Ms Oryema, a 32-year-old nurse has recently returned from Uganda where she has spent one month visiting friends and family. Two weeks after returning to the UK, she has become unwell. For the last two days, she has had diarrhoea, fever and abdominal pain. She has also had a cough and headache for the last 24 hours. Her only significant medical history is chronic plaque psoriasis, for which she uses topical emollients and steroids. She has no known drug allergies. She is a non-smoker and drinks around one glass of wine per night. She was born in Uganda but moved to the UK when she was 11 years old and usually lives with her partner in London.
Her observations are:
- Temp 38.3, pulse rate 95bpm, BP 110/75mmHg, respiratory rate 14, Sats 98% on air, GCS 15
- A: airway clear
- B: tachypneoic, air entry bilaterally, no crepitations or wheeze
- C: appears pale and sweaty, heart sounds normal, no peripheral oedema
- D: alert, pupils equal and reactive, no focal neurology
- E: abdomen soft, no masses, mild diffuse tenderness, but no guarding or rebound, bowel sounds present
Question: How would you approach investigating and managing Ms Oryema?
Question setter: Sarah Lawrence, Final Year Peer-assisted learning SSC student at UCL Medical School
Expert: Dr Mike Brown, Senior Lecturer and Consultant Physician in Infectious Diseases, London School of Hygiene and Tropical Medicine and Hospital for Tropical Diseases, UCL