Paediatrics Clerking Sheet- Shapi.pdf
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This is a presentation that will help a clinician develop information by asking questions. Ultimately, the answers will give the clinician an idea of what could be wrong with his/her patient
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Bronchiolitis | Case Study
- Bronchiolitis is a common viral infection that affects the lower respiratory tract of infants, caused primarily by respiratory syncytial virus. It presents with cough, wheezing, difficulty breathing and is usually self-limiting.
- Treatment focuses on supportive care like fluids, oxygen therapy, and monitoring for dehydration or respiratory distress. Medications like bronchodilators or antibiotics are not routinely recommended.
- Hospitalization is considered if the infant has toxic appearance, poor feeding, respiratory distress, apnea or hypoxemia. The clinical status, fluid balance and oxygen levels should be closely monitored.
CASE PRESENTATION ON BILATERAL BARTHOLIN CYST
A 24-year-old female patient presented with a bilateral Bartholin cyst that had been swelling and painful for 5 months. Physical examination and ultrasound revealed well-defined masses on the inner side of both labia, measuring 3.3 x 2.5 cm on the left and 2.9 x 2.2 cm on the right. The patient underwent incision and drainage of the cysts, with 10ml and 5ml of pus drained from the left and right cysts respectively. Post-procedure, the patient was discharged with medications including antibiotics and sitz bath instructions to prevent further complications and support healing.
Bronchiolitis -case presentation
3 month old baby Fathima Sampra presented with cough for 7 days. The cough was worse when lying down and caused waking at night. On examination, the baby had increased respiratory rate and bilateral crepitation at the lung bases. Differential diagnoses included bronchiolitis, bronchial asthma, and pneumonia. Treatment involved nebulized ipratropium and hypertonic saline, along with saline nasal drops. Oxygen supplementation was not needed as the baby's saturation was normal.
A Case Presentation on Febrile Seizures
This case presentation describes a 9-month-old male child admitted to the pediatric unit with febrile seizures. He presented with a 1-week history of fever, cough and cold, and experienced 3 seizure episodes lasting 10 minutes each. His condition was diagnosed as complex (atypical) febrile seizures. His treatment included antibiotics, anticonvulsants, and supportive care. Febrile seizures typically occur in children 6 months to 5 years old during fevers caused by infections and resolve on their own without long-term issues.
Newborn history and examination
This document provides guidance on performing a newborn history and examination. It outlines key components to include in the history such as the mother's obstetric history, antenatal care, labor/delivery details, and newborn's immediate care and current problems. The examination section describes assessing the newborn's appearance, vital signs, measurements, and performing a full physical exam including the neurological exam and evaluating primary reflexes like the Moro reflex. The goal is to obtain a thorough history and perform an examination of all body systems to identify any issues in the newborn.
Clinical pictures & complication of meningitis
The document summarizes the clinical pictures and complications of meningitis. Common symptoms of meningitis include fever, headache, vomiting, and stiff neck. In infants and young children, symptoms may include crying, lethargy, refusal of food, and pale appearance. Potential complications include disseminated intravascular coagulation, encephalitis, persistent fever, seizures, brain damage, vision or hearing loss, learning disabilities, paralysis, and in severe cases opisthotonos, coma, or death. Newborns are also at risk of heart, liver or intestinal problems and malformed limbs.
Case Presentation On Respiratory Medicine
A 68-year-old male presented with a 1-month history of persistent dry cough, nocturnal coughing exacerbations, hemoptysis, and chest pain exacerbated by coughing, along with weight loss and malaise. He had a history of recurrent gastrointestinal bleeding, exposure to tuberculosis, and long-term exposure to cable processing industry. Examination found decreased breath sounds and dullness on the right lung. Investigations showed anemia, elevated ESR, and a consolidation in the right lower lobe on HRCT with pleural adhesions. A provisional diagnosis of carcinoma, tuberculosis, or interstitial lung disease was made.
Paediatrics - Case presentation: fever+rash
This document presents a case history for a 6-year-old boy, S.K., who presented with a rash and fever. Over 4 days, the rash spread and he developed swelling of the hands, vomiting, diarrhea, and worsening fever. Differential diagnoses included viral exanthems, scarlet fever, toxin-mediated rash, and Kawasaki disease. On examination, he had a maculopapular rash, swollen throat and tonsils, and swelling of the hands and lower limbs. Investigations and management for potential scarlet fever were discussed.
Recommended
Bronchiolitis | Case Study
- Bronchiolitis is a common viral infection that affects the lower respiratory tract of infants, caused primarily by respiratory syncytial virus. It presents with cough, wheezing, difficulty breathing and is usually self-limiting.
- Treatment focuses on supportive care like fluids, oxygen therapy, and monitoring for dehydration or respiratory distress. Medications like bronchodilators or antibiotics are not routinely recommended.
- Hospitalization is considered if the infant has toxic appearance, poor feeding, respiratory distress, apnea or hypoxemia. The clinical status, fluid balance and oxygen levels should be closely monitored.
