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    Case # 1

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    AnneCanapi
    This case involves a 3 day old male infant presenting with jaundice. He was born full term via vacuum assisted delivery and discharged after 24 hours. At home, yellowish discoloration of the skin was noted and progressed down to the thighs. On examination, the infant had jaundice from the face to thighs with icteric sclerae. Labs are notable for elevated direct and total bilirubin. The differential includes neonatal jaundice due to breastfeeding issues or underlying pathology. Management may involve workup and treatment of the cause of prolonged jaundice.

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    Case # 1

    Uploaded by

    AnneCanapi
    11 views3 pages
    This case involves a 3 day old male infant presenting with jaundice. He was born full term via vacuum assisted delivery and discharged after 24 hours. At home, yellowish discoloration of the skin was noted and progressed down to the thighs. On examination, the infant had jaundice from the face to thighs with icteric sclerae. Labs are notable for elevated direct and total bilirubin. The differential includes neonatal jaundice due to breastfeeding issues or underlying pathology. Management may involve workup and treatment of the cause of prolonged jaundice.

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    This case involves a 3 day old male infant presenting with jaundice. He was born full term via vacuum assisted delivery and discharged after 24 hours. At home, yellowish discoloration of the skin was noted and progressed down to the thighs. On examination, the infant had jaundice from the face to thighs with icteric sclerae. Labs are notable for elevated direct and total bilirubin. The differential includes neonatal jaundice due to breastfeeding issues or underlying pathology. Management may involve workup and treatment of the cause of prolonged jaundice.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    11 views3 pages

    Case # 1

    Uploaded by

    AnneCanapi
    This case involves a 3 day old male infant presenting with jaundice. He was born full term via vacuum assisted delivery and discharged after 24 hours. At home, yellowish discoloration of the skin was noted and progressed down to the thighs. On examination, the infant had jaundice from the face to thighs with icteric sclerae. Labs are notable for elevated direct and total bilirubin. The differential includes neonatal jaundice due to breastfeeding issues or underlying pathology. Management may involve workup and treatment of the cause of prolonged jaundice.

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    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

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