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She admitted to no previous history. Her husband was a foundry worker and pigeon fancier in his spare time. On examination she was cyanosed but not clubbed. 7 °C, pulse was 130/min, and blood pressure was 120/70 mmHg. Heart sounds were normal, JVP was normal, and there was no peripheral oedema. Widespread inspiratory crepitations were audible. Hb 13. 37. No growth from induced sputum. Mantoux (1/100 tuberculin) negative. Blood cultures negative. Influenza A and B, parainfluenza, adenovirus, Coxiella burnetti, Mycoplasma and Chlamydia psittaci: initial titres negative.
Adrenaline 1 : 1000 had no effect on pupil size. 1% pilocarpine administration: (a) (b) Exam 6 43 1. What is the cause of the anisocoria? 2 A 32-year-old Brazilian plumber on holiday in the UK for two weeks had been on a five-day alcohol binge at a meeting near Stonehenge. He then travelled up to Scotland, where he suffered a generalized tonic–clonic seizure. He had recovered enough on arrival in hospital to inform the staff of his previous good medical health. The casualty officer arranged a CT scan on account of the following eye abnormality: (a) (b) 44 Questions 1.
The only past medical history obtained is of treatment for cellulitis two years previously. Barrier precautions are observed for examination due to a heavy infestation by lice of both head and body. He appears malnourished and unkempt, with numerous excoriations on his trunk and limbs. 1 °C. There is a marked purpuric rash over the extremities, as well as several conjunctival haemorrhages. The circulation is hyperdynamic and there is moderate hepatojugular reflux. A long early diastolic murmur is audible in expiration at the left sternal edge, and there are fine crepitations at both lung bases as well as mild ankle oedema bilaterally.