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    Dengue

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    alpha mae beltran
    The patient is a 12-year-old male who presented with fever and abdominal pain. On examination, he had a flushed appearance and a macular rash on his trunk and extremities. Differential diagnoses included measles, rubella, chikungunya, chickenpox, and dengue based on the rash and clinical manifestations. Further evaluation is needed to determine the specific diagnosis.

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    Dengue

    Uploaded by

    alpha mae beltran
    21 views20 pages
    The patient is a 12-year-old male who presented with fever and abdominal pain. On examination, he had a flushed appearance and a macular rash on his trunk and extremities. Differential diagnoses included measles, rubella, chikungunya, chickenpox, and dengue based on the rash and clinical manifestations. Further evaluation is needed to determine the specific diagnosis.

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    The patient is a 12-year-old male who presented with fever and abdominal pain. On examination, he had a flushed appearance and a macular rash on his trunk and extremities. Differential diagnoses included measles, rubella, chikungunya, chickenpox, and dengue based on the rash and clinical manifestations. Further evaluation is needed to determine the specific diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    21 views20 pages

    Dengue

    Uploaded by

    alpha mae beltran
    The patient is a 12-year-old male who presented with fever and abdominal pain. On examination, he had a flushed appearance and a macular rash on his trunk and extremities. Differential diagnoses included measles, rubella, chikungunya, chickenpox, and dengue based on the rash and clinical manifestations. Further evaluation is needed to determine the specific diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Arcilla-Beltran-Caagbay-Lina

    • Patient's father and maternal


    grandmother with fair reliability
    • Patient S.J.
    • 12 year old, Male
    • Roman Catholic
    • From Bago Bantay, Quezon City
    • Admitted for the first time
    5 days PTC 4 days PTC 3 days PTC
    2 days PTC 1 day PTC
    Day of Consult
    • No weight loss, good appetite
    • No Eye pain, ear pain, epistaxis, gum
    bleeding,
    • No vomiting, hemoptysis, hematemesis
    • No difficulty of breathing, chest pain
    • No diarrhea, constipation
    • No dysuria
    • No joint pain
    • No asthma
    • No known allergies
    • No previous hospitalizations nor
    surgeries
    • No previous trauma/accidents
    39 76 60 59

    42 38

    18 16 15 14 13 12

    (+) Hypertension - Paternal side


    (+) Depression - maternal side
    • H - patient lives with 4 other siblings in a well-lit,
    well ventilated 2 bedroom apartment.
    • E - Currently a grade 5 student with reported poor
    performance at as school as evidenced by low
    grades
    • A - Usually plays games on his tablet and
    occasionally plays basketball
    • D- Denies illicit drug use and expresses no desire
    in using it in the future
    • S- Currently has no girlfriend and denies crushes
    in school but was masturbating and was reported
    to be watching porn in his tablet and
    • Well-lit, well ventilated 2 bedroom
    apartment
    • 5 household members
    • Distilled water
    • Garbage collected 3 times a week
    • No creek or river near their
    apartment
    • (+) Smoker in the house
    • Born to a 26 y/o G6P6 (6006)
    • Delivered full term via NSD at Home
    attended by a traditional birth
    attendant.
    • Unrecalled BW
    • Mother was reported to have no
    prenatal check-ups, no maternal
    illnesses but was smoking and using
    illicit drug during pregnancy
    • Formula fed with Nestogen with
    unrecalled dilution from birth due
    to no production of milk
    • Complementary feedings was
    started at 6 months
    • Currently patient likes eating
    Chicken and Vegetables
    • unknown to informants
    • Able to walk alone - 1 year old
    • Sits alone - 6 months
    • Able to say mama - 8 months
    • Currently a grade 5 student with
    poor performance at school. With
    good relationship with peers
    General Awake, alert, not in cardiorespiratory distress
    Survey

    Anthropo Wt- 27kg


    metrics Ht- 141cm zscore -1= Normal
    BMI- 12.86 kg/m2 zscore below -2= Wasted

    Vital Signs BP- 100/60


    HR- 102
    RR- 19
    Temp- 37.4

    Skin Flushed appearance, warm to touch, moist, with petechial


    and erythematous confluent macular rash on trunk and
    extremities (LE>UE). Nails without clubbing or cyanosis,
    No other lesions noted.
    Head and Head- No lesions no masses, hair with average texture
    Neck Eyes- Anicteric sclerae, pink palpebral conjunctivae
    Ears- No ear tags, no aural discharge
    Nose- nasal mucosa pink, septum midline, no sinus
    tenderness, no nasal discharge
    Throat- Pink oral mucosa, good dentition, no
    tonsillopharyngeal congestion, no exudates
    Neck- Trachea midline, supple neck, no cervical
    lymphadenopathies

