Miah Zavarro – Pediatrics

Missed PE, Missed Hx, Missed tests (lot)

CC – Swollen hands and feet – 21months old

 Tachypnea

 Adopted – unknown FH

 Swollen hand/feet painful for 2days – suspect hand-foot-mouth disease, improves w/rest and

ibuprofen

 Abdominal pain

 Cold 1 week ago – suspect minimal change disease

Diagnosis –

- Sickle cell anemia, septic-arthritis, reactive-arthritis, psoriatic-arthritis, rheumatoid arthritis

-juvenile.

Tests- blood culture/sensitivity, peripheral blood smear, cbc, crp, hgb-electrophoresis, esr

Problem Statement:

( Demographic description – chief complaint – Hx and PE key findings – risk factors )

Miah Zavarro is a 21month old female brought in by her adoptive mother with complaint of swollen and

painful hands and feet. Swelling started 2 days ago and is painful. Her mother reports she also has

abdominal pain that’s made her fussy at night when sleeping and decreased her appetite. PE shows

scleral icterus and splenomegaly. Her mother reports she had a cold 1 week ago, and claims similar -less

severe- episodes of swelling have happened in the past that have resolved spontaneously

CC: Miah Zavarro is a 21month old female brought in by her adoptive mother with complaint of swollen

and painful hands and feet.

HPI: Swelling started 2 days ago and is painful. Her mother reports she also has abdominal pain that’s

made her fussy at night when sleeping and decreased her appetite.

Meds: Ibuprofen for symptoms

PMH: Her mother reports she had a cold 1 week ago, and claims similar -less severe- episodes of

swelling have happened in the past that have resolved spontaneously

FH: Adopted from Haiti

ROS: Only positive findings are seen in HPI

Physical Exam: