- A 12-year-old Sudanese child has ascites and an enlarged spleen. What are the possibilities?
- Congo. On an abdominal X-ray of an 18-year-old woman, a shell-like fine calcification is found in the small pelvis in the shape of a balloon. No foetal spine is seen. What could this be?
- In Brazil, a local woman has pain in the left kidney region. On microscopic examination of the urine you find some blood. Should S. haematobium be excluded?
- Some tourists go swimming in a small lake in Kenya. A few weeks later they develop fever and cough. A blood analysis shows eosinophilia of 40%, but Schistosoma serology is negative. The examination for eggs in the faeces and urine is also negative. What should be considered?
- One of the above subjects develops sudden paralysis of both legs. There is no history of trauma. Possible explanation?
- A Congolese man complains of increasing tiredness. Pitting oedema of both lower legs is observed and the jugular veins are distended. The liver is palpable 9 cm below the right costal margin. What does this suggest? Are there infections that can cause this?
- A woman in Mwanza, Tanzania, says that she passed blood at the age of 6 years. This disappeared gradually over the following years. She is now 34 and is again passing bloody urine each time. What are the possibilities?
- A 17-year-old Congolese girl has grown up in a small village. On one particular day she accidentally falls into the local river. A few weeks later she develops fever, cough and difficult, rapid breathing. On auscultation there are crepitations over the right lower lung field. What do you think? Is this compatible with Katayama syndrome? What if the symptoms were to occur 2 days after the accident?
- You find S. haematobium in a 5-year-old Egyptian child. How should you treat the child?
- Zambia. Your girlfriend washed her feet on one occasion in the local river. Three weeks later she notices violent itching on her feet. A convoluted red stripe is visible. What has happened?
- Make a life-size drawing of a schistosome pair.
- You want to demonstrate the prevalence of S. haematobium along a river in West Africa. With your team you visit five schools on the same day to test the children’s urine for eggs and blood. You leave at 6 a.m. in the morning and stay about 2 hours in each school, where 60 boys, all 6-11 years old, are examined each time (the journey time between schools is short). You return at about 6 p.m.. Can the prevalence be usefully compared between the schools? Should allowance be made for age? Is it important that contact with water can differ from place to place? Should there be a control group? What do you think about the potential importance of the circadian rhythm in the excretion of eggs? Is there rhythmic excretion with S. mansoni ?
- You are shown a chest X-ray with features of pulmonary hypertension. Do you direct your examination towards chronic lung disease, chronic left heart failure and mitral stenosis or recurrent pulmonary embolisms? Others?
- Zimbabwe. A patient has moderately severe renal failure. What information do you need to refine the distinction between immune-mediated glomerulonephritis, prostate hypertrophy, chronic pyelonephritis, diabetic nephropathy, obstructive uropathy due to calculi, schistosomiasis, renal tuberculosis and polycystic kidneys?
- Why is alfacalcidol or calcitriol given in chronic kidney disease, rather than the more usual vitamin D (cholecalciferol or ergocalciferol) ?
