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Prepared by...
Panuwong Sansamranjai, M.D. Thanyawee Puthanakit, M.D. |
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Department of Pediatrics, Chiang Mai
University
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| Patient: A 2-year old boy | |
| CC : Fever for 5 days |
| PI: | ||
| 7 days PTA he developed low grade fever, malaise, cough and sore throat. | ||
| 2 days PTA he still had fever, sore throat and
poor appetite. His mother noticed a group of small movable as along both side of his neck. At the district hospital, his complete blood count was Hb 12.1 mg/dl , Hct 41 %, wbc 44,600 cells/mm3 plt. 355,000. He was then referred to Chiang Mai University hospital for investigation of acute leukemia. |
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| PH: | ||
| no underlying disease, normal development, complete immunization | ||
| Physical examination | |
| GA : | A Thai boy, good consciousness |
| V/S : | BT 38.5 c , PR 128 /min , RR 26 /min , BP 105/70 mmHg , BW 13 kg , Ht 87 cm. |
| HEENT: | no pale conjunctiva, no icteric sclera, puffy
eyelids moderate injected pharynx & tonsils grade III, no exudate |
| Lymph Node: | symmetrical discrete multiple cervical lymphadenopathy,
posterior auricular and occipital lymphadenopathy size 1-2 cm in diameter |
| Heart: | normal S1S2 , no murmur |
| Lung: | no chest retraction, normal breath sound, no adventitious sound |
| Abdomen: | soft, not tender, liver 2 cm. below RCM, spleen 1 cm below LCM |
| Ext: | no edema, no petechiae |
| Initial laboratory tests | |
| CBC: | Hb 12.4 mg/dl, Hct 37.8 %, wbc 58,100 cells/mm3 ( Neu 24 % , Lymp 66 % , Mo 8%, Eo 2%), plt 316,000 / mm3 |
| ESR: | 13 mm/hr |
| What is your presumptive diagnosis? |
| Answer : NEXT |