CLIPP # 7 – Case of Respiratory Distress (Newborn)

This case is about Adam, a newborn delivered at 36 weeks by a C-section due to

breach position and now presenting with respiratory distress. The mother is
diabetic and states her blood sugar maintenance has been “fair,” which does not
describe whether her blood glucose was within the ideal reference range. Upon
further investigation, Adam turns out to have tachypnea and appears large for
gestational age. Chest X-ray showed lungs that had retained fluid. Other tests were
done but they were all normal. Adam was diagnosed with transient tachypnea of the
newborn (TTN), in which there is delayed clearance of lung fluid after birth that can
ultimately leads to respiratory distress. Adam was in a high-risk group for TTN since
he was a male, born through C-section to a diabetic mother. I initially considered the
diagnosis of respiratory distress syndrome (RDS) but the chest x-ray findings
showed there were peri-hilar streaks and pleural effusions. Therefore, RDS was not
the correct diagnosis and Adam was rightly diagnosed with TTN. This case was a
great example of 2 very similar presentations of respiratory distress in a newborn. It
also clarified many principles that can help diagnose the correct condition, as both
the conditions, RDS and TTN, require different treatments.

SIMPLE # 14 – Case of STI (College student)

This case is about Ms. Pham, an 18-year-old Asian-American female in need of a pre-
college physical examination. She is not sexually active and denies any alcohol or
drug use. After a few weeks, Ms. Pham returns with a primary complaint of dysuria
and white discharge from her vagina. She states that she is now sexually active with
a partner and use protection sometimes. Samples from her urine were sent for
analysis and they came back positive for leukocyte esterase, nitrites, and
hemoglobin. This confirmed bacterial activity and also noted the hematuria. She was
diagnosed with Chlamydia (gram -) and prescribed 1 gram of azithromycin or
doxycycline twice daily for 7 days. This case was a good example of common health
issues that occur in teens and college students. Sexually transmitted infections
(STIs) are very common in those that practice unsafe sex. This case also explained
the different tests that can rule out certain conditions like cystitis and tests that can
rule in STIs, and even identify specific bugs like chlamydia through gram-stain
microscopic analysis.