difficulty breathing

Physical examination:

General appearance: An irritable boy with noisy breathing. Because of difficulty swallowing secretion, he was kept in semi-upright position (figure 1).

Body weight: 9.5 kg (50 percentile), Height: is at 50 percentile.

Vital signs: BT (axillary):39.1 degree celsius, PR: 148/mins, RR:36/min, BP 118/68 mmHg

HEENT: puffy eyelids, puffy face, enlarged tonsils grade 2 with patches of exudate, bilaterally. Swollen neck (figure 1, 2)

Lymph nodes: enlarged anterial and posterial cervical LNs. ~ 2-3 cm, bilaterally.

Chest: mild suprasternal retraction, Heart: regular, Lungs: upper airway secretory sound

Abdomen: soft, no hepatosplenomegaly

Extremities : no edema, no clubbing

Neurological examination: with in normal limit

Skin: no rash

Figure 1: Puffy eyelids, puffy face, wollen neck

Figure 2 : Enlarged tonsils grade 2 with patches of exudate

Problem list:
> Acute high fever ( 3 days )
> Exudative tonsillits
> Periorbital swelling, facial swelling
> Cervical LN enlargement

What is the differentail diagnosis? Next to Page 2

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Prepared by... Kanokorn Leepetcharut, M.D. Virat Sirisanthana, M.D.
Department of Pediatrics, Chiang Mai University, Thailand
A 1-year-old boy. Address: Chiang Mai, Thailand
Chief compliant: high fever for 3 days

Present illness:
>	He had been well since birth.
>	3 days prior to admission, he developed fever which poorly responded to paracetamol.
>	2 days prior to admission, fever persisted and she developed puffy eyelids with noisy breathing.
>	1 day prior to admission, he was admitted at a hospital and was given intravenous cefotaxime. He had been getting worse so he was refered to our hospital.
Past history:
>	He has had normal growth and development.
>	His immunization has been up-to-date. These also included 3 doses of "diphtheria-tetanus-pertussis".