Pediatrics (General Admissions) 5

Contents
Antibiotics 3
Common medications 4
PEDIATRICS (GENERAL ADMISSIONS) 5
Fever (general) 6
Febrile convulsion 8
GE (with anal rash) 10
Prolonged fever 12
Kawasaki 14
Syncope 16
Breakthrough seizure 19
Afebrile convulsion 21
Allergy 23
Hematological malignancy (ie case of unexplained anemia) 25
Petechiae 28
UTI 29
PEDIATRICS (DAY WARD CLINICAL ADMISSIONS) 31
IVIG infusion 32
Palivizumab injection 33
Infliximab infusion 34
Thalassemia blood transfusion 35
BAER 36
DMSA / MAG3 37
MRI brain 39
CT brain 40
Entriflex change 41
Drug overdose 42
MSE 45
HEADSS framework (for adolescents) 45
O&G 46
Labor 47
1
Antenatal 49
Decreased fetal movement 50
Preterm 50
Abd pain cx pregnancy 50
Antepartum hemorrhage 50
BP monitoring 51
Elective C/S 51
Gynaecological hx taking 52
Threatened abortion 53
Hyperemesis gravidarum 54
Menorrhagia 54
Bartholin’s abscess 54
Gaped episiotomy wound 54
Pelvic inflammatory disease 55
Post LEEP bleeding 55
Persistent lochia 55
SURGERY 56
(Literally the most basic template you need for Surg) 57
Hematuria 58
Loin pain 59
AROU 60
Green OT 61
FBI 62
PTX 63
2
Antibiotics
1) Augmentin
a) IV augmentin 1.2g Q8H
- if eGFR 15-30: loading dose 1.2g, then 600mg Q12H
- if eGFR <15: loading dose 1.2g, then 600mg Q24H
b) PO augmentin 1g BD
- if eGFR 15-30: PO augmentin 375mg TDS
- if eGFR <15: PO augmentin 375mg BD
c) syrup augmentin 457mg/5ml 10ml BD
2) Tazocin (anti-pseudomonas)
a) IV tazocin 4.5g in 100ml NS over 30 mins Q8H
- if eGFR <20, loading dose 4.5g, then 2.25g in 100ml NS over 30 mins Q8H
3) Levofloxacin
a) IV levofloxacin 500mg over 60mins Q24H
- if eGFR 20-49: loading dose 500mg, then 250mg Q24H
b) PO levofloxacin 500mg daily (+/- 250mg)
4) Ciprofloxacin (anti-pseudomonas)
a) IV ciprofloxacin 200mg or 400mg over 60 mins Q12H
- if eGFR 5-30: 200mg or 400mg over 60 mins Q18H to Q24H
b) PO ciprofloxacin 500mg (+/- 250mg) BD
- if eGFR 30-50: PO ciprofloxacin 250mg to 500mg Q12H
- if eGFR 5-29: PO ciprofloxacin 250mg to 500mg Q18H
IV contrast steroid cover:
- PO prednisolone 40mg 12 hours and 40mg 2 hours before examination
Meningitic dose (peds)
For meninigitic dose of IV ampicillin and IV cefotaxime
IV Ampicillin 300mg Q6H (50mg/kg/dose) Q6H
IV Cefotaxime 300mg (50mg/kg/dose) Q6H
3
Common medications
1) Hypertension
- PO Norvasc 2.5mg or 5mg stat x1
- PO hydralazine 25mg stat x1
- PO betaloc 25mg PO stat x1 (C/I: heart failure, bradycardia, asthma, PVD)
- IV labetalol 5mg IV stat or 100mg in 100ml NS (30ml/hr +/- 5ml/hr)
2) Cough
- PO fluimucil 200mg TDS
- PO bisolvon 8mg TDS (mucolytic)
- PO cocillana 10ml QID PO prn
- PO MES 10ml TDS PO prn (expectorants)
- PO Phensedyl 10ml TDS PO prn (cough suppressant) --> may cause AROU
3) Sore throat
- PO Dequadin 500mg QID prn
- LA Thymol gargle MW 10mg TDS
- LA 0.2% Chlorhexidine MW 10ml TDS
4) Oral ulcer
- LA Bonjela TDS prn
- LA Thymol gargle MW 10mg tds
5) Skin itchiness
- LA aqueous cream TDS prn
- LA Eurax cream TDS prn
- PO piriton 4mg TDS prn
- PO atarax 25mg TDS prn
6) Insomnia
- PO piriton 4mg nocte prn
- PO imovane 3.75mg nocte prn
7) Gout
- PO colchicine 0.5mg TDS prn (omit if diarrhea)
8) Alcohol dependence
- PO ativan 1mg TDS or BD
- PO thiamine 100mg daily (50mg if chronic drinker)
- IV thiamine 100mg Q8H if Wernickes
4
PEDIATRICS (GENERAL
ADMISSIONS) 
5
Fever (general)
[Age]
NKDA
Informant: mother / father / self
NSD / VA / forceps / c-section at FT / weeks days in _____ hospital
Birth weight kg
AN / PN uneventful
Development normal so far (details if febrile convulsion / growth problem / syndromal)
GM:
FM:
Social:
Language:
No visual or hearing concern
Vaccination up to date (any flu vaccine)
GPH and important PMH
===================
Admitted for fever x day
Seen with (informant)
Fever since
Temp up to 'C (tympanic / rectal)
No chills / rigors
No cough / RN / sore throat
No SOB / noisy breathing
No vomiting / diarrhea (if suspect GE: ask abdominal pain)
No foul smelling urine / hematuria / tea colored urine
No rash
No jaundice
TOCC
Attended ___ on ____ for D_ fever.