CASE PRESENTATION ON BILATERAL BARTHOLIN CYST
A 24-year-old female patient presented with a bilateral Bartholin cyst that had been swelling and painful for 5 months. Physical examination and ultrasound revealed well-defined masses on the inner side of both labia, measuring 3.3 x 2.5 cm on the left and 2.9 x 2.2 cm on the right. The patient underwent incision and drainage of the cysts, with 10ml and 5ml of pus drained from the left and right cysts respectively. Post-procedure, the patient was discharged with medications including antibiotics and sitz bath instructions to prevent further complications and support healing.
Bronchiolitis -case presentation
3 month old baby Fathima Sampra presented with cough for 7 days. The cough was worse when lying down and caused waking at night. On examination, the baby had increased respiratory rate and bilateral crepitation at the lung bases. Differential diagnoses included bronchiolitis, bronchial asthma, and pneumonia. Treatment involved nebulized ipratropium and hypertonic saline, along with saline nasal drops. Oxygen supplementation was not needed as the baby's saturation was normal.
A Case Presentation on Febrile Seizures
This case presentation describes a 9-month-old male child admitted to the pediatric unit with febrile seizures. He presented with a 1-week history of fever, cough and cold, and experienced 3 seizure episodes lasting 10 minutes each. His condition was diagnosed as complex (atypical) febrile seizures. His treatment included antibiotics, anticonvulsants, and supportive care. Febrile seizures typically occur in children 6 months to 5 years old during fevers caused by infections and resolve on their own without long-term issues.
Newborn history and examination
This document provides guidance on performing a newborn history and examination. It outlines key components to include in the history such as the mother's obstetric history, antenatal care, labor/delivery details, and newborn's immediate care and current problems. The examination section describes assessing the newborn's appearance, vital signs, measurements, and performing a full physical exam including the neurological exam and evaluating primary reflexes like the Moro reflex. The goal is to obtain a thorough history and perform an examination of all body systems to identify any issues in the newborn.
Clinical pictures & complication of meningitis
The document summarizes the clinical pictures and complications of meningitis. Common symptoms of meningitis include fever, headache, vomiting, and stiff neck. In infants and young children, symptoms may include crying, lethargy, refusal of food, and pale appearance. Potential complications include disseminated intravascular coagulation, encephalitis, persistent fever, seizures, brain damage, vision or hearing loss, learning disabilities, paralysis, and in severe cases opisthotonos, coma, or death. Newborns are also at risk of heart, liver or intestinal problems and malformed limbs.
Case Presentation On Respiratory Medicine
A 68-year-old male presented with a 1-month history of persistent dry cough, nocturnal coughing exacerbations, hemoptysis, and chest pain exacerbated by coughing, along with weight loss and malaise. He had a history of recurrent gastrointestinal bleeding, exposure to tuberculosis, and long-term exposure to cable processing industry. Examination found decreased breath sounds and dullness on the right lung. Investigations showed anemia, elevated ESR, and a consolidation in the right lower lobe on HRCT with pleural adhesions. A provisional diagnosis of carcinoma, tuberculosis, or interstitial lung disease was made.
Paediatrics - Case presentation: fever+rash
This document presents a case history for a 6-year-old boy, S.K., who presented with a rash and fever. Over 4 days, the rash spread and he developed swelling of the hands, vomiting, diarrhea, and worsening fever. Differential diagnoses included viral exanthems, scarlet fever, toxin-mediated rash, and Kawasaki disease. On examination, he had a maculopapular rash, swollen throat and tonsils, and swelling of the hands and lower limbs. Investigations and management for potential scarlet fever were discussed.
Hepatospleenomegaly in children
Approach in children with Hepatosplenomegaly
To summarize the key points:
1. A full examination including inspection, palpation, percussion and auscultation of the abdomen should be performed to evaluate for hepatosplenomegaly.
2. Common causes include infections, hematological disorders, vascular congestion, tumors and infiltrations, and storage disorders.
3. Initial investigations should include a complete blood count, liver function tests, ultrasound and further testing based on history and exam findings.
4. Treatment is directed at the underlying cause and may include antibiotics for infections, chemotherapy for tumors, or management of metabolic disorders.
Acute appendicitis -Case Presentation
Turki Ali Ahmed, a 37-year old Saudi male, presented to the emergency room with sharp right lower quadrant pain for two days. On examination, he had tenderness in the right lower quadrant with rebound and other signs positive for acute appendicitis. Laboratory tests showed elevated white blood cell count. The differential diagnosis included appendicitis, testicular torsion, urinary tract infection, kidney stones, and inflammatory bowel disease. Given the clinical findings, appendicitis was considered provisional. The patient was admitted for IV fluids, NPO status, and pre-op management. He then underwent an open appendectomy and was started on IV antibiotics and pain medications post-surgery.
Fever in children
Fever is a common reason children see doctors and causes concern for parents. A fever is defined as a temperature over 37.2°C before noon or 37.7°C after noon. Fever occurs due to infection, inflammation or injury and raises the hypothalamic temperature set point. While sometimes indicating a minor self-limiting infection, fever can also signal a serious disorder. The document discusses evaluating fever, defining related terms like bacteremia and sepsis, the pathophysiology of fever production, and methods for safely measuring a child's temperature.
