Pediatric Patient #1: Case Study
I couldn't find a pediatric patient with the same symptoms as the picture above; but you get the picture. HAHA.
I am once again doing a paper.... this time on pediatrics.
So there's internal medicine, surgery, psychiatry and pediatrics that requires a paper submitted containing the history, physical examination, clinical impression, differential diagnosis, treatment and management.
KILL ME NOW.
Medicine is getting challenging. OMG. Oh well.
Sharing the history of present illness for those inspiring medical students, if you are curious about the correct differential diagnosis, just let me know.
I got my differential diagnosis incorrect with my surgical patient. Apparently, it was thyroid carcinoma although the history taking was indicative of something else. Oh well! You never get it right anyways at this level, that is why it's a learning process and the reason why we have consultants in order to guide junior doctors like myself. :)
Anyways, need to finish this damn paper.
Pediatric Patient #1: JM. 3 months old, male.
HISTORY OF THE PRESENT ILLNESS
1 week PTA, grandmother noticed blood and pus on the pillowcase of baby JM. It was only then that they noticed an erupted mass, about the size of a 1-peso coin at the patient’s nape. Betadine (povidone-iodine) was applied on the mass. The patient was later brought to a nearby clinic where he was prescribed unrecalled oral drops to be given at 2 mL q8h, It was only given to him once, and discontinued to avoid disturbing his sleep. No fever, diarrhea, or vomiting were associated.
6 days PTA, a second pimple-like lesion was noticed at the patient’s nape, next to the erupted mass, which was now dried up. No intervention was done on the pimple or on the erupted mass.
5 days PTA, the second mass grew to about 25-centavo coin in diameter. It appeared as a raised, red lesion with pus. No intervention was done. The patient experienced low-grade fever (38°C), for which the patient was given paracetamol once. Fever subsided.
1 day PTA, the second mass grew to about a 5-peso coin in diameter. He was brought to a clinic for consultation but no diagnosis or medications were provided. The clinic referred him to UERM.
A few hours PTA, the 5-peso-coin-sized mass became firm, warm to touch and painful such that the patient would cry when the mass was touched. He was then brought to the UERM-ER, and was eventually admitted.
3 feedbacks
Good day. I'm currently a resident from a different institution. I stumbled upon your blog while searching for cases. I was hoping you would tell me what is your impression. Not trying to sound rude, but how could you say that it is indeed, in your own words, the "correct differential diagnosis" since as mentioned above you were not right with your surgical diagnosis.
ReplyDeleteHello! :)
ReplyDeleteMy clinical impression for this case is: (a) Folliculitis secondary to Staphylococcus sp. or Streptococcus sp. infection due to persistent sweating as a result of sleeping position.
Well, according to my professor, he thinks that the surgical case was malignant in nature. I, on the other hand thought it was benign and due to infectious disease such as Tuberculosis lymphadenopathy. I read Harrison, and it states that if the mass is less than 2 cm, it is usually benign, but my professor said that in his clinical experience, Harrison is wrong.
We do not really say that the clinical impression we have is the correct differential diagnosis since we do not usually look at the patient's chart, but according to my professor, it looks like a malignant case (thyroid cancer) rather than TB lymphadenopathy but more laboratory tests are needed to either confirm or rule out working impression.
Hope that helps! :)
I guess the correct term was "differential diagnosis that seems to be more correct based on the given history" :)
ReplyDelete