Pedia 3B Manual Prelims - SGD cases

PARASITOLOGY CASE (PAGE 41)

Case 1:
1. What are the possible Differential Diagnosis? Give your Basis.
● Shigellosis
○ (+) Tenesmus
○ (+) Blood tinged Stool
○ (+) Diarrhea
● Balantidiasis (Invasive Colonic Balantidiasis / Balantidium Colitis)
○ (+) Diarrhea
○ (+) Dysentery with bloody mucoid stool
○ (+) Tenesmus, abdominal pain
● Salmonellosis
○ (+) Abdominal pain
○ (+) Mild to severe watery diarrhea and sometimes by diarrhea containing
blood and mucus
○ (-) Nausea, vomiting
● Trichuriasis
○ (+) Colic abdominal pain
○ (+) diarrhea with blood and mucus
○ (+) tenesmus
● Amoebic Colitis
○ (+) diarrhea
○ (+) tenesmus
○ (+) colicky abdominal pain
○ (+) bowel movement 6-8 times/day
○ (+) stool is blood tinged with mucus
● Capillariasis
○ (+) abdominal pain
○ (+) watery diarrhea in large volumes (frequent bowel movements 6-8x per
day)

2. What is the most likely diagnosis? Give your Basis.

● Amoebic Colitis
● Basis:
○ Age prevalence of 1-5 y/o
○ Primary complaint is diarrhea
○ (+) Tenesmus
○ (+) Colicky Abdominal Pain
○ Frequent bowel movement of 6-8times/day
○ Stool is blood tinged and with mucus
● Other signs and symptoms to look for:
 ○ Onset: gradual
○ Signs of dehydration and electrolyte imbalance because of the frequency
of bowel movement
○ Constitutional signs and symptoms maybe absent, but fever may be
observed in 10% of infants
○ Rapidly progressive for those who are immunocompromised and for
younger patients
○ Sign of rectal ulceration and presence of some leukocytes in the stool
3. What is the specific Drug of Choice if this is a case of Intestinal amebiasis? Give the
dose and the duration of treatment.
Intestinal Amoebiasis
● Metronidazole ​(Drug of choice)
30 – 50 mg/kg/day in 3 divided doses for 7-10 days
Max 500 – 750 mg/dose for 10 days
● Tinidazole
Amoebic colitis: 50mg/kg/day OD for 3 days

Case 2:
What is the most possible diagnosis? The disease is at its highest incidence between
what particular age?

● Most possible diagnosis: Toxocariasis (history of pica and contact with puppies)
● Highest age incidence: Age 1-4 years old (highest in pica and with contact with
dogs)

VIROLOGY CASE (PAGE 106)

1. What is your most likely diagnosis? Give your basis ​(Dioso)

● Measles/Rubeola
○ (+) 4 day history of fever, cough, cold and eye redness.
■ Prodrome period:3-5 days. +fever, nonspecific respiratory symptoms,
conjunctivitis
○ (+) multiple erythematous maculopapular lesions on the face down to the neck
■
○ (+) White lesions on the buccal mucosa
■ Koplik spots (grayish white macules located at the buccal mucosa in front
of the premolars)
○ (+) Palpable lymph nodes
■ Lymphadenopathy
 ○ (+) poor appetite
■ Anorexia
2. Give at least 2 differential diagnoses. ​(Flores)
Rubella - the difference with measles is that in rubella there is more prominent cervical
lymphadenopathy
Roseola infantum - in measles the onset of rashes and fever are the same but in roseola
infantum when the fever is gone, that is the time the rashes will appear.
Drug rashes

3. What is the most common complication of this disease?​ (Caguitla)

The most common complication of measles is Otitis Media which is an inflammation of
the middle ear.

4. What measures could have prevented this disease?​ (Cruz)

● Active Immunization:
○ Post-exposure immunization - measles vaccine given within 72hrs after
exposure
○ Pre-exposure immunization - 1st dose: given at 6mos of age
2nd dose: 6-9mos after 1st dose, as MMR
3rd dose: 4-6 y/o or 11-12 y/o, as MMR
● Passive Immunization - immunoglobulin given to prevent or modify measles in a
susceptible person within 6 days after exposure
○ Indications: - susceptible household contacts especially <1y/o
- pregnant women
- Immunocompromised children
5. How will you manage this patient​? (Batac)

Give supportive measures

-Antipyretics
-Fluid and Electrolytes

Give Oral Vitamin A

For 1 year old and older: 200,000 IU/day for 2 days

6. What will you advise the family regarding this disease and what to watch out
for? ​(Domingo)
-Tell the family that the disease is highly contagious and that they should monitor
themselves for clinical manifestations after 8-12 days, from 1-2 days before the onset of
symptoms of the patient (3 days before to 4-6 days after the onset of rash) to know if
they contracted the disease.
-If they show symptoms, consult immediately to get the proper management and prevent
further complications.
RHEUMATOLOGY CASE (PAGE 253)

1
2 ​What diagnostic tool or examination are you going to perform to evaluate her complain of
limping
-PGALS Assessment Tool (Pediatric Gait, Arms, Legs and Spine)
3​. if the above patient is presumed to have kawasaki disease what are the criteria she
fulfilled?
Patient presented with
-Fever of 8 days( fever more than 5 days criteria)
0
- rashes, maculo papular and solitary patches
( polymorphous rash, primarily truncal non vesicular)

-swelling on left ankle( changes in perioheral extremities)

- redness of eyes with no discharge ( bilateral conjunctival injection)
- watery nasal discharge(changes in oropharyngeal mucous membranes)
- strawberry red lips and tongue
- + palpable 1.5 c 2cm cervical lymph node

by juris juanitez

4.what diagnostic test will you request to confirm the diagnosis of kawasaki disease?
No diagnostic test for KD
- leukocyte count often elevated, predominanxe of neutrophils and immature forms
- esr elevated
- c- reactive protein value present during acute

2-d echo to measure the coronary arteries and evaluate heart and valves

by juris juanitez

5. What are the treatment in a patient with kawasaki disease at this stage of illness?
She is in the acute phase
treatment would be
-intravenous immoglobulim 2g/kg over 10-12 hr
- aspirin 80-100 mg/kg/day divided every 6 hr orally until patient afebrile for atleast 48 hr

by juris juanitez
references: pedia manual

ENDOCRINOLOGY CASE 1 (PAGE 280)

CASE A
Camille, 6 year old, was brought to the clinic for update of immunizations. Parents did not have
any other concerns. She is currently enrolled in Prep 1 and she excels in class and has good
relationships with her peers. Anthropometric measurements are: Weight= 19kg; Height= 105cm.
Mother's height= 164cm; Father's height= 174cm

1. Compute for the mid-parental height.

MPH for girls= (Father's height - 13cm + Mother's height) ÷2
= (174cm -13cm + 164cm) ÷2
= 162.5 cm
2. Interpret and Illustrate the mid-parental height in relation to the projected height.
The mid-parental height is a measurement of one’s genetic potential.
A difference of more than 10cms between the midparental height and projected height is
considered to be pathologic. In the case of Camille, her projected height is 105 cm while
the mid-parental height is 162.5 cm there is a difference of 57.5 cm, which is considered
to be pathologic.

On physical examination, vital signs were CR 84/min, RR 21/min, T 37C. She has redundant
neck skin folds, widely spaced nipples, and her arms when extended are deviated towards the
midline of the body.

3. Describe the BP and peripheral pulses you would expect to find in Camille’s case.
If this is a case of Turner’s syndrome, a case where aortic coarctation is a common
arterial anomaly, then the blood pressure and pulses would be different between the upper and
lower extremities. The upper extremities’ blood pressure and pulses would be lower than the
lower extremities.
(REYES) Congenital heart abnormalities occur in up to 50% of individuals, affecting mainly the
left side of the heart and including bicuspid aortic valve (BAV), coarctation of the aorta, and
thoracic aortic aneurysm.

One-third of Turner's syndrome (XO) patients have a coarctation. There is an association with a
bicuspid aortic valve with a reported incidence of 30-40% or more.

The major clinical manifestation is a difference in systolic blood pressures between the upper
and lower extremities, while the diastolic blood pressures are usually similar. Other classic
findings are hypertension in the upper extremities, diminished or delayed femoral pulses
(referred to as the brachial-femoral delay), and low blood pressures in the lower extremities. If
the origin of the left subclavian is distal to the narrowing, the left arm blood pressure may also
be diminishe

4. Give 3 diagnostic examinations that would help you evaluate her case and give the expected
results that would confirm you diagnosis.

If this is a case of Turner’s syndrome the following results are expected:

-Karyotyping- 45X or the 45X/46XX mosaic
-TSH and FT4- to rule out thyroid abnormalities ( result within normal levels)
-IGF-1 and IGF-BP3 Growth hormone provocation test- to rule out GH deficiency ( result within
normal levels)
-Extended FISH- done if karyotype is normal but suspicion remains high

ENDOCRINOLOGY CASE 2 (PAGE 281)

CASE B
Jepoy, 17 year old, was brought to your clinic for medical clearance prior to school entrance. He
was asymptomatic with updated immunizations. He was born to a Filipino mother and a Puerto
Rican Father.

BP= 140/90mmHg CR= 90/min

Height= 180cm RR= 18/min
Weight= 93kg T= 37C
Waist circumference= 95cm

PE showed diffuse darkening of his nape as well as the skin over inter-scapular spaces, gluteal
folds and interphalangeal joints.

1. Give your complete diagnosis

● The patient has Type II DIabetes Mellitus.
Basis: The patient’s ethnicity puts him at risk of Type 2 DM. The patient is also obese
and has signs of acanthosis nigricans.

2. What diagnostic test/s. If any, would you like to request in this case?
● A fasting plasma glucose measurement of 2-hour oral glucose tolerance test can
be requested for the patient.

3. Give your pharmacologic and non-pharmacologic management of this case. When are
medications warranted and which drugs would you use.
a. For non-pharmacologic management of the patient, weight reduction with control
of appetite and proper nutrition can be recommended to the patient. In line with
this, increased physical activity or exercise of at least 1 hour a day can be
helpful.

b. Drugs that can decrease insulin resistance, such as metformin can be prescribed
to the patient. It can reduce hepatic glucose production, increase insulin
sensitivity and reduce intestinal glucose production without increasing insulin
secretion. This can be effective since the patient is obsese. Sulfonylurea is
second line but used only if monotherapy with metformin is contraindicated or
unsuccessful. Insulin can be prescribed as well but only indicated if with the
presence of DKA or if FBS is >250 mg/dL or post-prandial glucose levels >300
mg/dL. For the patient’s hypertension, lifestyle modification is first line. Only when
the patient has secondary hypertension or with insufficient response to lifestyle
modification that antihypertensive such as Ace inhibitors,CCB, beta blockers and
diuretics are indicated.