    Chest and Symmetrical chest expansion, clear breath sounds, no


    Lungs retractions

    Cardiovas Adynamic precordium, normal rate, regular rhythm,


    cular distinct S1 and S2, no murmurs, no thrills

    Abdomen Flat, normoactive bowel sounds, soft, direct tenderness


    on epigastric area, no palpable masses, liver span is 6cm
    in right midclavicular line, edge not felt, no costovertebral
    angle tenderness
    Genitalia Grossly male, Tanner stage II on Genitalia and pubic hair

    Extremities Full and equal pulses, CRT <2sec, no edema, no pallor

    Neurologic Mental status exam


    Frontal: Awake, alert, coherent, cooperative
    Parietal: No R-L disorienttaion, no finger agnosia
    Temporal: Intact remote, recent, immediate memory,
    oriented to time place person
    Occipital: Recognizes objets and colors
    GCS: 15 ( E4 V5 M6)
    Cranial Nerves
    CN I: Can smell
    CN II: Pupils 2-3mm equal and briskly recative to light
    CN III, IV, VI: EOMs intact
    CN V: Intact corneal reflex, good masseteric and
    temporalis muscle tone
    CN VII: No facial assymetry
    CN VIII: Intcat gross hearing
    CN IX, X: Intact gag reflex
    CN XI: Good shoulder shrug
    CN XII: Tongue midline
    Motor: Good muscle tone, 5/5 strength on both upper and lower extremities
    Sensory: 100% to light touch
    Reflexes: 2+ on biceps, brachioradialis, knee, ankle; no babinski
    Meninges: No neck rigidity
    Cerebellar: No nystagmus, no dysdiadochokinesia, good gait
    SUBJECTIVE OBJECTIVE
    (+) Fever
    (+) Abdominal pain
    (+) Rashes on both upper and
    lower extremities
    Disease Measles Rubella Chikungunya Chickenpox Dengue
    Rash -Maculopapular -Pink macules that -Diffuse erythematous-Initially, intensely -Occurs 1-2 days
    rash coalesce maculopapular rash ofpruritic erythematous after defervescence
    -Begins on forehead, -Begins on face, the trunk and macules that evolve to -generalized,
    behind ears and on neckthen spreads extremities, papular stage to form morbiliform,
    upper neck then spreads centrifugally sometimes involving clear, fluid filled vesicle maculopapular rash
    downward -Fades in 3 days the palms and soles. -Begins on scalp, face sparing palms and
    -Fades over about 7 -No desquamation -May evolve into or trunk soles
    days petechiae, urticaria, -Clouding and -Fades in 1-5days
    -Leaves fine xerosis, or umbilication occurs -Desquamation may
    desquamation hypermelanosis; or occur
    resolves with
    desquamation
    Age 90% before 15 yr of age Pre-school age and All age groups -Most children infected All age groups
    school age by 15 years of age
    -<5% adult

    Clinical Prodromal phase: Prodrome phase: -High fever (40°C/ Prodrom phase: -Sudden onset of
    Manifestation -mild fever -low grade fever 104°F) with flushed -Fever 37.8-41.1oC fever (39.4-41.1oC)
    -conjuctivitis with -sore throat appearance -malaise -Frontal or
    photophobia -red eyes -Chills -anorexia retroorbital pain
    -coryza -headache -Joint pain (lower -headache -Severe back pain
    -prominnet cough -malaise back, ankle, knees, -occasional mild -Myalgia, arthralgia
    -increasing fever -anorexia wrists or phalanges) abdominal pain -2nd -6th day of
    -Koplik spots 1-4 days -lymphadenopathy -Joint swelling fever nausea and
    before rash -Headache vomiting,
    Rash occurs with -Muscle pain gen.lymphadenopat
    Rash on 4th day Forchheimer spots -Nausea hy, anorexia
    -Abdominal pain
    -Retro-orbital pain

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