fever and rash

Assalamualaikum & good day everyone!!!

differential diagnosis:

1) dengue fever
- transmitted by aedes mosquito
- symptoms appear 3 to 14 days after infective bite
- dengue triad = fever, rash, headache
- character of the scar = whitish center surrounded by redness skin

2) kawasaki disease
- characterized by high fever

- together with at least 4 of the followings
: conjuctivitis
: redness / swelling of hands and feet
: rash
: cervical lymphadenopathy
: strawberry tongue

- always appear toxic, irritable, non-active
- never unilateral

3) measles
- spread by coughing & sneezing
- high fever begins at day 10 to day 12 & lasts for 7 days
- characterized by 3c (cough / coryza / conjuncivitis)- slowly fades away at day 7 to day 9
- scar was brownish coppery hyperpigmented macule aka post-inflammatory hyperpigmented macule

4) hand footh mouth (HFM)
- caused by enterovirus eg coxsackie
- spread by direct contact with the virus
- clinical features include mouth ulcer, rashes on the palm & sole

5) chicken pox

- caused by varicella-zooster virus

- an air-borne disease

- contagious five days before & five days after the rash appeared

- no longer contagious when the scar / crust present

 6) rubella

- contagious one week before the rash appeared & one week after the rash disappeared 

- possessed a lifetime immunity once being infected

- post cervical lymphadenopathy

7) SLE

- an autoimmune disease

- mainly affect women

- criterias to diagnosed SLE

: malar / butterfly rash

: patchy redness that cause scarring

: photosensitivity

: mucous membrane ulcers

: arthritis

: pleuritis / pericarditis

: kidney abnormalities

: seizure / psychosis

: blood count abnormalities

: immunologic disorder

: positive antinuclear antibody

8) scrub typhus 

- caused by orientia tsutsugamushi

- infected by the bites of chigger 

- characterized by aschar / necrotic lesion & abdominal pain

- usually in groin area

- treatment = doxycycline 

- tested with immunoperoxidase test

9) scarlet fever

- infected by group A streptococcus

- very high fever associated with lymphadenopathy

- characterised by strawberry tongue / sore throat

- macular rash of sandpaper appearance

- toxic looking

CHEST X-RAY interpretation in paediatrics.

Assalamualaikum & good day everyone!!!

1. note the personal details of the patient.
- is it the right person?
- right age?
- what about the date?
- is it compatible to the history?

2.how about the positioning of the X-ray?
- is it AP or PA view?
- it does makes a difference where AP view will give larger view of the heart, where in actual condition, there is no cardiomegaly.
- to determine whether there is cardiomegaly, look at the cardiothoracic ratio:
- it is acceptable if the cardiac shadow is < 60%- less than 1 year
                                                              <50%- more than 1 year

3.comment on the quality of the film.
- is it a good quality film?
- seen by:- a) good penetration
                     can you see the intervertebral spaces?
                 b) is it centered?
                     look at the trachea, is there any deviation form the midline
                     also look at the medial part of the clavicle whether it is symmetrical for both sides.
                 c) any rotation?
                     seen by the outline of theX-ray
                     (this is my clue: see whether u can see the head turned to any side)
                     and of course if there is deviation of the trachea from the midline.
                  
- in case of rotation,u will realize that the vascular marking is remarkably visible only at one side, as when then X-ray is taken, that side is focussed more than the other side (as u see, children do move when the X ray was taken), but it does not mean, perihilar haziness is more prominent on one side of the heart only.

4. is the X-ray showes hyperinflation?
- count the posterior ribs
- if it is more than 7, it shows hyperinflated lung in case of: e.g: acute bronchiolitis, Asthma.

5.any area of consolidation?
- assess the lung by a lobe at a time.
- focus more on the periphery rather than mentioning perihilar haziness as it may only indicate the vascular marking

6. comment on any other features such as gas in bowel, or any other abnormal features seen.
- e.g: in situs inversus, liver can be noted to be on the left side, and of course, the heart (left ventricle located on the right side)

7. check for mediastinum (the outflow of heart aka the blood vessels at the top)
- wide: in newborn (before 6 months, the thymus can make the mediastinum looks wider)
- narrower in case of transposition of Great Arteries.

8. in case of dilated bowels, gas can be seen in the bowels..

ok, that's all for today, tomorrow, i will be coming back with example of X-ray and how to interpret it....

thanx...

roger and out!!!

vomiting and diarrhea

Assalamualaikum & good day everyone!!!

Ms. AF, 8-year-old Malay student was admitted yesterday with a complaint of vomiting and diarrhea for a day. She vomited 10 times yesterday which was watery in nature with no food particles, two table spoons in amount and it was colourless. There was no blood associated with it. She ate at her school's canteen during lunch time with her sister but there was no one else in the family that was having the same problem. While for her diarrhea, she had it for 6 times yesterday. It was yellowish, loose and filled up the whole toilet bowl. There was no blood but she experienced abdominal pain throughout the day.

Basically, that was the summary of a patient that we discussed during our CP last time. We need to think of some investigations to come up with a diagnosis and some plans to manage the patient.

Do u guys have an offer to make about the investigations and also the plans?
I bet u guys already have the answer isn't it?

Yup.. The investigations that should be done are:
- renal profile : to check the electrolyte levels, whether any imbalance exists
- stool culture & sensitivity : to detect the type of organism that may cause the diarrhea

The diagnosis : Acute gastroenteritis

Plans:
- Hydrate the patient
- Monitor vital signs

At the end of the day, the things that i learned was:

- to know how well the patient is, we can deduct it from his activity, appetite and sleep pattern

- to know whether the patient is dehydrated or not, check his urine volume and frequency

- to ask about immunisation status, look at the card or ask when is the last time that the patient had his vaccination

- for developmental history in a student, ask about the academic's performance which consists of his level in the class and the scores on the subjects

- for general examination, Dr ML wants us to mention about capillary refill time, clubbing, pallor, jaundice, cyanosis and edema

- if someone is at home and suddenly develops vomiting and diarrhea, isotonic drinks can maintain the hydration status

- oral rehydration salt (ORS) and banana have potassium which can maintain the electrolytes level in the body

- if a small kid can't tolerate orally, ice-cream is given because it is soothing to the mouth and it has enough calories for the kid

the start of a new chapter

Assalamualaikum & good day everyone!!!

finally we have came up with the idea of sharing resources and infos throughout our journey as medical students. how do we came up with such an idea? it's because we faced different clinical scenario everyday, so we felt responsible to share them with peers. don't u guys think so? ;)

"how other people will approach this situation?"

everyone will have their own reasoning and judgements. so guys!!! this is the time to voice out what you have in mind, may it be just small info from clinical presentation (CP), or any little questions that might tingling you, let this be the platform for self-directed learning. make full use of this, and Insyaallah.... we will gain as much knowledge as possible. let's make it possible!!!

Thanx!!!

XOXO MIRA & AIFAA XOXO