Pediatric pneumonia
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
normal New born case sheet Dr.Shanmugasundaram
its an undergraduate level case sheet for normal new born without any complications we can alter the history and examination according to findings
History taking in neurology 2012
This document outlines the components of a neurological history. It discusses establishing the main complaint, performing a detailed symptom analysis and chronological history, and conducting a systematic neurological examination. Specific symptoms related to areas like headaches, seizures, motor and sensory function are described. Taking a full history of the patient's medical, social, and family histories is also emphasized to understand the illness from their perspective. The goal is to understand the biomedical and contextual aspects of the neurological problem.
Febrile seizures
This case presentation discusses a 1 year and 2 month old female child admitted to the hospital with febrile seizures. The child presented with a history of fever and two episodes of abnormal movements involving stiffening and up rolling of the eyes. On examination, the child was conscious with tachycardia and normal temperature. Laboratory investigations revealed microcytic hypochromic anemia. The child was diagnosed with febrile seizures and treated with intravenous antibiotics, anticonvulsants and antipyretics. The child improved with treatment and was discharged on oral medications including anticonvulsants and antipyretics to prevent recurrence of seizures during fever.
History taking
This document outlines the clinical approach to evaluating a patient presenting with cough, including taking a thorough history. Key aspects of the history include determining onset and duration of cough, characterizing the cough, examining sputum production, and identifying aggravating/relieving factors and associated symptoms. A detailed medical history including past illnesses, treatments, and family history is also important. Differential diagnoses that may cause cough include pneumonia, asthma, COPD, bronchiectasis, and lung cancer among others. A targeted history can help identify the underlying cause and guide appropriate management.
Approach to URTI
- Harshad has mild croup based on the description provided.
- Treatment for mild croup would include:
1. Reassurance to parents
2. Oral/nebulized steroids (dexamethasone/budesonide)
3. Ensure adequate hydration
4. Monitor for worsening of symptoms which may require nebulized adrenaline/hospitalization.
L3.approach to fever
This document provides information on fever (pyrexia), including:
1. Thermoregulation and how the body maintains a normal temperature of 37°C through the hypothalamus despite environmental variations.
2. Features of a normal body temperature and what constitutes a fever. Fever enhances the immune system and inhibits some microbes.
3. Patterns of fever onset, main phases, and end. Fever's diagnostic features and the importance of taking a thorough medical history are also outlined.
Approch to cough in children
This document provides an overview of the approach to cough in children. It begins with background on cough and the cough reflex pathway. It then discusses classifications of cough based on duration, quality, and etiology. The document outlines the important components of history taking and physical examination for a child with cough. It recommends investigations such as chest X-ray, pulmonary function tests, and bronchoscopy if needed. The document concludes with guidelines for managing cough in children based on its underlying cause.
Febrile seizures
Febrile seizures are common in young children under 6 years old, occurring in 2-4% of children. They are convulsions associated with a fever over 38°C without an infection of the brain or metabolic abnormality. Febrile seizures are categorized as simple or complex based on duration and features. Treatment involves antipyretics to reduce fever along with anticonvulsants if seizures last more than 5 minutes. While concerning for parents, febrile seizures are generally benign and do not require long-term anticonvulsant treatment in otherwise healthy children with simple febrile seizures.
Approach to a child with Hepatosplenomegaly
This document discusses hepatosplenomegaly, or the enlargement of the liver and spleen. It begins with an introduction and overview of hepatomegaly and splenomegaly. It then covers the various causes of hepatosplenomegaly including infections, hematological disorders, vascular congestion, tumors and infiltrations, storage disorders, and miscellaneous causes. The document provides details on evaluating a patient's history, physical examination findings, investigations, and treatment strategies for hepatosplenomegaly in both children and neonates. It concludes with references for further information.
Acute chest syndrome (sickle cell)
This document defines and discusses acute chest syndrome (ACS) in patients with sickle cell disease. ACS is characterized by fever, respiratory symptoms, and new lung infiltrates seen on chest x-ray. It is commonly caused by infection, fat embolism, or hypoventilation. Clinical features include chest pain and symptoms like cough. Diagnosis can be challenging as symptoms may be mild and radiological signs lag behind. Treatment involves oxygen, IV fluids, pain management, respiratory support like bronchodilators, and antibiotics. Preventing recurrent ACS involves therapies like hydroxyurea and long-term blood transfusions. Distinguishing asthma from wheezing caused by sickle cell disease can also be difficult.
Case presentation in Dermatology erythrodermic psoriasis
- Ahmad, a 50-year-old male, presented with generalized redness and scaling of his skin that began 3 days prior. He had a history of plaque psoriasis 5 years earlier.
- On examination, he had widespread erythema and thick scaling affecting over 90% of his skin surface, thick scaling of his scalp, and nail dystrophy.
- He was diagnosed with erythrodermic psoriasis based on his history of psoriasis, presentation of widespread redness and scaling, and physical examination findings. Erythrodermic psoriasis is a potentially life-threatening exacerbation of psoriasis involving over 90% of the skin surface.
