Do GPE of 4 year old ahsan.
4 year old Ahsan is a healthy looking child who remained conscious and cooperative during my examination having multiple bruises in different stages all over his body.
He has radial pulse rate of 90/min which is regular , good in volume , BP of 100 / 60 mmHg, RR of 24 / min and temp of 98 degF.
His OFC is 50 cm , height is 100 cm , weight is 14 KG, which appear normal for his age but i would like to plot them on percentile charts.
He has multiple bruises in various ages over his trunk and limb the maimum of which meaures 5 by 8 cm, there is no associated gum bleeding, nose ear or conjunctival haemorrhage and the examination of joints is normal.There is no pallor, jaundice , lymphadenoapthy or bone tenderness., clubbing,koilonychia, palmer eryhtema, the examination of oral cavity is normal.there is no neck swelling and bcg scar is present. except for bruises there is no sign of any micronutrient deficieny ?
Both radial bones are palpable and there is no eczema.
on extending my examination, the examiantion of abdomen is unremarkable for any visceromegally.
------------------------
D/D
ITP
drug induced thrombocytopenia
vWD
leukemia (on t/m)
---------------------------------------------------------
Ix ( cbc, USS abd, HIV screen as in chr , EBV serology ?, coombs for evan syndrome)
Counselling and reassurance of parents.
no IM injections, no NSAIDS,
remove offending drug or get its drug levels, (NSAID, valproic, vanco , steroids, Heparin IT)
monitor for progression of bruises, get cerial CBC,
tm if less than 10,000 plt count.
(steroids, IVIG, RhoGam ( ICH ? plt , PCV transfusion)
romiplastin stimulates platelet production.
---------------------
if this were a FEMALE child,
i would include SLE in D/D and look for clinical signs of SLE,
and in investigation include workup for SLE also.
since i found bruises, i have to look for other sites of bleeding, and specially for joint bleeds,
and for cause of bleeding >>> acute hepatitis , CLD, malnutrition with Vit K deficiency, hemphilia, vWD or Plt related disorders,
4 year old Ahsan is a healthy looking child who remained conscious and cooperative during my examination having multiple bruises in different stages all over his body.
He has radial pulse rate of 90/min which is regular , good in volume , BP of 100 / 60 mmHg, RR of 24 / min and temp of 98 degF.
His OFC is 50 cm , height is 100 cm , weight is 14 KG, which appear normal for his age but i would like to plot them on percentile charts.
He has multiple bruises in various ages over his trunk and limb the maimum of which meaures 5 by 8 cm, there is no associated gum bleeding, nose ear or conjunctival haemorrhage and the examination of joints is normal.There is no pallor, jaundice , lymphadenoapthy or bone tenderness., clubbing,koilonychia, palmer eryhtema, the examination of oral cavity is normal.there is no neck swelling and bcg scar is present. except for bruises there is no sign of any micronutrient deficieny ?
Both radial bones are palpable and there is no eczema.
on extending my examination, the examiantion of abdomen is unremarkable for any visceromegally.
------------------------
D/D
ITP
drug induced thrombocytopenia
vWD
leukemia (on t/m)
---------------------------------------------------------
Ix ( cbc, USS abd, HIV screen as in chr , EBV serology ?, coombs for evan syndrome)
Counselling and reassurance of parents.
no IM injections, no NSAIDS,
remove offending drug or get its drug levels, (NSAID, valproic, vanco , steroids, Heparin IT)
monitor for progression of bruises, get cerial CBC,
tm if less than 10,000 plt count.
(steroids, IVIG, RhoGam ( ICH ? plt , PCV transfusion)
romiplastin stimulates platelet production.
---------------------
if this were a FEMALE child,
i would include SLE in D/D and look for clinical signs of SLE,
and in investigation include workup for SLE also.
since i found bruises, i have to look for other sites of bleeding, and specially for joint bleeds,
and for cause of bleeding >>> acute hepatitis , CLD, malnutrition with Vit K deficiency, hemphilia, vWD or Plt related disorders,
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