Presentation Title

Arcilla-Beltran-Caagbay-Lina
 Informant
• Patient's father and maternal
grandmother with fair reliability
 General Data
• Patient S.J.
• 12 year old, Male
• Roman Catholic
• From Bago Bantay, Quezon City
• Admitted for the first time
History of Present Illness
5 days PTC 4 days PTC 3 days PTC
History of Present Illness
2 days PTC 1 day PTC
History of Present Illness
Day of Consult
 Review of Systems
• No weight loss, good appetite
• No Eye pain, ear pain, epistaxis, gum
bleeding,
• No vomiting, hemoptysis, hematemesis
• No difficulty of breathing, chest pain
• No diarrhea, constipation
• No dysuria
• No joint pain
 Past Medical History
• No asthma
• No known allergies
• No previous hospitalizations nor
surgeries
• No previous trauma/accidents
 Family History

39 76 60 59

42 38

18 16 15 14 13 12

(+) Hypertension - Paternal side

(+) Depression - maternal side
 Psychosocial History
• H - patient lives with 4 other siblings in a well-lit,
well ventilated 2 bedroom apartment.
• E - Currently a grade 5 student with reported poor
performance at as school as evidenced by low
grades
• A - Usually plays games on his tablet and
occasionally plays basketball
• D- Denies illicit drug use and expresses no desire
in using it in the future
• S- Currently has no girlfriend and denies crushes
in school but was masturbating and was reported
to be watching porn in his tablet and
 Environmental History
• Well-lit, well ventilated 2 bedroom
apartment
• 5 household members
• Distilled water
• Garbage collected 3 times a week
• No creek or river near their
apartment
• (+) Smoker in the house
 Maternal and Birth
History
• Born to a 26 y/o G6P6 (6006)
• Delivered full term via NSD at Home
attended by a traditional birth
attendant.
• Unrecalled BW
• Mother was reported to have no
prenatal check-ups, no maternal
illnesses but was smoking and using
illicit drug during pregnancy
 Feeding History
• Formula fed with Nestogen with
unrecalled dilution from birth due
to no production of milk
• Complementary feedings was
started at 6 months
• Currently patient likes eating
Chicken and Vegetables
Immunization History
• unknown to informants
Growth and Developmental
History
• Able to walk alone - 1 year old
• Sits alone - 6 months
• Able to say mama - 8 months
• Currently a grade 5 student with
poor performance at school. With
good relationship with peers
 Physical Examination
General Awake, alert, not in cardiorespiratory distress
Survey

Anthropo Wt- 27kg

metrics Ht- 141cm zscore -1= Normal
BMI- 12.86 kg/m2 zscore below -2= Wasted

Vital Signs BP- 100/60

HR- 102
RR- 19
Temp- 37.4

Skin Flushed appearance, warm to touch, moist, with petechial

and erythematous confluent macular rash on trunk and
extremities (LE>UE). Nails without clubbing or cyanosis,
No other lesions noted.
 Physical Examination
Head and Head- No lesions no masses, hair with average texture
Neck Eyes- Anicteric sclerae, pink palpebral conjunctivae
Ears- No ear tags, no aural discharge
Nose- nasal mucosa pink, septum midline, no sinus
tenderness, no nasal discharge
Throat- Pink oral mucosa, good dentition, no
tonsillopharyngeal congestion, no exudates
Neck- Trachea midline, supple neck, no cervical
lymphadenopathies

Chest and Symmetrical chest expansion, clear breath sounds, no

Lungs retractions

Cardiovas Adynamic precordium, normal rate, regular rhythm,

cular distinct S1 and S2, no murmurs, no thrills

Abdomen Flat, normoactive bowel sounds, soft, direct tenderness

on epigastric area, no palpable masses, liver span is 6cm
in right midclavicular line, edge not felt, no costovertebral
angle tenderness
 Physical Examination
Genitalia Grossly male, Tanner stage II on Genitalia and pubic hair

Extremities Full and equal pulses, CRT <2sec, no edema, no pallor

Neurologic Mental status exam

Frontal: Awake, alert, coherent, cooperative
Parietal: No R-L disorienttaion, no finger agnosia
Temporal: Intact remote, recent, immediate memory,
oriented to time place person
Occipital: Recognizes objets and colors
GCS: 15 ( E4 V5 M6)
Cranial Nerves
CN I: Can smell
CN II: Pupils 2-3mm equal and briskly recative to light
CN III, IV, VI: EOMs intact
CN V: Intact corneal reflex, good masseteric and
temporalis muscle tone
CN VII: No facial assymetry
CN VIII: Intcat gross hearing
CN IX, X: Intact gag reflex
CN XI: Good shoulder shrug
CN XII: Tongue midline
Motor: Good muscle tone, 5/5 strength on both upper and lower extremities
Sensory: 100% to light touch
Reflexes: 2+ on biceps, brachioradialis, knee, ankle; no babinski
Meninges: No neck rigidity
Cerebellar: No nystagmus, no dysdiadochokinesia, good gait
 Salient features
SUBJECTIVE OBJECTIVE
(+) Fever
(+) Abdominal pain
(+) Rashes on both upper and
lower extremities
 Disease
Differentials
Measles Rubella Chikungunya Chickenpox Dengue
Rash -Maculopapular -Pink macules that -Diffuse -Initially, intensely -Occurs 1-2 days
rash coalesce erythematous pruritic erythematous after defervescence
-Begins on forehead, -Begins on face, maculopapular rash macules that evolve to -generalized,
behind ears and on neckthen spreads of the trunk and papular stage to form morbiliform,
upper neck then spreads centrifugally extremities, clear, fluid filled vesicle maculopapular rash
downward -Fades in 3 days sometimes involving -Begins on scalp, face sparing palms and
-Fades over about 7 -No desquamation the palms and soles. or trunk soles
days -May evolve into -Clouding and -Fades in 1-5days
-Leaves fine petechiae, urticaria, umbilication occurs -Desquamation may
desquamation xerosis, or occur
hypermelanosis; or
resolves with
desquamation

Age 90% before 15 yr of age Pre-school age and All age groups -Most children infected All age groups
school age by 15 years of age
-<5% adult

Clinical Prodromal phase: Prodrome phase: -High fever (40°C/ Prodrom phase: -Sudden onset of
Manifestation -mild fever -low grade fever 104°F) with flushed -Fever 37.8-41.1oC fever (39.4-41.1oC)
-conjuctivitis with -sore throat appearance -malaise -Frontal or
photophobia -red eyes -Chills -anorexia retroorbital pain
-coryza -headache -Joint pain (lower -headache -Severe back pain
-prominnet cough -malaise back, ankle, knees, -occasional mild -Myalgia, arthralgia
-increasing fever -anorexia wrists or phalanges) abdominal pain -2nd -6th day of
-Koplik spots 1-4 days -lymphadenopathy -Joint swelling fever nausea and
before rash -Headache vomiting,
Rash occurs with -Muscle pain gen.lymphadenopat
Rash on 4th day Forchheimer spots -Nausea hy, anorexia
-Abdominal pain
-Retro-orbital pain