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:
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VS: Pulse – 134; BP – 90/58 RR – 28; T – 98.6F; SpO2 – 98%
Eyes: Scleral icterus noted
Abdomen: abdomen is distended, splenomegaly noted with tenderness to palpation, liver WNL, normal
bowel sounds heard.
Extremities: Right foot swelling with warmth, left hand and fingers swelling with dactylitis, patient
refuses to bear weight on feet.
ASSESSMENT/PLAN
Test Results:
Blood culture and sensitivity: Negative
Peripheral blood smear: Normocytic, normochromic anemia with abnormal sickle-shaped cells
CBC: leukocytosis w/ normal differential, thrombocytosis, normocytic anemia (MCV in range)
CRP: Elevated
Hgb electrophoresis: Diagnostic for homozygous (SS) Sickle cell disease, w/o evidence of
concurrent thalassemia
ESR: Elevated
Left Hand X-ray: Dactylitis in hands – thinning of bony cortex
Right Hand X-ray: Dactylitis in hands – thinning of bony cortex
Left Foot X-ray: Dactylitis in feet – thinning of bony cortex
Right Foot X-ray: Dactylitis in feet – thinning of bony cortex
Reticulocyte count: elevated – showing signs of worsening anemia
Liver function tests (LFT): Increased unconjugated bilirubin- suggesting extravascular hemolysis
Lactate dehydrogenase (LDH): Increased
Antinuclear antibody (ANA): negative
Tuberculin skin test (PPD): negative
Rapid Plasma Reagin (RPR): Negative.
Management Plan
Hydration, pain management, nasal oxygen, and bed rest
Avoid triggers of crises
Penicillin prophylaxis
Hydroxyurea
Erythropoetin
ALLOGENIC BONE MARROW TRANSPLANT for curative therapy
Exercises:
1. Diagram
2. 25%
3. No change
1. decrease
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Authors | qwivy.com |
Pages | 4 |
Language | English |
Tags | Miah Zavarro ihuman Pediatrics |
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