Chronic 2

Blood & Lymphoreticular System

Step 1: View Clinicals

{"ops":[{"insert":"A 72 year old woman presents with progressive, bilateral hearing loss for 1 year.\n\nShe was treated for bilateral otitis media earlier, which included placement of myringotomy tubes. However, her symptoms have not improved.\n\nClose questioning reveals a history of chronic fatigue and dyspnea on exertion for more than 2 years, which she attributed to old age.\n\nHer medical, surgical and family histories are unremarkable and she is not on any medications currently.\n\nHer complete blood count reveals a leukocyte count of 85,600 with 80% lymphocytes, a hemoglobin level of 10.9 g\/dL, and a platelet count of 130,000\/mm3.\n\nA peripheral blood film reveals lymphocytosis, thrombocytopenia and smudge cells.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-115_en.png"}},{"insert":"\n"}]}

Step 2: Order Relevant Investigations

1. Flow Cytometry
2. Bone Marrow Aspiration and Biopsy
3. Biopsy Tympanic Membrane
4. CSF Analysis

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