case of h.c
DESCRIPTION
Case of H.C. Pedia -Ortho SGD. General Data. H.C. 6 years old Male From Urdaneta R flank mass and R inguinal mass. History of Present Illness. Diagnosed case of Pott’s disease since March 2009, currently on his 3 rd month of treatment with HRZE - PowerPoint PPT PresentationTRANSCRIPT
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Case of H.C.
Pedia-Ortho SGD
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General Data
• H.C.• 6 years old• Male• From Urdaneta• R flank mass and R inguinal mass
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History of Present Illness– Diagnosed case of Pott’s disease since
March 2009, currently on his 3rd month of treatment with HRZE
– Patient was referred to Rehab for fabrication of TLSO brace, because patient will need brace immediately post-op
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8 mos PTA (Nov 2008)• Patient’s mother noted 1x1cm mass on
the R lower lumbar area. The mass was movable, fluctuant and non-tender. No consult was done.
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7mos PTA• The mass was noted to be enlarging,
occupying the lower lumbar area, with associated 50% weight loss and anorexia, occasional cough, undocumented fever (Paracetamol) and night sweats.
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3mos PTA• Continuous increase in size of the mass
and fever prompted consult to a private doctor. Chest X-ray was done which revealed PTB. Patient was started on Anti-Koch’s medications (HRZE)
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1week PTA• Patient’s mother noted the presence of
– 3x4cm soft, non-tender, non pulsatile R inguinal mass
– 6x5cm soft, non-tender non-fluctuant R flank mass
• Patient was brought to the ER and was advised for admission
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Review of Systems(+) fever (+) unprod cough (-) abd’l pain(+) weight loss (-) colds (-) BM
changes(+) anorexia (-) dyspnea (-) GU changes(-) headache (-) orthopnea (-)
dysuria(-) nausea (-) chest pain(-) vomiting (-) easy fatigability(-) BOV (-) easy bruisability
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Past Medical History
• (-) previous hospitalization• (-) allergies• (-) other illness
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Family Medical History
• (-) DM, BA, HD, thyroid disease• (+) HPTN- maternal
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Birth and Maternal History
• Born FT to a then 26y/o mother G2P1(1001) via NSVD in a lying-in clinic assisted by a midwife. With regular PNCU’s c/o local health center. Mother denies any maternal illness, (-) fetomaternal complications.
• Patient was born with good cry and good suck
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Personal and Social History
• Middle child, w/ 10yo brother and 3yo younger brother
• Mother 32yo, housewife• Father 35yo, tricycle driver
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Nutritional History
• Patient was exclusively breastfed until about 1 year of age
• (+) complimentary feeding started at 6-8 months old
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Immunization History
• BCG• DPT 3doses• OPV 3 doses• Hep B 3 doses• Measles• c/o Local Health Center
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Developmental History
• Generally at par with age• Grade 1 student
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Physical Examination
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General
• Alert, awake, conscious, not in cardiorespiratory distress
• HR= 140’s• RR= 38• T= 38.4 C
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HEENT• Slightly pale palpebral conjunctivae,
anicteric sclerae, (-) NVE• (+) multiple CLAD
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Chest and Lungs
• Clear breath sounds• (-) use of accessory muscles• (-) suprasternal/ intercostal retractions
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Heart
• Adynamic precordium• Distinct heart sounds• (-) heaves, thrills,murmurs
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Abdomen
• Firm and globular abdomen• NABS• Non-tender, (-) masses• Non-palpable liver edge, intact
Traube’s space
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Extremities• Pulses full and equal, CRT<2s• DTR’s: normoreflexive• Full ROM’s • MMT:
– C5-T1: 5/5– L2-S1: 5/5
• Sensory: (-) sensory deficits– C5-T1: 100%– L2-S1: 100%
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Present Working Impression
Pott’s Disease, ongoing treatmentAbscess R paravertebral area with psoas
extension– s/p Anterior Debridement,
Decompression and Interbody Fusion T11-L1 (7/6/09, PGH)
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Medications on Board
• Isoniazid• Rifampicin• Paracetamol PRN• Clindamycin
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Thank you!