CASE # 1

General data:
3 days old, male, Chinese, from Malabon

Chief complaint:
Yellowish discoloration of skin

History of present illness:

Patient was born term (37 5/7 weeks age of gestation) to a 19 year old G1P0 delivered via
vacuum assisted delivery at a maternity clinic by an ob-gynecologist. Birth weight 3kgs.
Discharged after 24 hours. Given BCG and hepatitis B vaccine.
At home, patient was being breastfeed with good suck though mother complains that she
doesn't have much milk. The baby was observed to have good cry and activity but have
yellowish discoloration of the face. Progression of the the discoloration down to the thigh
prompted consult at the emergency room.

Physical Examination:
Asleep, comfortable
HR 130bpm RR 43cpm
Weight 2.75kgs Height 48 cms. HC 30cms
Jaundice on face to thigh, (+)
No deformities on the head, open fontanelles, icteric sclerae
Symmetrical chest expansion, clear breath sounds
Adynamic precordium, normal rate regular rhythm
Globular abdomen, dry cord, normoactive bowel sounds, soft, no hepatosplenomegaly
Grossly male genitalia with descended testes
No gross deformities of the extremities, full pulses

OMMC CASE Viral exanthem

CASE # 2

8 year old female, Filipino, from Tondo, Manila came in for fever and rash of 3 days duration

QUESTION # 1
What other information in the history and physical examination do you need to come up with a
logical impression?

QUESTION # 2
What is your impression? Give at least 2 other differential diagnosis and give bases.

QUESTION # 3
How will you manage the case?

General Data:
CC: prolonged jaundice

History of Present Illness

Patient is a 5mo old F, born FT to a 35 year G4P3 (3003) mother at home assisted by a TBA, apparently normal at birth.
1 month PTA, noted to have progressive jaundice and light-yellow stools

3 weeks PTA, noted to have gradual abdominal enlargement, prompting consult today.

(-) prenatal check-ups

(+) maternal cough and colds during first trimester of pregnancy
(-) previous pregnancies delivered normally
NBS : (-)

Ancillary History
Family Medical History: (-) Family history of bronchial asthma or malignancy, (-) family history of DM and hypertension
Immunization history: given BCG x1, OPV x1, DPT x1 dose only.
Nutritional History: Purely breastfed

PHYSICAL EXAMINATION

General Survey
Awake, not in CP distress
Anthropometrics
Weight =6 kg, length =63 cm, HC = 42, CC=40, AC= 39
Vital signs
BP 80/50 HR110 bpm RR 39 bpm T 36.5C O2 sats (room air) = 100%
Skin
No rash, (+) jaundice
Head and Neck
AFSF, pink conjunctivae, icteric sclerae, (-) nasal congestion, (-) cervical lymphadenopathies
Chest and Lungs
equal chest expansion, (-) retractions, no wheezes
Cardiac
Adynamic precordium, normal rate and regular rhythm, no murmurs
Abdomen
Normoactive bowel sounds, (+) distended abdomen,(+) hepatomegaly,
Extremities
Full and equal pulses, (-) edema/cyanosis/clubbing, CRT less than 2 sec

LABORATORY RESULT:

CBC
Date Normal
WBC 5 x109/L
RBC 3.1x109/L
Hgb 110 g/L
Hct 0.38%
MCV 85fL
MCH 25 pg
Platelets 350x109/L
Neut% 0.7
Lymph% 0.3
Mono% 0.0
Eo% 0.0
Baso% 0.0

HBT USG: (+) cystic dilatation of the extrahepatic ducts

AST: elevated
ALT: elevated
Serum Direct bilirubin: elevated
Serum Total bilirubin: elevated
PT PTT: normal
Hepatitis profile: normal
TORCH titers: normal