An approach to a child with fever
Here are the answers to the questions:
1. D
2. C
3. A
4. A
5. A, B
6. D
7. D
8. B
An Interesting Case of Seizure
A 17-year-old female presented with seizures for the past 6 months. On examination, she was found to have hypocalcemia with a serum calcium level of 5.7 mg/dl. Further workup revealed low levels of parathyroid hormone, indicating hypoparathyroidism as the cause of her hypocalcemia and seizures. Brain CT and EEG were normal. She was started on calcium and vitamin D supplementation, which improved her symptoms and lab abnormalities.
Childhood TB
Tuberculosis is caused by Mycobacterium tuberculosis and is a chronic infectious disease characterized by vague symptoms and a protracted course. India accounts for one third of the global TB burden, with 15 million infected people in India and 3-4 million of those being children. Tuberculosis most commonly enters the body through inhalation and can spread through droplets or ingestion. Primary infection typically occurs in the lungs or lymph nodes and may heal or progress to more serious complications affecting multiple organs if not contained. Common symptoms in children include failure to thrive, fever, and painless lymphadenopathy.
case presentation on neonatal jaundice
This case presentation describes a 3 day old baby boy who presented with jaundice. The baby's mother had borderline gestational diabetes that was controlled with diet. The baby was delivered via normal vaginal delivery at 37 weeks with good APGAR scores. On the third day of life, the baby developed yellowish discoloration of the skin and eyes. Initial workup found a serum bilirubin level above the exchange transfusion threshold. The baby was started on triple phototherapy and given IV fluids and FFP. Over the next few days, the bilirubin level decreased with phototherapy and the baby was discharged once the level was well below the phototherapy threshold.
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
This document discusses splenomegaly and hypersplenism, including their causes, clinical features, and surgical management. The spleen's anatomy and functions are described. Causes of splenomegaly and hypersplenism include increased function (e.g. hereditary spherocytosis), abnormal blood flow (e.g. cirrhosis), and infiltration (e.g. Gaucher's disease). Indications for splenectomy include bleeding disorders and refractory cases. Surgical techniques including open and laparoscopic splenectomy are outlined, as well as postoperative care and complications.
Pediatric history & physical exam
This document provides guidance on performing pediatric history and physical examinations for anesthesia students. It outlines key differences compared to adult exams, including relying more on the parent as historian and examining the child at their level. The history should include prenatal, birth, developmental, immunization and family histories. The physical exam evaluates vital signs, growth parameters, and unique pediatric findings for each body system from head to lungs. Examinations require understanding developmental stages and using distraction to minimize distress.
Pediatric history & physical exam
This document provides guidance on performing pediatric history and physical examinations for anesthesia students. It outlines key differences compared to adult exams, including relying more on the parent as historian and examining the child at their level. The history should include prenatal, birth, developmental, immunization and family histories. The physical exam evaluates vital signs, growth parameters, and unique pediatric findings for each body system from head to lungs. Examinations require understanding developmental stages and using distraction to minimize distress.
More Related Content
What's hot
Hepatospleenomegaly in children
Approach in children with Hepatosplenomegaly
To summarize the key points:
1. A full examination including inspection, palpation, percussion and auscultation of the abdomen should be performed to evaluate for hepatosplenomegaly.
2. Common causes include infections, hematological disorders, vascular congestion, tumors and infiltrations, and storage disorders.
3. Initial investigations should include a complete blood count, liver function tests, ultrasound and further testing based on history and exam findings.
4. Treatment is directed at the underlying cause and may include antibiotics for infections, chemotherapy for tumors, or management of metabolic disorders.
Acute appendicitis -Case Presentation
Turki Ali Ahmed, a 37-year old Saudi male, presented to the emergency room with sharp right lower quadrant pain for two days. On examination, he had tenderness in the right lower quadrant with rebound and other signs positive for acute appendicitis. Laboratory tests showed elevated white blood cell count. The differential diagnosis included appendicitis, testicular torsion, urinary tract infection, kidney stones, and inflammatory bowel disease. Given the clinical findings, appendicitis was considered provisional. The patient was admitted for IV fluids, NPO status, and pre-op management. He then underwent an open appendectomy and was started on IV antibiotics and pain medications post-surgery.
Fever in children
Fever is a common reason children see doctors and causes concern for parents. A fever is defined as a temperature over 37.2°C before noon or 37.7°C after noon. Fever occurs due to infection, inflammation or injury and raises the hypothalamic temperature set point. While sometimes indicating a minor self-limiting infection, fever can also signal a serious disorder. The document discusses evaluating fever, defining related terms like bacteremia and sepsis, the pathophysiology of fever production, and methods for safely measuring a child's temperature.
Pediatric pneumonia
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
normal New born case sheet Dr.Shanmugasundaram
its an undergraduate level case sheet for normal new born without any complications we can alter the history and examination according to findings
History taking in neurology 2012
This document outlines the components of a neurological history. It discusses establishing the main complaint, performing a detailed symptom analysis and chronological history, and conducting a systematic neurological examination. Specific symptoms related to areas like headaches, seizures, motor and sensory function are described. Taking a full history of the patient's medical, social, and family histories is also emphasized to understand the illness from their perspective. The goal is to understand the biomedical and contextual aspects of the neurological problem.
