SCENARIO 2

High Fever

A 10-year-old girl, brought to the outpatient unit by her mother because of high fever. It has
occurred for the last 3 days. High fever appeared suddenly and persisted all day and night, without
chills or convulsions. On the second day, the patient began to get headache, nausea, and vomiting.
Vomiting about 3 times a day with a volume of ½ cup each time she vomited, filled with liquid and
food residue, but there was no blood. On the third day, the complaint s became more severe with
intermittent epigastric pain. The patient has not defecated since the illness and there was no
complaint of urinating. There was no history of bleeding gums, nosebleeds, cough, runny nose or
shortness of breath. History of black or bloody defecation also not present. The basic immunization
history is complete, and the patient is rarely sick since her birth. History of similar diseases were
found in their neighbours.

The girl was compos mentis but look moderately ill. She was 35 kg and 140cm. On physical
examination revealed pulse rate of 125 bpm, respiratory rate of 24 x/minute, temperature of 39.1⁰C,
blood pressure of 90/50 mmHg. The CRT was 5 seconds, no anaemic conjunctiva nor icteric sclerae.
Thoracic examination within normal limits. Abdominal examination showed epigastric tenderness
and slight palpable liver and spleen. The acral extremities are cold and moist. Petechie were found
in extremities. Routine blood count showed Haemogblobin 14,6g/dL, haematocrit 45%, leukocytes
4.900/µL, platelets 40.000/µL. Widal test resulted Typhi H Antigen, Typhi O Antigen, Paratyphi A -O
Antigen, Paratyphi B-O Antigen were negative, while serologic test on Dengue IgM and dengue IgG
were positive. The doctor advises the patient to be hospitalized for next treatment and so that a serial
blood tests can be done.

Please discuss the scenario above with seven jumps!

PROGRAM STUDI S1 KEDOKTERAN

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SURAKARTA