pediatrics case studies

8/14/2019 Pediatrics case studies

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Demographic information

Name: Master. Arun

Age: 8 years

Sex: Male

Date of birth: 18 April 2005 Religion: Hindu

Born of non-consanguineous marriage

Tharamani, Chennai

Socio economic status class 3

Informant : Mother reliable


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Chief Complaints

Cough and cold- 4 months.

Breathlessness- 2 months.


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History of presenting illness The patient was apparently asymptomatic 4 months

back, then he developed

Cough and cold

Insidious in onset

Duration 4 months

Progressive

Productive cough with copious, yellowish-green incolour, purulent, foul smelling sputum

Exacerbated on lying on the left lateral position

No diurnal or seasonal variations Relieved by mediations temporarily


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Breathlessness

Breathlessness for 2 months

Insidious in onset,

Progressive,no postural variations

Class 2 according to NYHA classification

No relieving factors.

No H/o Paroxysmal nocturnal dyspnea


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Negative history

No h/o fever, chest pain, wheeze.

No h/o hemoptysis, ear discharge

No h/o Jaundice, chronic diarrhoea

No h/o syncope, cyanosis, chest pain,palpitations.

No h/o oliguria, abdominal distension, pedal

edema.

No h/o loss of appetite, loss of weight

No h/o hoarseness of voice

No h/o foreign body aspiration/known choking

spells.


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Past history

H/o exanthematous fever probably measles 6months back. Was admitted in Govt. general

hospital and treated.

No h/o similar illness in the past.

No H/o contact with tuberculosis

No H/o oil instillation in the ear

No h/o previous hospitalizations.

No h/o known allergies, Asthma


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Birth history

Delivered at term by emergency cesarean section(Indicationmeconium stained liquor)

Birth weight 2.8kgs

Cried after birth

No H/o jaundice, seizures, feeding difficulties. No H/o discharge or redness of umbilical stump

No H/o Ventilatory/Incubatory care, Phototherapy

Breast feeding started immediately

Meconium and urine passed within 24hrs

Antenatal history Spontaneously conceived

Booked and immunised Trimesters - uneventful


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Developmental history

Gross motor, fine motor, language, social and

adaptive milestones attained corresponding to the

age

The child is studying in 3rdstandard. Fairly good

scholastic performance.


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Family history

Pedigree chart

During birth,

Maternal age 26

Paternal age 30

Born of a non-consanguineous marriage 1 elder brother -15 years healthy

No h/o of asthma, cystic fibrosis in the family


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Immunisation

BCG scar present

Immunised till 6 months

Pulse polio immunisation given until 5 years


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Dietary history

Expected Observed Gap

Calories 1700 1121 579

Proteins 21 32.7 -

Exclusively breast fed for 6 months.

24hr dietary recall


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Socio-economic status

MotherEducation 10th

Occupation household maid

Income Rs.5000/month

Class 3 Lower middle

Housing condition pacca house, 1 room, 1 kitchen,

adequately ventilated

Sewage and garbage disposal done properlyWater for the children is not boiled before

consumption


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History Summary

8 year old male child presented with complaintsof chronic cough and breathlessness for the past

4 months. Cough was associated with copious,

purulent sputum production. There is past history

of an episode of exanthematous fever 6monthsback which resolved following treatment. This

child is most probably suffering from a

suppurative lung disease. I would like to proceed

with the examination of respiratory system.


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Examination


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General Examination

The child was Conscious

Oriented to time place and person

Lethargic

Co-operative

Clubbing present grade 1, pan digital

No pallor, icterus, cyanosis, lymphadenopathy, pedeledema

No dysmorphic features

No external markers of allergy and Tuberculosis

BCG scar present


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Vitals

Pulse rate

98 beats/ min. Normal in rate, rhythmand volume

Respiratory rate 31 breaths/ min. Thoraco-

abdominal. Intercostal retraction present.

