You are in Resus and a gentleman has been brought in from assessment looking jaundiced and febrile at 38.6°C.

He states that he has noticed that he has been putting weight onto his abdomen and has been feverish on many nights for several weeks. He had consulted his GP who had diagnosed a viral illness. He is concerned, as his wife had noted a yellow tinge to his skin. The triage nurse had asked him if he'd been abroad recently and he'd stated that he hadn't been anywhere for 4 months.

On examination of the abdomen you notice an enlarged tender spleen and that he is jaundiced.


Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What are the possible causes of splenomegaly and which causes would be possible in this case?

  2. What further questions would you like to ask him and why?

  3. What investigations would you order for this gentleman?

    On further questioning you find out that he was stationed in Zimbabwe for 6 months earlier this year and returned to the country 5 months ago. He had remained mostly well out there and had taken malarial prophylaxis.

  4. What are suitable malarial prophylaxis drug regimes?

  5. How would you treat this patient?

  6. What abnormal blood tests might you expect in this case?