat) or
• tetracycline 250mg PO, ii qid × 7 dys, #56 or
• doxycycline 100mg PO, i bid × 10 days, #20
Case scenario 3
Intended diagnosis: possible chloroquine-resistant malaria, anaemia
• sulfadoxine/pyrimethamine (Fansidar), i stat, # 1
Case scenario 4
Problems with the case description for hypertension: BP 160/100 is mild hypertension but shortness of breath and tiredness after exertion are signs of heart failure.
Intended diagnosis: mild hypertension
• for hypertension, first a diuretic, then re-evaluation after 2-4 weeks or intended diagnosis: mild heart failure
• hydrochlorothiazide 50mg PO, qd #30. Review in 2-4 weeks and add a second drug if necessary.