A 21 years-old medical student went to a Friday night party.

She had a history of asthma

and was on inhaled corticosteroid and intermittent bronchodilator for 2 years; however, the
medication was discontinued for 2 weeks. During non-stop dancing in the party a few hours
after dinner, she felt shortness of breath and lightheadedness. She was brought to emergency
room for investigation and treatment. Physical examination revealed BT36.7 C,
PR100/minutes, RR 24/minutes, BP 100/70 mmHg, generalized erethrematous rashes,
stridors and wheezing heard both lungs and increased bowel sound. Similar'Ñw anaphylaxis law
VAO Iaiwili asthma exacerbation ilainniliitxasanaphyiaoi
Question:
1. What is your diagnosis?
2. What is your investigation plan?
3. What are the possible causes of her symptoms?
4. What is the possible mechanism of the disease?
5. What is your treatment plan? Prevention?
-
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on Ñioln

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Infective endocarditis penicillin gentamicin

penicillin
penicillin

penicillin
normal saline

penicillin

penicillin dose
PR 100/min, BP 80/60 mmHg, generalized
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infective endocarditis
or desensitization
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: Tx anaphy ironists no:

 A 20-year-old forth year medical student has walery running nose sneeze, itching of
nose and eye almost daily in the morning. Her symptoms increase when she visits her boy friend
who has cats at home.
Past medical history: asthma
Past surgical history: none
Allergy: No known drug allergy
Medication: antihistamine as needed
Physical examination: Well developed, well nourish female
Vital sign:T 37 C, p 64/min, R 16/min, BP 100/60
HEENT:moderately congested and pale nasal mucosa with moderate amount of clear rhinorrhea.
Chest: clear to auscultation
Cardiovascular:unremarkable.
Further information and laboratory date will be available upon request.
Questions:
1. What is your diagnosis?
2. What is your investigation plan?
3. What are the possible causes of his symptoms?
4. What the possible mechanism of the disease?
5. What is your treatment plan? Prevention?

Suggested reading:
1. Clinical practice guideline: Internal Medicine Department, Chulalongkorn University.
2. Cecil text book of Medicine
3. Harrison text of Internal medicine