Febrile seizures
This case presentation discusses a 1 year and 2 month old female child admitted to the hospital with febrile seizures. The child presented with a history of fever and two episodes of abnormal movements involving stiffening and up rolling of the eyes. On examination, the child was conscious with tachycardia and normal temperature. Laboratory investigations revealed microcytic hypochromic anemia. The child was diagnosed with febrile seizures and treated with intravenous antibiotics, anticonvulsants and antipyretics. The child improved with treatment and was discharged on oral medications including anticonvulsants and antipyretics to prevent recurrence of seizures during fever.
History taking
This document outlines the clinical approach to evaluating a patient presenting with cough, including taking a thorough history. Key aspects of the history include determining onset and duration of cough, characterizing the cough, examining sputum production, and identifying aggravating/relieving factors and associated symptoms. A detailed medical history including past illnesses, treatments, and family history is also important. Differential diagnoses that may cause cough include pneumonia, asthma, COPD, bronchiectasis, and lung cancer among others. A targeted history can help identify the underlying cause and guide appropriate management.
Approach to URTI
- Harshad has mild croup based on the description provided.
- Treatment for mild croup would include:
1. Reassurance to parents
2. Oral/nebulized steroids (dexamethasone/budesonide)
3. Ensure adequate hydration
4. Monitor for worsening of symptoms which may require nebulized adrenaline/hospitalization.
L3.approach to fever
This document provides information on fever (pyrexia), including:
1. Thermoregulation and how the body maintains a normal temperature of 37°C through the hypothalamus despite environmental variations.
2. Features of a normal body temperature and what constitutes a fever. Fever enhances the immune system and inhibits some microbes.
3. Patterns of fever onset, main phases, and end. Fever's diagnostic features and the importance of taking a thorough medical history are also outlined.
Approch to cough in children
This document provides an overview of the approach to cough in children. It begins with background on cough and the cough reflex pathway. It then discusses classifications of cough based on duration, quality, and etiology. The document outlines the important components of history taking and physical examination for a child with cough. It recommends investigations such as chest X-ray, pulmonary function tests, and bronchoscopy if needed. The document concludes with guidelines for managing cough in children based on its underlying cause.
Febrile seizures
Febrile seizures are common in young children under 6 years old, occurring in 2-4% of children. They are convulsions associated with a fever over 38°C without an infection of the brain or metabolic abnormality. Febrile seizures are categorized as simple or complex based on duration and features. Treatment involves antipyretics to reduce fever along with anticonvulsants if seizures last more than 5 minutes. While concerning for parents, febrile seizures are generally benign and do not require long-term anticonvulsant treatment in otherwise healthy children with simple febrile seizures.
Approach to a child with Hepatosplenomegaly
This document discusses hepatosplenomegaly, or the enlargement of the liver and spleen. It begins with an introduction and overview of hepatomegaly and splenomegaly. It then covers the various causes of hepatosplenomegaly including infections, hematological disorders, vascular congestion, tumors and infiltrations, storage disorders, and miscellaneous causes. The document provides details on evaluating a patient's history, physical examination findings, investigations, and treatment strategies for hepatosplenomegaly in both children and neonates. It concludes with references for further information.
Acute chest syndrome (sickle cell)
This document defines and discusses acute chest syndrome (ACS) in patients with sickle cell disease. ACS is characterized by fever, respiratory symptoms, and new lung infiltrates seen on chest x-ray. It is commonly caused by infection, fat embolism, or hypoventilation. Clinical features include chest pain and symptoms like cough. Diagnosis can be challenging as symptoms may be mild and radiological signs lag behind. Treatment involves oxygen, IV fluids, pain management, respiratory support like bronchodilators, and antibiotics. Preventing recurrent ACS involves therapies like hydroxyurea and long-term blood transfusions. Distinguishing asthma from wheezing caused by sickle cell disease can also be difficult.
Case presentation in Dermatology erythrodermic psoriasis
- Ahmad, a 50-year-old male, presented with generalized redness and scaling of his skin that began 3 days prior. He had a history of plaque psoriasis 5 years earlier.
- On examination, he had widespread erythema and thick scaling affecting over 90% of his skin surface, thick scaling of his scalp, and nail dystrophy.
- He was diagnosed with erythrodermic psoriasis based on his history of psoriasis, presentation of widespread redness and scaling, and physical examination findings. Erythrodermic psoriasis is a potentially life-threatening exacerbation of psoriasis involving over 90% of the skin surface.
An approach to a child with fever
Here are the answers to the questions:
1. D
2. C
3. A
4. A
5. A, B
6. D
7. D
8. B
An Interesting Case of Seizure
A 17-year-old female presented with seizures for the past 6 months. On examination, she was found to have hypocalcemia with a serum calcium level of 5.7 mg/dl. Further workup revealed low levels of parathyroid hormone, indicating hypoparathyroidism as the cause of her hypocalcemia and seizures. Brain CT and EEG were normal. She was started on calcium and vitamin D supplementation, which improved her symptoms and lab abnormalities.
