Game 5
Solve
in
1
A quite angry customer comes in to your practice.
​
"The doctors are so useless. Couldn't even give me treatment for my condition, how the healthcare system has fell"
​
You do your best to reassure her that you will do your best to assist her. You immediately notice her left eye is filled with tears, and she is covering them. The right eye is slightly red, and her ear area is slightly swollen on the left side.
Solve
in
2
She has no great reaction with light, but looks fairly dazed and confused.
​
"do you have any eyedrops, I think there's something in my eye."
​
You advise her not to rub her eyes, as you go in to stain with fluorescin.
But nothing shows up. The staining was a failure.
Solve
in
3
You decide to inquire her for a bit before you find out that she works at UNSW Optometry Clinic. That's interesting, since you had someone just the other day with almost identical symptoms, and also worked there.
​
What are the chances?
​
Suddenly you freeze. You should probably not have let her into your one and only consultation room, and the negative impact of your initial lack of history taking.
last
chance
You tell her that the doctors were right, and that there is indeed nothing you can do, or anyone. You explain that not only are antiviral drugs ineffective, but her condition is self resolving.
​
You take her temperature, and it turns out she has a fever. You thus tell her to go home and rest easy, whilst also making sure she self-isolates.
​
She doesn't enjoy the prospect of self-isolation, but she understands her predicament
The Answer
Adenoviral Keratitis
​
- Self-limiting and ineffective treatment by antiviral or antibiotics.
- Lack of photophobia indicates corneal epithelium is not involved, and thus no need for steroids
- Generally, due to the high infectivity of adenovirus, you don't want patients entering the consultation room, or risk other patient safety and your own
- Is sort of similar to HSV, except bilateral. Usually starting out unilateral.
- High in office transmissions, with 49 day survival on plastic, 35 day survival on metal. The patient from the same workplace with same disease may indicate transmission