2. Case history and examination
• 24 months old boy brought to emergency
department by her mother with the complaints of
vomiting 3 episodes and loose motions 3-4
episodes with watery consistency in a day. On
examination child is irritable. His heart rate is 120
beats per minute, respiratory rate is 25 breaths
per minute . child is afebrile. he is having dry
mucous membranes and slightly sunken eyes. His
capillary refill time is normal.
3. Case history and examination
• Dheeraj 12 months old boy referred to OPD with
complaint of not gaining weight and poor appetite.
His birth weight was 3 kg. His present weight is
5.5kg and height is 70 cm. His mid upper arm
circumference is 110mm . He has perianal and
perioral excoriations. His hair are wooly and fuzzy
with brown discoloration. He has loose skin folds
There is no pedal edema .
4. Case history and examination
• Tariq is a 2 year old boy presented with bow legs
and poor weight gain. He was breastfed for one
year after that he was having bottle feed with cow
milk. His mother told that he has poor appetite
with poor intake of solids. He has no
gastrointestinal symptoms. His mother feels that he
is not as active as other boys of his age. On
examination he has prominent forehead and bow
leg deformity. He has widened wrists and ankles.
His height is on 25th percentile.
5. Case history and examination
• Yuvan a 5 year old boy presented with the history of
fever, cough, blocked runny nose and sticky eyes for 6
days. On the 4th day of the fever child developed rashes
behind his ear and hair line. Later on rashes became
generalized on whole body. On examination his
temperature was 38.5 degree celsius. His heart rate is
115 beats per minute, respiratory rate 24 per minute
and oxygen saturation is 97%. He has widespread
maculopapular erythematous rashes. There is no
respiratory distress. But he is coughing. He has a
purulent discharge from his right eye.
6. Case history and examination
• 13 year old girl presented in OPD with complain of
passing urine frequently for last 2 days and complaining
of pain when doing so. She had a temperature of 39
degree celsius .She had an episode of violent shivering.
She has also complain of pain in her back and lower
abdomen and has vomited 3 times today. On
examination she is flushed and miserable. Her
temperature is 39.1 degree celsius, heart rate 100 beats
per minute, respiratory rate 16 breaths per minute. Her
abdomen feels soft and not distended. But there is
significant discomfort when palpating the lower
abdomen.
7. Case history and examination
• Raina is a 6 year old girl who presents to emergency
department with red coloured urine. She has got a jar
of urine which contains a reddish brown urine. She has
no dysuria, frequency or abdominal pain and there is
no history of trauma. She is otherwise well but she had
a recent episode of cold and throat pain 7 days back.
There is no nosebleed or abdominal bruising. Joints are
normal. On examination there is no anaemia. She is
afebrile. There is no skin rash or bruising.. There is no
edema of legs. Blood pressure is 124 /80 mm hg(raised)
8. Case history and examination
• Anshul is a 3 year old boy who presents to
paediatric OPD with five days history of puffy eyes
and puffy (swollen )face.On examination he looks
well and is afebrile. He has puffy eyes and pitting
pedal edema. Pulse is 112 beats per minute . blood
pressure is 98 / 70 mm HG . there is no abdominal
distension, tenderness or organomegaly. His
scrotum appears edematous. Respiratory rate is 28
breaths per minute. There are no abnormal
respiratory signs.
9. Case history and examination
• Rekha a 2 years old female child presented with
the complain of cough, cold and fever since 5 days.
She is not feeding well according to her mother.
Yesterday child developed difficulty in breathing.
On examination her temperature is 38.8 degrees
celsius. Her heart rate is 120 beats per minute
.Respiratory rate is 55 breaths per minute. There
are intercostal retractions in bilateral lower chest.
On auscultation there are fine crepts all over the
chest
10. Case history and examination
• Meena 10 years old female child presented with
complain of pain in her right chest, fever and cough.
