4. Read the texts silently. Make sure that every sentence is clear to you. Be ready to give full information in English.
CASE REPORTS
Case I A four-year old boy presented with abdominal pain, especially in the right upper quadrant, nausea, vomiting, anorexia and fever of four day’s duration. On physical examination, generalized abdominal tenderness and guarding in the right upper quadrant were the only positive signs. Past medical history was negative. The blood chemistry and complete blood count, apart from leukocytosis, were normal. Ultrasonic examination revealed a dilated gallbladder and diffuse wall thickening.
Emergency laparotomy was performed and an inflamed hemorrhagic acalculous gallbladder was identified. A cholecystectomy was performed.
Thick-walled gallbladder, vascular congestion, some localized hemorrhage and infiltration of polynuclear cells, especially eosinophils were seen on pathological examination. Later follow-up showed that he was suffering form giardiasis which was treated with metronidazole. Post-operative sonography is shown in.
Case II A 7 month-old white female infant entered the hospital because of a twenty-four-hour history of difficult breathing. Examination revealed a pale, acutely ill infant with rapid respirations and fever. Tachycardia was present, but no cardiac murmurs were heard.
Twenty-four hours following hospital entry the infant was cyanotic and the vomiting contained bright red blood. The systolic blood pressure in the right and left arms ranged from 140 to 160, while in the leg it was 55 to 70.
Digitalis was given. Oxygen therapy resulted in gradual improvement. Chest roentgenograms revealed moderate cardiac enlargement with elevation of the apex. The right ventricular enlargement was also seen on the roentgenogram. Pulmonary vascular enlargement was present. The patient was treated with cardiacs. In a month she was discharged in a satisfactory condition.