Blood pressure 100/70mm of Hg

Febrile 98.4 F


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Anthropometryobserved expected

Weight 15.1kgs 25kgs 61% Grade 2

malnutrition

Height 115cms 135cms 85% Grade 2

stunting

BMI

11Head circumference48cms

Chest circumference 53cms

Abdominal circumference 58 cmsHead to footexamination

Halitosis present

Normal facies

Chest appears normal

Polydactly medial extra digit in left hand

External genitalia appears normal


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Local examination - Respiratory

UPPER RESPIRATORY TRACT-

Nose is normal - no DNS, Polyp, congestion,

rhinorrhoea, foreign body

No sinus tenderness

Oral cavity appears normal. No dental caries,

bleeding gums.

Tonsils not enlarged


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Inspection Chest wall is symmetrical Trachea appears to be in midline.

Apex beat seen in the left fifth intercostal space1cm medial to MCL.

Chest wall moves equally with respiration. Intercostals retractions present

No grunt/stridor

No drooping of shoulders, bony abnormalities,chest wall deformity seen.

No scars, sinuses, engorged veins.


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Palpation

Tracheal position and Apex beat confirmed.

Chest expansion 4 cm (during inspiration,

circumference: 57 cm, during expirationcircumference: 53 cm)

Chest wall moves equally with respiration.

No Tactile fremitus, no tenderness

No chest wall deformities

No kyphosis or scoliosis


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RIGHT LEFT

SUPRACLAVICULAR NORMAL NORMAL

INFRACLAVICULAR NORMAL NORMAL

MAMMARY NORMAL

AXILLARY NORMAL NORMAL

INFRAXILLARY NORMAL

SUPRASCAPULAR NORMAL NORMAL

INTERSCAPULAR NORMALINFRASCAPULAR NORMAL

VOCAL FREMITUS


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RIGHT LEFT

SUPRACLAVICULA

R

RESONANT RESONANT

INFRACLAVICULAR RESONANT RESONANT

MAMMARY DULL RESONANT

AXILLARY RESONANT RESONANT

INFRAXILLARY DULL RESONANT

SUPRASCAPULAR RESONANT RESONANT

INTERSCAPULAR DULL RESONANT

INFRASCAPULAR DULL RESONANT

NO PERCSSION

PERCUSSION


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RIGHT LEFT

SUPRACLAVICULAR NVBS NVBS

INFRACLAVICULAR NVBS NVBS

MAMMARY BRONCHIAL VR NVBSAXILLARY NVBS NVBS

INFRAXILLARY BRONCHIAL VR NVBS

SUPRASCAPULAR NVBS NVBS

INFRASCAPULAR NVBS NVBS

INTERSCAPULAR BRONCHIAL VR NVBS

AUSCULTATION


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Persistent coarse leathery crepitations is heardwell in both lung bases both during inspiration

and expiration.

No Bronchophony, Aegophony, and Whispering

pectoriloquy.

No wheeze, pleural rub, pericardial rub.


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Examination of other systems

Abdomen:Soft, no mass felt, No organomegaly

Cardiovascular system:S1 S2 heard. No

murmur.

CNS:No focal neurological deficits


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Summary

8 year old male child presented with complaints ifchronic cough and breathlessness for the past 4

months. Cough was associated with copious,

purulent sputum production. There is past history

of an episode of exathematous fever 6monthsback which resolved following treatment.

Examination revealed pan digital clubbing and

halitosis. On auscultation, bronchial breath

sounds and coarse leathery basal crepitationswere heard in the right lung.


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Diagnosis

Bronchiectasis of the right lung involving themiddle and lower lobe with the probably etiology

being post-measles infection with grade 2

malnutrition and grade 2 stunting.


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Investigations

Blood

Hb%, total count, differential count,platelet

ESR

Mantoux test

Sputum culture & AFB

X-ray chest

HR-CT

Fibreoptic bronchoscopy

Broncho-alveolarlavage

Bronchography

Sweat chloride test


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Management

Medical management Chest physiotherapy and postural drainage

Antibiotics and Vaccination support

Nutritional support Symptomatic therapy bronchodilators,

corticosteroids

Long term oxygen therapy

Surgical management

Segmental or lobar pneumonectomy


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Thank you

pediatrics case studies

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