On examination she is looking miserable, flushed, toxic
and febrile with normal capillary refill time. Her pulse is
110 beats per minute and oxygen saturation is 91% in
air with normal blood pressure. She seems to be in pain
especially when she coughs and her respiratory rate is
38 breaths per minute with nasal flaring .There is stony
dull sound on percussion in right lower zone
posteriorly and absent air entry in that area.
11. Case history and examination
• 5 years old rehan presented in paediatric OPD
with complain of easy fatigability since 15 days. His
mother told that his child eats non edible
substances such as mud scrapping of wall ice etc.
On examination child was looking pale. Nails were
thin, brittle and spoon shaped (koilonychia).
12. Case history and examination
• 5 year old pinky presented in OPD with complain
of fever with chills and rigors, headache and
vomiting since 5 days. Her mother gave the history
of fever on alternate days. On examination child is
looking pale. His temperature is 38.8 degree
celsius.Per abdomen liver is 2cm below costal
margin and spleen is 5cm below costal margin.CNS
examination is normal.
13. Case history and examination
3 years old Ravi admitted in paediatric emergency
with history of loose motions, abdominal pain and
fever. Her mother told that there are 4 to 5 episodes
of loose stools, child complaints pain abdomen
before passing stools. Blood and pus present in
stools. On examination child is crying but alert
.Tongue is moist. Child drinks normally , skin pinch
goes back quickly and passing urine adequately.
14. Case history and examination
• 4 years old Rahul presented in paediatric OPD with
history of yellow discoloration of urine, pain
abdomen, mild fever, malaise, decreased appetite
and vomiting. On examination temperature is 38
degree celsius, pulse rate 100 beats per minute
and respiratory rate is normal, sclera is yellow.
Liver is 4 cm below costal margin. There is
tenderness over right hypochondrium
15. Case history and examination
• 7 years old Raju presented in pediatric emergency
department with complain of dry cough, fever and
decreased appetite since one month .Her mother is
saying that his clothes became very loose. Raju's
grandfather has cough with expectoration since 3
months for which he is taking treatment. On
examination child is looking malnourished and pale.
He is febrile. His respiratory rate is 38 breaths per
minute. On auscultation decreased air entry and
crepts are present on right upper chest with
bronchial breathing.
16. Case history and examination
• Rita is a 7 year old girl who presented to our pediatric unit
with a abnormal face. Her mother noticed that saliva was
drooling from the left side of her mouth and her left eyelid
has been drooping. When she smiles her face becomes very
asymmetric .She is otherwise well but that drooling has
made eating and drinking difficult. Her left eye also feels
dry. The child's mouth droops on the left side. Her smile in
particular is asymmetric. It is well delineated with the
normal facial creases on the right side of the face but on left
side it is poorly formed and weak he is also unable to shut
his left eye. No cranial nerve abnormality. Neurological
examination otherwise normal. Otoscopy is normal. Blood
pressure is normal.
•
17. Case history and examination
• Sonu 1 year old male child presented in pediatric
department with history of fever ,irritability
,vomiting, refusal to feed ,excessive cry and
convulsions. On examination he is febrile. His
heart rate is 120 beats per minute and respiratory
rate is 40 breaths per minute. His anterior
fontanelle is bulging.
18. Case history and examination
• Rani 4 years old female child brought in emergency
with complain of loose motions and vomiting. She
has the history of watery diarrhea 7 to 8 episodes
in a day and vomiting 4 to 5 episodes. On
examination she is drowsy. Her tongue is dry. Skin
pinch is very slow going, pulse is feeble and
decreased urine output .
19. Case history and examination
• Harsh 5 years old child admitted in paediatric
emergency with history of cough, cold and fever
since 6 days. On examination her respiratory rate is
48 per minutes her heart rate is 110 beats per
minutes. Her saturation is 88% without oxygen. Air
entry is significantly reduced on left side of chest.
On percussion the left side of chest is hyper
resonant. On auscultation absent breath sounds in
left side of chest.