Childhood TB
Tuberculosis is caused by Mycobacterium tuberculosis and is a chronic infectious disease characterized by vague symptoms and a protracted course. India accounts for one third of the global TB burden, with 15 million infected people in India and 3-4 million of those being children. Tuberculosis most commonly enters the body through inhalation and can spread through droplets or ingestion. Primary infection typically occurs in the lungs or lymph nodes and may heal or progress to more serious complications affecting multiple organs if not contained. Common symptoms in children include failure to thrive, fever, and painless lymphadenopathy.
case presentation on neonatal jaundice
This case presentation describes a 3 day old baby boy who presented with jaundice. The baby's mother had borderline gestational diabetes that was controlled with diet. The baby was delivered via normal vaginal delivery at 37 weeks with good APGAR scores. On the third day of life, the baby developed yellowish discoloration of the skin and eyes. Initial workup found a serum bilirubin level above the exchange transfusion threshold. The baby was started on triple phototherapy and given IV fluids and FFP. Over the next few days, the bilirubin level decreased with phototherapy and the baby was discharged once the level was well below the phototherapy threshold.
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
This document discusses splenomegaly and hypersplenism, including their causes, clinical features, and surgical management. The spleen's anatomy and functions are described. Causes of splenomegaly and hypersplenism include increased function (e.g. hereditary spherocytosis), abnormal blood flow (e.g. cirrhosis), and infiltration (e.g. Gaucher's disease). Indications for splenectomy include bleeding disorders and refractory cases. Surgical techniques including open and laparoscopic splenectomy are outlined, as well as postoperative care and complications.
What's hot (20)
Case presentation in Dermatology erythrodermic psoriasis
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Similar to Paediatrics Clerking Sheet- Shapi.pdf
Pediatric history & physical exam
This document provides guidance on performing pediatric history and physical examinations for anesthesia students. It outlines key differences compared to adult exams, including relying more on the parent as historian and examining the child at their level. The history should include prenatal, birth, developmental, immunization and family histories. The physical exam evaluates vital signs, growth parameters, and unique pediatric findings for each body system from head to lungs. Examinations require understanding developmental stages and using distraction to minimize distress.
Pediatric history & physical exam
This document provides guidance on performing pediatric history and physical examinations for anesthesia students. It outlines key differences compared to adult exams, including relying more on the parent as historian and examining the child at their level. The history should include prenatal, birth, developmental, immunization and family histories. The physical exam evaluates vital signs, growth parameters, and unique pediatric findings for each body system from head to lungs. Examinations require understanding developmental stages and using distraction to minimize distress.
SOAP NOTE SAMPLE FORMAT FOR MRCNameDateTime AgeS.docx
SOAP NOTE SAMPLE FORMAT FOR MRC
Name:
Date:
Time:
Age:
Sex:
SUBJECTIVE
CC:
“ .”
HPI:
.
Current Medications:
PMHx:
Allergies:
Medication Intolerances:
Chronic Illnesses/Major traumas
Hospitalizations/Surgeries
Family History
Social History
ROS
General
Cardiovascular
Skin
Respiratory
Eyes
Gastrointestinal
Ears
Genitourinary/Gynecological
Nose/Mouth/Throat
Breast
Neurological
Heme/Lymph/Endo
Psychiatric
OBJECTIVE
Weight lb
Temp -
BP
Height 5’1
Pulse
Respiration
General Appearance
Skin
HEENT
Cardiovascular
Respiratory
Gastrointestinal
Genitourinary
Musculoskeletal
Full ROM seen in all 4 extremities as patient moved about the exam room.
Neurological
Speech clear. Good tone. Posture erect. Balance stable; gait normal.
Psychiatric
Alert and oriented. Dressed in clean clothes. Maintains eye contact. Answers questions appropriately.
Lab Tests
Special Tests- No ordered at this time.
Diagnosis
Differential Diagnoses
Diagnosis
Plan/Therapeutics
· Plan:
· Medication –
· Education –
· Follow-up –
References
.
Physical diagnosis
The document provides guidelines for performing a pediatric clinical diagnosis, including taking a thorough patient history, conducting a full physical examination involving multiple body systems, and documenting findings. The physical exam section details how to assess things like vital signs, growth measurements, skin appearance, and examination of specific organ systems like heart, lungs, abdomen, and musculoskeletal system.
All clinico social formats
This case summary provides details of an under-5 child presenting with failure to gain weight. The key details include:
1. The child's birth history, including preterm delivery, low birth weight, and initiation of breastfeeding.
2. History of the current complaints of failure to gain weight, fever, cough and respiratory difficulty.
3. Past medical history noting recurrent infections, hospitalizations, and treatment history.
4. Socioeconomic factors like family income, ration card status, mother's antenatal and birth history are also documented.
5. A comprehensive history is taken to understand the physical, nutritional and social determinants influencing the child's health and development.
Case study format (Nursing)
A case study is a research method involving an up-close, in-depth, and detailed examination of a particular case.
Paediatric history
Paediatric history and examination
Paediatric history
Summary
Standard history, plus the paediatric extras, BINDS:
Birth
Immunisations
Nutritrion/feeding
Development
Social history in detail, including School, Siblings, Smoking (parents), Salaries (parents' jobs), and Social services input.
Past medical history
Key points: previous hospital admissions (inc. surgery), or out of hours GP or walk-in centre.
