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Solve the Medical Riddle: Her Daughter Feels as Though the Room is Shrinking, Second Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her daughter’s symptoms and the doctor proceeded with the examination. That was step #1, S, of the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
O=Objective Findings
A=Assessment or Analysis
P=Treatment Plan or Recommendations

This week the doctor will move on to O and A in order to continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will move on to P to reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

The Doctor Looks for Clues to the Medical Riddle

O=Objective Findings

When Marlene brought her daughter Chloe in for an appointment, the doctor took a complete history and ruled out many possible causes of the disturbing episodes during which the room seemed to be shrinking and some colors appeared to be changing in addition to severe fatigue.

O: Objective:
Moving on to “O”, the doctor asked Marlene to take Chloe to an ophthalmologist for a complete eye exam.The eye care specialist found nothing amiss with Chloe’s eyes.

Chloe then returned for a complete physical exam with the PCP. During the exam, the doctor discovered that Chloe had painless but swollen lymph nodes behind her ears and groin. Chloe also had an enlarged spleen.

A=Assessment or Analysis
At this point the doctor suspected infectious mononucleosis, often called the “kissing disease”. Mono can have relatively mild symptoms. Yet it may have neurologic ones because it infects the brain. The doctor told Marlene and Chloe that mono is not highly contagious but that living in close quarters such as a dorm could spread it, as could kissing. Chloe blushed and admitted that she had a new boyfriend at college that she hadn’t mentioned to her parents. “We haven’t done anything but kiss and I don’t think he has mono!” Chloe said. Marlene smiled and said she was glad to hear about the boyfriend. The doctor said that Chloe could have contracted mono at the dorm.

The doctor drew a blood sample for a complete blood count and sent it to a lab. The result was that Chloe’s white blood count was elevated about 18,000 with 12% atypical lymphocytes. This indicated cells fighting the mono virus, which is classic for mono. The mono test was positive and Epstein Barr virus acute antibody was positive.