An 18-month-old child presents to the emergency center having had a brief, generalized tonic-clonic seizure. He is now postictal and has a temperature of 40°C (104°F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient?
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE. Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America
The correct answer is e; Shigella.
Clinical manifestations of shigellosis range from watery stools for several days to severe infection, with high fever, abdominal pain, and generalized seizures. In general, about 50% of these children have emesis, greater than two-thirds have fever, 10 to 35% have seizures, and 40% have blood in their stool. Often, the seizure precedes diarrhea and is the complaint that brings the family to the physician. Fever usually lasts about 72 h, and the diarrhea resolves within 1 to 2 weeks. Presumptive diagnosis can be made on the clinical history; confirmation is through stool culture. Supportive care, including adequate fluid and electrolyte support, is the mainstay of therapy. Antibiotic treatment is problematic; resistance to trimethoprim-sulfamethoxazole and ampicillin is common, necessitating therapy with third-generation cephalosporins in many cases.