Ask specifically about asthma.
1 Hx & PE in pediatrics
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Paediatric_Clerkship-1.pdf
This document provides a template for documenting a pediatric patient history and physical exam. It includes sections for identifying information, chief complaint, history of present illness, review of systems, past medical history, antenatal/natal/neonatal history, immunization history, dietary history, developmental history, family social history, and a physical exam. The physical exam section includes assessing the patient's general appearance, vital signs, and examination of specific body systems and features.
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It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
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Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
History Taking
This document provides guidance on performing a thorough patient history. It outlines the key components of a patient history, including chief complaint, history of present illness, past medical history, drug history, family history, and social history. The importance of obtaining an accurate history is emphasized as it allows the healthcare provider to determine the etiology of the patient's problem. Guidelines are provided on how to conduct each part of the history respectfully and obtain relevant information through active listening and open-ended questioning.
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dental history taking
A case history provides essential clinical information to arrive at an accurate diagnosis and treatment plan. It involves gathering details from the chief complaint, medical history, dental history, and diagnostic tests. A thorough case history examination covers vital statistics, medical/dental histories, a review of symptoms, and physical and dental examinations. This information is analyzed to form provisional and differential diagnoses before confirming the final diagnosis and developing an appropriate treatment plan. A case history is a critical part of the clinical decision making process.
Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
Running head: SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1
SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 7
Skin Conditions and Differential Diagnosis
Adesola Turner
Walden University
NURS-6512N-17
Advanced Health Assessment.
December 22, 2019.
Introduction
The number 2 graphic (figure below) is characterized as Cherry angiomas that appear in older adults. With time cherry angiomas turn dark, though after infection it is identified by round tiny bright ruby red papules. As age numerically increase Dunphy et al (2015) argues that the disease virtually occurs to everyone above the age of 30 years. One of the ways in which I would perform differential diagnosis is by observing the skin of a patient who is 70 years of age.
Graphic #2
Patient Initials: AB Age: 70 Gender: male
SUBJECTIVE DATA:
Chief Complaint (CC): AB comes in clinic complaining about development of hard red bumps on the chest
History of Present Illness (HPI): Patient AB who is 70 years old comes in the hospital with complaints of having red bumps on his chest that appeared 2 weeks ago. He states that he wants to be done aa physical examination to be performed. AB says that last year he developed at least 4 new bumps on his chest that formed gradually. He is filled with anxiety because upon doing a Google search about his condition, he found that it could some tumors that are developing on his chest. He deniesrefutes any bleeding, painful and itchy bumps, exudation, or any climate variations. The bumps are located around the chest and the abdomen. AB says he has not come into contact with an irritant, denies having a fever, or does he take medications. Also, he reports he is neither under stress nor lifestyle changes. He claims, no one in his family lineage has ever been diagnosed with skin cancer.
Medications: none
Allergies: NKDA
Past Medical History (PMH): identified with stage 4 blood pressure Hypertension and the age of 60 which was well managed.
Past Surgical History (PSH): At age 40, his left shoulder was repaired from a torn rotator cuff.
Sexual/Reproductive History: Married and not sexually active.
Personal/Social History: denies smoking, taking alcohol, substance abuse, or under any influence of ETOH
Immunization History: His immunizations are current. In 2017, he got immunized of Pneumococcal vaccines and influenza vaccine
Significant Family History: Living with no parents who perished from a car accident. Living with his healthy daughter whom he got at his 30s
Social History: Live with her daughter and his 3 grandchildren. Being a widow for 8 years, he has been working as an engineer before he retired. In his free time, he does light exercises. Every day he attends catholic mass and then joins his 6 friends for breakfast at the local diner.
Review of Systems (ROS):
General: Mr. AB is a well-organized and neat man. He is alert and corporate during the discussion. He responds t ...
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: August Cases
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
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• COVID-19
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Diversity and Health AssessmentsCase 1Subjective Dat.docx
Diversity and Health Assessments
Case 1
Subjective Data
CC: "Annual physical exam"
History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking "pot" and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.
Drug Hx:
Current medication - denied
Allergies: no allergies to food or medications.
Family history: is very positive for diabetes, hypertension, and alcoholism.
Review of Systems (ROS)
General: no recent weight gains of losses, fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT):
Neck:
Respiratory:
CV: no chest discomfort or palpitations
GI:
GU:
Integument: history of eczema – not active
MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements
Psych:
Objective Data
PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6
General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.
HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.
Lungs: CTA AP&L
Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop
Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.
Ext: no cyanosis, clubbing or edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII
To prepare:
•Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
•Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
•Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
•Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
Post 1 page on
:
an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient above . Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history a.
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This document provides guidance for medical interns on case sheet writing and obtaining patient consent. It outlines the necessary components of a case sheet including demographics, history of present illness, past medical history, examination findings, diagnostic testing, treatment plan, and discharge instructions. Tips are provided for taking a patient's history such as introducing oneself, speaking softly, and avoiding hurtful language. The different types of consent are defined including informed consent, written consent, and high risk consent. Obtaining proper consent is emphasized as an important part of hospital practice.
