7 Exercises

1. Sudan. A mother asks you how she should prepare a drink that she can give her 2-year-old daughter in the case of diarrhoea. What is your answer?
2. Mauritania. The supply of ORS bags from the WHO has run out. Someone asks you how they can make these themselves in the hospital. What is your answer?
3. India. A medical assistant in a dispensary asks you what she should do if someone comes with diarrhoea. How would you reply?
4. Zambia. A child weighing 25 kg had watery diarrhoea for 5 days. There is no fever, the child is drowsy and feels cold. You cannot feel a pulse. The eyes are sunken and folds in the skin remain for 10 seconds. What do you do?
5. Gambia. A 50-year-old man has since 3 days a temperature of 39° C, and mentions sudden abdominal cramps and diarrhoea (14 stools a day, 4 at night). He appears toxic (seriously ill). Urine = 150 ml/24 hours. Microscopy of the faeces shows WBC +++ and RBC +++, no trophozoites. What is the probable diagnosis and therapy?
6. Borneo. An adult has had a temperature of 38.5° C for 10 days. The stools contain mucus with some blood. His general condition is moderately good. Bacterial culture of the stools: Vibrio cholerae. What do you think and what do you do?
7. A European tourist in Kenya. After 10 days suddenly he has a fever of up to 40° C, watery diarrhoea, general malaise, headache and muscular pain. What do you think and what do you do?
8. Northern Kenya. A local man has had fever for 2 months, emaciation, asthenia. Three weeks ago he had repeated epistaxis. For 4 days his general condition has deteriorated with frequent diarrhoea containing bloody mucus. Physical examination reveals: cachexia, enlarged spleen and liver. What do you think and what do you do?
9. In Brazzaville, Congo, you see a 24-year-old woman with chronic pruritus, persistent fever and emaciation. For 2 months she has had diarrhoea and difficulty swallowing. The stools do not contain any blood. Physical examination reveals cachexia and an area of depigmentation on the left thorax. What do you think?
10. Guinea-Bissau. A child has had persistent diarrhoea for 2 months. There is no fever or other symptoms. What do you think?
11. West Irian (New Guinea). At a village feast large quantities of beer, chicken, sweet potatoes, sago cakes and pigmeat were prepared. Two days later 100 people became ill, mainly children. They complain of sudden bloody diarrhoea/melena, fever, abdominal cramps, bloated abdomen and appear toxic. What could it be?
12. Local village idiot in Zambia. Chronic diarrhoea. Dark coarse skin in the face and the arms with rash in the neck, arms and legs. He is very emaciated and there are no signs of AIDS (chronic candidosis, repeated shingles, Kaposi’s sarcoma lesions, prolonged fever).
13. Draw (to scale) a Giardia lamblia trophozoite, an Entamoeba histolytica trophozoite and cyst, a neutrophil.
14. Ivory Coast. A man in stupor is sweating a lot and has severe diarrhoea, t° = 39° C. The central venous pressure is 0 cm, BP = 7/-. There are no abdominal masses. For 2 days urine production has been just 50 ml per day. His older neighbour in the bed to the left of him was admitted with subacute abdominal pain and also has urine production of just 75 ml per day. On palpation of this man’s abdomen a mass can be felt suprapubically. His neighbour to the right is a boy of 8 years who was admitted with aching joints and fever. At present his urine production is just 80 ml per day. The urine contains protein ++++, red blood cells and many casts. Which of the patients is most likely to have pre-renal, renal and post-renal renal insufficiency? Can you think of a specific cause?