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- 1. BYDR RABIAPGR WEST MEDICAL WARD
- 2.
BIODATANAME-------------IHTASHAMAGE------------13OCCUPATION--------STUDENTMARRITAL
STATUS ------UNMARRIEDRESIDENCE----------MUGHAL PURA LAHOREDOA
----------29/11/13MOA---------EMERGENCY
- 3. PRESENTING COMPLAINTS FEVER -------3 DAYS SORE THROAT
----------------3 DAYS PAINFUL DISCRETE SWELLINGS IN NECK
WITHDIFFICULTY IN MOVING NECK------------3 DAYS
- 4. HOPCPATIENT WAS IN USUAL STATE OF HEALTH 3DAYS AGO WHEN HE
DEVELOPED FEVER THATWAS SUDDEN IN ONSET, INTERMITTENT,HIGHGRADE
RELEIVED BY MEDICATION FROMLOCAL DOCTOR.NO H/O RIGORS CHILLS
ANDNIGHT SWEATS
- 5. FEVER WAS ASSOCIATED WITH SORE THROATAND PRESENCE OF PAINFUL
DISCRETESWELLINGS IN NECK.BECAUSE OF THESESWELLINGS PATIENT FELT
DIFFICULTY INSPEAKING,EATING SOLIDS AND MOVING HISNECK FROM SIDE TO
SIDE
- 6. NO HISTORY OF HEADACHE PHOTOPHOBIA VOMITTING NECK RIGIDITY
EAR DISCHARGE RETERO ORBITAL PAIN BODYACHES BLEEDING FROM ANY SITE
OR RASH ANYWHEREON BODY
- 7. NO HISTORY OF DIARRHEA CONSTIPATION FLANK PAIN BURNING
MICTURATION DARK COLOURED URINE HAEMATURIA
- 8. PERSONAL HISTORY SMOKER-VE ADDICT-VE DM VE HTN VE ASTHMA-VE
TB-VE CONTACT WITH TB-VE
- 9. PAST HISTORY NO HISTORY OF PREVIOUS ADMISSION INHOSPITSL OR
ANY SERIOUS ILLNESSS
- 10. FAMILY HISTORY INSIGNIFICANT DRUG HISTORY INSIGNIFICANT NO
H/O BLOOD TRANSUFION IN LIFE
- 11. DIFFERENTIALS INFECTIOUS MONONUCLEOSIS PERITONSILLAR
ABSCESS LYMPHOMA ENTERIC FEVER
- 12. GENERAL PHYSICAL EXAMINATIONA YOUNG BOY WELL ORIENTED IN
TIME PLACEAND PERSON WITH GCS 15/15WITH VITALSBP 110/70 mm hgPULSE
90/MINTEMP 101R/R 17/MIN
- 13. GENERAL PHYSICAL EXAMINATION PALLOR VE CYANOSIS-VE
CLUBBING-VE LEUKONYCHIA-VE KOILONYCHIA-VE JVP NOT RAISED NO RASH ON
THE BODY
- 14. GENERAL PHYSICAL EXAMINATION PALLOR VE CYANOSIS-VE
CLUBBING-VE LEUKONYCHIA-VE KOILONYCHIA-VE JVP NOT RAISED NO RASH ON
THE BODY
- 15. EXAMINATION OF NECK B/L PAINFUL DISCRETE FIRM OVAL 2X2
ANTERIORCERVICAL LYMPH NODES WITH NO PURULENTDISCHARGE NO OTHER
LYMPH NODES PALPABLE AXILLARY LYMPH NODE VE INGUINAL LYMPH
NODES-VE
- 16. EXAMINATION OF ORAL CAVITY INSIGNIFICANT PALATAL
PETCHIAE-VE APTHOUS ULCERS VE CANDIDIASIS-VE GUM BLEED-VE
GINGIVITIS-VE
- 17. GITINSPECTIONABDOMEN FLAT ,MOVING WITH RESPIRATIONUMBILICUS
CIRCULAR AND INVERTEDNO VISIBLE PULSATIONS,STRIAE,SCAR MARKSOR
PROMINENT VEINSHERNIAL ORIFICES INTACTPALPATION TENDERNESS IN LEFT
HYPOCHONDRIUM SPLEEN PALPABLE 2 FINGER BREADTHBELOW COSTAL
MARGIN
- 18. NO OTHER VISCERA PALPABLEPERCUSSION FLUID THRILL VE
SHIFTING DULNESS -VE AUSCULTATIONBOWEL SOUNDS +VENO BRUIT OR
FRICTION AUDIBLE
- 19. CVS INSPECTION PRECORDIUM IS OF NORMAL SHAPE AND NOVISIBLE
PULSATIONS OR SCAR PALPATION APEX BEAT IN 5TH INTERCOSTAL SPACE
MEDIALTO MIDCLAVICULAR LINE ,OF NORMALCHARACTER. NO OTHER SOUND
PALPABLE AUSCULTATION BOTH HEART SOUDS OF NORMAL INTENSITY NO ADDED
SOUNDS OR MURMUR
- 20. RESPIRATIONINSPECTIONRESPIRATORY RATE OF 16/min
SHAPENORMAL,ABDOMINOTHORCIC TYPE OFRESPIRATION,B/L EQUAL
MOVEMENTPALPATIONTRACHEA CENTRAL, NO TENDERNESS ORCREPITUS,EQUAL
MOVEMENT ON BOTHSIDES,EXPANSION OF CHEST IS 3cmPERCUSSIONUPPER
BORDER OF LIVER IN 5TH INTERCOSTAL SPACE
- 21. AUSCULTATIONBREATH SOUNDS VESICUAR AND OF
NORMALINTENSITY,NO ADDED SOUND,VOCALRESONANCE EQUAL ON BOTH
SIDES
- 22. INVESTIGATIONS HB------10.7 WBC ---25.110 RBC---38110 RBC
DISTRIBUTION WIDTH45.5 PLATELET COUNT -----21210RED CELL
INDICESHCT34.9%MCV.91.6flMCH28.1pgMCHC..30.7g/dl
- 23. DIFFERENTIALSNEUTROPHILS89.2%LYPHOCYTES9.4% IMMATURE CELLS
METAMYLOCYTES VE MYLOCYTES ------------VE PROMYLOCYTES VE BLAST
CELLS -VE
- 24. LFTS BILIRUBIN----0.8 ALT33 AST---27 ALKALINE
PHOSPHATASE215 TOTAL PROTEIN 6.8 ALBUMIN---3.6
- 25. RFTS BLOOD GLUCOSE ---100 mg/dl UREA-------23 SERUM
CREATININE------0.6ELECROLYTES SODIUM------135
POTASSIUM-----3.5
- 26. HETEROPHIL ANTIBODY TEST -VE
- 27. URINE COMPLETE SPECIFIC GRAVITY-----1.02 PUS CELLS ---1 -2
RBCS --nil PROTEINS--------nil KETONESnil
- 28. Call to ENT department was written regarding
patientsassesmnt.ACCORDING TO THEM THERE IS NOISSUE RELATEDTO EAR
NOSE AND THROATT
- 29. CHEST X RAY ------NORMAL
- 30. CASE SUMMARY A YOUNG BOY PRESENTED WITH ACUTE H/O FEVER
,SORE THROAT ,PAINFUL DISCRETECERVICAL LYMPH NODES IN NECK WITH
NOOTHER LYMPH NODES PALPABLE AND TENDSPLEENOMEGALY.PERIPHERAL BLOOD
PICTURESHOWED NEUTROPHILIA
- 31. Question Why patient has neutrophilia? Why patient has
painful spleenomegaly? What other investigations we should go for?
What can be the management policy