H
This document describes the case of a 1-year-old male patient who presented with recurrent fractures of both femurs and tibias without any history of trauma. On examination, he had frontal bossing, wide-opened fontanelles, and other signs of rickets including bowed legs and widened wrists. Laboratory results found hypocalcemia, hypophosphatemia, and elevated alkaline phosphatase and PTH levels despite normal vitamin D levels. Based on these findings, the final diagnosis was vitamin D-dependent or vitamin D-deficient rickets.
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This document provides information on nursing history taking and physical examination. It discusses the importance of obtaining an accurate patient history, which is critical for diagnosis. The key components of history taking are identified as demographic data, chief complaint, history of present illness, past medical history, family history, drug history, review of systems, and physical examination. The principles and techniques of physical examination are outlined, including inspection, palpation, percussion, and auscultation. A head-to-toe assessment approach is recommended to perform a thorough physical exam.
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Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
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Paediatrics Clerking Sheet- Shapi.pdf
- 1. Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. Page 1 PAEDIATRICS CLERKING SHEET A. HISTORY TAKING Identity: - Name: - Age: - Sex: - Tribe: - Religion: - Residence: - Informants: ?pt/parent - Date of Clerking (DOC): - Language of interview: - Referral/Not and frm where and for what? Presenting complaint: - What do parents think or fear is the problem? Development of Symptoms: - Detailed info about child’s illness - It shd be recorded systematically to give separate paragraphs and headings to each new dateline, rather than giving the whole hx in essay form - Days of wks shd not be written in hx since they don’t indicate duration of disease Review of Systems: a) CVS; - Easy fatigability - Palpitations - Swelling of legs b) RS; - Chest pain - Cough - Dyspnoea - Wheeze - Haemoptysis - Sore throat c) GIT; - Appetite - Vomiting - Diarrhoea - Constipation - Abd pains d) MSS;
- 2. Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. Page 2 - Skin rash - Joint/bone pains - Joint swellings - Yellowing of eyes/palms e) GUT; - Frequence - Haematuria - Dysuria - Nocturia - Incontinence f) CNS; - Headache - Weakness/paralysis - Seizures - Abnormal movements Past Medical Hx: - Hospital admissions - Hx of similar illness - Operations - Accidents, injuries Drug Hx: - Past and present medications - Allergies Birth Hx: - Place of birth - Gestation age at birth, method of delivery, duration of labour, birth wt. - Perinatal problems and method of feeding Immunisation Hx: - Under 5 card - Immunisations given Nutrition Hx: - Breast feeding - When other feeds started? - ?Type of feeds and how much daily Developmental Hx: - Smile - Head support - Sit
- 3. Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. Page 3 - Stand - Walk - Talk - ?is pt at school Family Hx: - ?Parents alive - Siblings and their ages - Deaths incl miscarriages, stillbirths, terminations - Family illness and allergies - Family tree (asthma, TB, HTN, DM, epilepsy) Socio-economic Hx: - Occupation of parents - Housing - Relationship of parent - Smoking - Water source - Toilet Summary of Hx: Differentials/Impression: B. PHYSICAL EXAMINATION B1. GENERAL EXAMINATION: - Obtain a child’s cooperation - Be sensitive when undressing child, and make sure yr hands are warm! - If child appears very ill, first assess: Airway, Breathimg, Circulation, Disability, Exposure (ABCDE) - P, J, C - Lymphadenopathy - Oral cavity – ?membrane lesions
- 4. Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. Page 4 - Teeth - ?carries Vitals: - Temp - Respiratory rate - Pulse: ?regular, full volume, RR and RF delay - BP Anthropometric Measurements: a) Weight; - Initially 12% loss - Regains birth wt by 10th day - Then gains 30g/day - Wt doubles by 5 mo - Wt trebbles by 1 yr b) Height; - 50cm at birth - 75cm at 1 yr - 100cm at 4 yr - Then gains 5cm/yr c) Head circumference (Occipito-frontal); - 35cm at birth - 40cm at 3 mo - 47cm at 1 yr - 0.5cm/yr btn 2-7 yr - 0.3cm/yr btn 8-12 yr d) Mid- upper arm circumference (MUAC); B2. SYSTEMATIC EXAMINATION RS: - chest; ?symmetrical, deformities - scars; ?tatooes, surgical - tenderness - trachea; ?central - chest mvts - percussion - breath sounds; ?bronchial, vesicular - added sounds - vocal resonance CVS:
- 5. Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. Page 5 - Distended neck veins - Precordium - Apex beat - S1, S2 - Added sounds Per Abdomen: - Inspection; ?skin, inverted umbilicus, scars, dilated vessels - ?moving with respiration - Liver/spleen - Abd masses - Ballotable kidneys - Renal angle tenderness - Shifting dullness - Bowel sounds CNS: - ?pt conscious – interacting with environment and cooperative - ?talk and answer questions - ?crainal nerves intact - ?gait Urinalysis: e.g. - SG: 1.020 - Leukocytes: 500/Ul - Nitrites: -ve - Bilirubin: -ve - Glucose: normal - pH: 5 - blood: -ve - ketones: -ve - proteins: 15mg/dl Summary of Examination: Differentials/Impressions: