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Clinical Case 4
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Objectives:

  • Identify signs and symptoms of toxic shock syndrome
  • Describe the pathophysiology of toxic shock syndrome
  • Initiate management for a patient with sepsis and toxic shock syndrome



1

A 23-year-old female college student presents to student health services with "the flu." She has noted a fever of 38.9 C and myalgias. She is treated with symptomatic care and discharged back to her dormitory. Three hours later her roommate finds her lethargic and difficult to arouse. On exam her blood pressure is 70/30 with a pulse of 145. Her neck is supple but she is lethargic and complaining of severe muscle aches. She denies headache. There is a fine macular rash over her abdomen.

Which of the following is an important historical factor in this case?
A)History of splenectomy.
B)Use of tampons.
C)History of acetaminophen overdose.
D)A and B.
E)A, B, and C.
2

The patient is able to give you the additional history that she does not use tampons and has not taken any medication except for occasional acetaminophen and ibuprofen in recommended doses. She has her spleen.

On the basis of this information you decide that:
A)It is unlikely that this is toxic shock syndrome given that she does not use tampons.
B)The combination of acetaminophen and ibuprofen in this patient with the flu has led to hypotension.
C)Given that she is immunocompetent and has her spleen intact, this cannot be sepsis since it started so quickly.
D)Toxic shock, which was a big problem in the 1980s and early 1990s, no longer occurs since the advent of less absorbent tampons.
E)None of the above.
3

The organism(s) responsible for toxic shock syndrome are:
A)Staphylococcus.
B)Haemophilus influenza.
C)Klebsiella.
D)D) Streptococcus.
E)A and D.
4

Which of the following would you NOT expect to find on laboratory testing?
A)Creatinine of 2.0 mg/dl (normal 1 mg/dl).
B)Elevated ALT/AST.
C)Platelets of 100,000-150,000/mm3 (normal 250,000/mm3).
D)Elevated CPK.
E)All of the above would be found in toxic shock syndrome.
5

Which of the following treatments would be important in this patient?
A)Nafcillin to treat the sepsis.
B)Fluids for IV hydration.
C)Dopamine as a pressor.
D)Dexamethasone.
E)B and C.







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