Beruflich Dokumente
Kultur Dokumente
Date of Interview
Time of Interview
Source of Data
: Mar 2, 2018
: 03:55 PM
: Grandmother
M.R.B.
8-year old, Female
Reliability : 95% Roman Catholic, Filipino,
Referral : Private clinic Brgy. Baso, Cabucgayan, Biliran
FEVER
HISTORY OF PRESENT ILLNESS
The patient was apparently until four days prior to admission, she
had undocumented on and off moderate grade fever not associated with
headache, cough & colds, nausea & vomiting, loss of appetite,
abdominal pain, diarrhea or constipation. She was immediately brought
to Naval Rural Health Center where in after assessment she was given
Paracetamol 125 mg/5 ml at 10 mg/kg/day rendering temporarily relief
of fever. She was sent home with instruction to continue Paracetamol
every for 4 fours for fever.
HISTORY OF PRESENT ILLNESS
FINE MOTOR
Stares at 2 hands 4 4
Uncovers toys 8 8
Bangs 2 objects 8 8
Pretend play 17 16
LANGUAGE
Social smile 2 2
Monosyllabic babble 6 6
Mama or Dada 10 10
Speaks 4-6 words 15 15
Knows full name 24.5 24
Names one or more colors 24 24
PAST MEDICAL HITORY
Illnesses : Measles & mumps (didn’t have chicken pox, dengue fever)
: No previous confinement
Psychiatric : None
Actual Weight/ Ideal Weight for age x100 Actual Length/ Ideal Length for Age x 100
Head
Skull : normocephalic, with long, black fine hair equally distributed,
temples not depressed, no nits and lies, no scalp lesion, no
dandruff, no engorged veins, no flakes, and no tenderness
PHYSICAL
PHYSICAL
EXAMINATION
EXAMINATION
Eyes:
Eyebrow : symmetrical with equally distributed hair
Eyelashes : short, fine, curved, black oriented outwards
Eyelids : no ptosis, lid lag, discharges, tenderness, swelling, nodules,
Eyeballs : globes firm on pressure, full EOM
Conjunctiva: pinkish palpebral conjunctiva, no discharges, no lesions,
no ulcers or spots
Sclera : anicteric, without hemorrhages
Cornea : clear, no ulceration, no scars
Pupils : 2-3 mm in diameter and briskly reactive to direct
and consensual light, with good accommodation and good
convergence
PHYSICAL
PHYSICAL EXAMINATION
EXAMINATION
Ears: symmetrical, auricle in line with the outer canthus of the eye, dry cerumen noted on ear
canals, no impacted cerumen, no discharges, no hearing loss, no tenderness, no lesions
Nose and Sinuses: pink mucous membrane, septum at midline, no discharges, no congestion,
no nasal flaring, no nasal polyps, non-perforated nasal septum, no sinus tenderness
Throat:
Uvula at midline, tonsils not enlarged, no lesions, no discharges
PHYSICAL
PHYSICAL
EXAMINATION
EXAMINATION
Neck
Inspection : No neck vein engorgement, neck moves without
discernible restriction, no lesions, trachea at midline,
no lumps
Palpation : Neck supple, thyroid not enlarged and moves with
deglutition, no palpable lymph nodes
Breast
Inspection : Symmetrical, brown areola and nipples at the same level,
no lesions, no discharges
Palpation : No lumps, no palpable lymph nodes, no tenderness
PHYSICAL
PHYSICAL
EXAMINATION
EXAMINATION
Chest and Lungs
Inspection:
Symmetrical lung expansion, no lagging, no subscapular and
intercostal retraction on respiration, breathing not labored
Palpation:
Bilateral symmetrical lung expansion, unimpaired tactile fremitus, no
masses, no tenderness
Percussion:
Resonant all over lung fields.
Auscultation:
Bronchovesicular breath sounds over all lung fields, no crackles, no
rales, no wheezing, no pleural friction rub
PHYSICAL
PHYSICAL
EXAMINATION
EXAMINATION
Cardiovascular
Inspection
No precordial bulging, no visible pulsation
Palpation
PMI noted at 5th ICS mid clavicular line, no heaves, no thrills, no lumps,
and no tenderness
Auscultation
Heartbeat is 92 bpm with normal rate & regular rhythm, synchronous
with radial pulse 92, no murmur, S1 louder than S2 at apex, S2 louder
than S1 at base, no pericardial friction rub
PHYSICAL
PHYSICAL
EXAMINATION
EXAMINATION
Abdomen
Inspection
Full, symmetrical, no visible pulsation and peristalsis, no distended veins,
no scars, no bulging flanks.
