Thursday, July 9, 2015

Disease Investigation
Script:
Doctor: Hi, what seems to be the problem with Lily today?
Me: Hello Doctor. Well I was changing Lilys clothes and saw there was a lot of swelling
mostly her hands, fingers, and toes.
Doctor: When did you first observe the swelling?
Me: Last night, around seven oclock
Doctor: Have you seen this type swelling before?
Me: Well, I have observed small-scale swelling before this point, around two months ago
when she was two and a half years old. But, that swelling was not too bad so I was not too
concerned at that time
Doctor: Have you noticed any other symptoms besides the swelling of those body parts?
Anything that seemed abnormal?
Me: Yes, I also noticed that for the past four days or so, her skin becomes paler than normal,
and her eyes also sometimes are a yellowish color.
Doctor: Anything else? Has Lily been coughing or complaining of pain during in the chest,
before, or after the swelling.
Me: Yes! This morning after I the noticed the swelling didnt get better, I went to go make a
doctors appointment and meanwhile Lily would not stop crying. When I got off the phone
she said hurt hurt, holding her chest. She seemed to be weak and in lots of pain and it
persisted for a long time.
Doctor: How long does her pain usually last?
Me: Usually about an hour, sometimes more. Sometimes it is accompanied by fatigue. We
just assumed they were growing pains
Doctor: Is Lily taking any medications at the moment?
Me: No, she is not taking anything at the moment.
Doctor: Did Lily fall recently or hit her hands or legs?
Me: Nothing recently
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Thursday, July 9, 2015

Doctor: Has Lily been outside for extended periods of time within the last week or two?
Me: Yes, she has been going to day care and they mostly have the kids do activities outside.
Doctor: So she has been exposed to the greatly fluctuating temperature during this time of
year?
Me: Yes she has.
Doctor: Have you visited any places in high altitudes lately?
Me: No, we have not
Doctor: Does Lily engage in physically challenging activities often? Like running?
Me: She plays normally but she sometimes, even with little to no physically demanding
activities, she has a shortness of breath as if she has been running for a long time.
Doctor: Have these symptoms that you have described been continuous or occasional?
Me: The swelling happens once in a while. But when it does happen, it usually last for a long
time. Same with the yellowing of skin, it is usually continuous when it occurs.
Doctor: So does anything else seem to make these symptoms worse?
Me: Im not sure
Doctor: Does Lily complain of pain, fatigue, etc. after been exposed to colder weather?
Me: Usually when we go out in the cold, we bundle her up pretty well. But I have noticed
that when compared to the summer, she does complain of this pain more.
Doctor: Oh ok
Me: Now that I think back, the I have noticed swelling only when it is the temperature is
colder and dry either in our house or outside?
Doctor: Dry, you say? Please, remind me again where your parents and your husbands
parents are from.
Me: Sure, my mom is from India and my dad is from Latin America. Both of my husbands
parents are from central Africa.
Doctor: Ok, let me just take a look at Lily and see what is going on.

Thursday, July 9, 2015

Physical Exam Findings:

- Initial Observations: Swelling of hands and feet

- pale complexion
- jaundice
- Temperature: 99.5oF
- Blood Pressure: 85/60 mmHg
- Pulse: 116 beats per minute
- Respiratory rate: 27 breaths per minute
- enlarging of spleen and kidney
- rhonchi in both lungs are normal
- vision lessening: 20/30
- auscultation of lungs shows low-scale pneumonia
- palpation shows tenderness is chest, spleen, and abdomen
- patient is falling below growth isobars
- cold hands and feet, cold intolerance, brittle nails, and fatigue show signs of
hypothyroidism