General medicine case
A 13 year old boy with fever and swelling over neck since 15 days
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Case:
A 13 year old boy with swelling over neck since 15 days and fever since 10 days.
Date of admission: 10/12/21 morning
History of present illness:
Patient was apparently asymptomatic 20 days back before the standing illness.The patient was admitted to casualty with swelling over neck since 15 days and fever since 10 days.
Patient's mother works at a poultry and his father is a car driver.
The boy was studying 7th standard and was joined in hostel 20 days back. 10 days back when the boy had neck swellings and fever they visited a local hospital where it was told that he had food poisoning since he stays in hostel.
The boy's daily routine in hostel was to wake up by 4 o'clock in the morning and make rounds in the ground and getting back by 6.30 and used to have milk and gets ready for classes.By 8 o' clock goes to school and at 4 pm after school they had 2 hrs of ganes but the boy was not interested in playing with them so he used to sleep in the classroom until 6 o' clock and after they used have dinner by 8 o' clock and then study hours until 9.30 pm and then goes to bed.
17 days the boy stayed in hostel in chikatimamidi and in between those days his father used to visit him where he used to take the boy to bakery. Before the appearance of neck swellings the boy went to bakery 10 days back.
The boy went to poultry where his mother works 6 to 7 days back for helping his mother in her work.
Patient had cat as a pet since 5 years.He used to play with it daily.He had scratches over abdomen dy
The neck swellings are initially small in size and had grown to present size gradually.
The boy started getting pain in the neck swellings not immediately but after 6 days of appearance of swellings.
The fever was intermittent and recur every 2 days.
He had difficulty in swallowing since a day before admission.
Since 5 days patient was only on chapati .
Since 5 days the patient had severe fatigue.
Past history
No h/o HTN/DM/Epilepsy/TB/Thyroid disorders
Personal history
Diet : mixed
Appetite : loss of appetite since 4 days.
Bladder and bowel movements:normal
Sleep : disturbances since 4 days
Family history
No history of DM/HTN/CVA/CAD/Asthma/thyroid disorders
No similar complaints in the family previously.
Treatment history
Not significant.
General examination
Patient is conscious, coherent and cooperative.
Oriented to time,place and person.
No pallor, history of icterus previously but not now,no cyanosis,no clubbing,no lymphadenopathy.
Vitals
Bp :110/70 mm hg
PR:136 bpm
RR: 20 cpm
Spo2: 96%
GRBS:116 mg/dl
Temperature: 103'F
Systemic examination:
CARDIOVASCULAR SYSTEM:
Inspection:
Chest wall is bilaterally symmetrical.
No precordial bulge.
Palpation:
JVP: normal
Auscutation:
Normal with regular heartbeat
S1, S2 heard
No murmurs
RESPIRATORY SYSTEM-
Position of trachea: central
Normal Bilateral air entry
No AV sounds
PER ABDOMEN:
Normal. No mass is palpable.
No organomegaly
CENTRAL NERVOUS SYSTEM:
Patient is Conscious, coherent and cooperative.
Provisional diagnosis:
Irreducible indirect incomplete inguinal hernia.
Provisional diagnosis:
Pyrexia under evaluation
Suspecting its due to cat scratch???
Investigations:
Blood urea :30 mg/dl
Blood parasites: negative
Cat scratch over the abdomen:
Neck swellings:
Fever chart:
Treatment:
10/12/21
Inj. PCM 450 mg/IV/sos
Tab. Pan 20 mg/po/od
IVF NS,RL @ 100ml/hr
Tab. Dolo 500 mg /po/tid
Plenty of oral fluids
Tepid sponging 4 th hrly
BP/PR/Temp 4th hrly
11/12/21
Inj. PCM 450 mg/IV/sos
Tab. Pan 20 mg/po/od
IVF NS,RL @ 100ml/hr
Tab. Dolo 500 mg /po/tid
Plenty of oral fluids
Tepid sponging 4 th hrly
BP/PR/Temp 4th hrly
Inj. Proflaxacin 500 mg/bd/iv
Strict i/o charting
Tab. Azithromycin 500 mg/po/OD
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