Auscultation
Normoactive bowel sounds, no bruits, no peritoneal friction rubs,
Percussion
Tympanitic in all regions, liver span 6 cm at right MCL and 5cm at
midsternal line, Splenic span of 5 cm at anterior axillary line,
Palpation
Soft, nontender, liver, spleen and kidneys not palpated, no ballotable
organs, bladder not palpable, no mass, no lumps, negative kidney
punch
PHYSICAL
PHYSICAL
EXAMINATION
EXAMINATION
Back and Spine:
Inspection : no abnormal deviation, no retraction, no bulging, no mass, no
scars
Palpation : no paravertebral tenderness or mass, negative kidney punch
test
Extremities
Inspection : equal in length and size, full range of motion, no rashes, no
cyanosis, no varicosities, no edema
Palpation : skin is warm and moist, all pulses 2+ equal and symmetric no
muscle tenderness
NEUROLOGIC EXAMINATION
Mental Status
Conscious, coherent, responsive, conversant, oriented to time, place and
person
Language and Speech
No aphasia nor dysarthria
Cerebellar
No involuntary movements, no ataxia
Cranial Nerves
No cranial nerve deficits
Motor Function
Flex and extend upper and lower extremities without limitation, no atrophy
of muscle, no involuntary movements, no spasticity, no rigidity, no flaccidity,
muscle strength grade 5.
NEUROLOGIC EXAMINATION
Reflexes
Biceps 2+ Triceps 2+
Brachioradialis 2+ Patellar 2+
Plantar 2+
Pathologic Reflexes
(-) Babinski
(-) Ankle clonus
Meningeal Signs
(-) Brudzinki's sign
(-) kernig sign
(-) nuchal rigidity
Autonomic Nervous System
(-) incontinence, excessive sweating lacrimation, salivation
COURSE IN THE WARD
08:15 AM 48 hours afebrile Reduce Voluven to 10 gtts/min Strict I&O monitoring then record
Awake, conscious
Bloated abdomen Continue PLR 1L at 15 gtts/min Monitor vital signs every 4 hours
Full pulses then record
UO: 2 cc/kg/24 hours
08:20 AM Weak looking Maintain Voluven at 10 gtts/min then Continue BP, HR, RR every 4 hours
Full pulses consume and shift to heplock line monitoring
(+) ascites
Slightly decreased breath Increase PLR 1L to 25 gtts/min once
sounds Voluven is consumed
08:45 AM (+) Herman’s rash Reduce serial hematocrit and Furosemide 20 mg slow IVTT now
(+) Ascites platelet count to every 8 Reduce IVF rate at 15 gtts/min
hours Cetirizine (alnix) 7,5 ml now then OD
Chest X-ray Result
(03/06/2018)
BIBASAL PNEUMONIA
BILATERAL PLEURAL FLUID
Hematocrit & Platelet Count
Monitoring
F E V E R
4 Days Intermittent Fever
Rheumatologic/ Malignancy/
Miscellaneous
Infectious Inflammatory Neoplastic
Disorders
disorders disorders
Juvenile
Drug-Induced
Viral Rheumathoid
Fever
arthritis
Rheumatic
Bacterial
Fever
Others
Reference: Jin Han Kang. Febrile illness with skin
rashes. Infect Chemother. 2015 Sep; 47(3): 155–
166.
APPROACH TO DIAGNOSIS
CHIKUNGUNYA LEPTOSPIROSIS URINARY TRACT INFECTION
Intermittent fever Intermittent fever Intermittent fever
(-) Conjunctival
Body weakness, loss Bodysuffusion
weakness, loss Body weakness, loss of
of appetite, mild (-)appetite,
of Photophobia
mild appetite, mild
abdominal pain, abdominal pain, non- (-) Dysuria
abdominal pain, non-
non-projectile
(-) Diarrhea
projectile vomiting projectile vomiting
(-) Arthralgia
vomiting (-) Muscle pain (-) Abdominal
(-) Calf pain tenderness
Stagnant waters
near the house with
(-) History of contact
visible mosquitos to contaminated
water
APPROACH TO DIAGNOSIS
DENGUE FEVER
Intermittent fever
DENGUE FEVER
WITH WARNING SIGNS
DISCUSSION
• Benign syndrome caused by several arthropod-
borne viruses (Flavivirus: Arbovirus)
• Composed of single-stranded RNA; Four serotypes
(Dengue 1,2,3,4)
• Transmitted by mosquitoes of the Stegomyia family
MOSQUITO
• Aedes aegypti
- daytime biting mosquito,
- principal vector
- all 4 virus types have been recovered from it.
- in most tropical areas, it is highly urbanized, breeding in water stored for
drinking or bathing and in rainwater collected in any container.
• Aedes albopictus
- 2001 Hawaiian epidemic
- breed in water trapped in vegetation.
390 million dengue infections
occur annually
96 million have clinical
disease.
Dengue outbreaks in urban
areas infested with A. aegypti
may be explosive; up to 70-
80% of the population may be
involved.
Most overt disease occurs in
older children and adults.
Legend- Cases
1.00- 500.00
500.01-1000.00
1000.01-1500.00
1500.01+
• Living or travelling to an
endemic area (mostly
tropical places)