Given _________.
Taken ____ doses of Augmentin so far.
In view of persistent fever tonight, attended ______
<For prolonged fever>

No obvious symptomatic foci
No coryzal symptoms
No GE symptoms, no V/D/ abdominal pain
No foul smelling urine
No sign of Kawasaki, no red eyes/lips, no limb edema, BCG scar normal
--> Add Ix: Blood x CBCdc film comment LRFT CaPO4 CRP EBV ASOT ANA anti-dsDNA ANCA
C3 C4 + HB
--> PE: any sign of Kawasaki disease / joint swelling
<For rash>
Developed rash over body since _____ (D_ of fever)
Rash distributed over buttock / thighs / limbs / back
Started in _____ and then spread to _____ over ___ days
Not itchy
No vesicles
Not vasculitic
No more rash now
6
Oral intake (% of baseline)
Baseline of feeds per day (both solid food and breast milk / formula milk)
Water (all compare baseline and now)
Urine output per day
BO normal per day, yellow/brown stool, no pale stool, no blood/mucus
Remained active and playful / Patient unwell, more agitated than usual
TOCC:
No recent travel history
No sick contact
No poultry contact
Social hx:
Lives with
Family members all healthy
PE:
BW: kg (th centile)
BH: cm (th centile)
HC: cm (th centile)
Temp: 'C
HR: /min BP: mmHg
SpO2: %RA RR: /min
GC well, alert
Hydration good, oral mucosa moist
Capillary refill <2 seconds
Throat not congested, no ulcers/vesicles
No red eyes
No cervical LNs palpable
Chest clear, AE equal
HSDNM
Abdomen soft, non distended, T-G-R-, BS +ve
No rash
Ix:
Imp:
Mx:
Single isolation until COVID negative
DAT
Routine obs
NPS x resp viruses
NPS + TS x CoVID-19
Urine MS
Blood x CBC LRFT CaPO4 CRP C/ST amylase (if GE)
Panadol (10-15mg/kg) mg Q4H PO PRN (usually lowest possible dose)
ORS
Stepdown if n-COV -ve
Await MO assessment 
7
Febrile convulsion
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
Admitted for fever x day and episodes of convulsions
Seen with
Fever since
Temp up to 'C (tympanic / rectal)
No chills / rigors
Witnessed by
Developed 4 limbs stiffness GTC at 12pm.
LOC +
No teeth clenching, up rolling eye balls, cyanosis or drooling of saliva.
No incontinence, no vomitus noted around mouth
_______ can't recall exact duration: ~5 minutes.
Given PR Valium once at A&E R room and convulsion stopped.
Regained full consciousness afterwards and recognized ____.
Post ictal drowsiness +
Mild head injury last Friday, hit corner or table.
Developed bruise over left frontal area.
Did not cry. Playful as usual.
No cough or runny nose
No sore throat
No headache, no aura, no photophobia
No vomiting or diarrhea
Appetite satisfactory
B/O: normal, once per day on average
Father has history of hydrocephalus. FU at QEH neurosurgery.
Conservative monitoring. No surgical treatment required. No seizure or focal neurological deficit.
No other family history of neurological condition
TOCC:
No sick contact
No recent travel
No poultry contact
Been to Disneyland on 28/6/2020
8
Development:
GM: runs well, walks up and down stairs without support, can ride bicycle
FM: writes alphabets, numbers, draws circle, tripod grasp
Language: no concerns
Visual and hearing normal
P/E:
BW: kg (th centile)
BH: cm (th centile)
HC: cm (th centile)
Temp: 'C
HR: /min BP: mmHg
SpO2: %RA RR: /min
Alert and GCS full
Sleeping (post ictal drowsiness)
GC well, not septic looking
Well perfused, cap refill 1s
Hydration satisfactory
No respiratory distress
Neck soft, no enlarged LN
No rash
Throat not congested, no exudate / ulcer
Bilateral ears waxy
CN grossly intact
All 4 limbs power full, reflexes all normal
Bilateral plantar downgoing
No cerebellar signs
Chest AE equal, no audible crep/wheeze
HS dual no murmur
Abdomen soft, non tender
No rash
Ix:
CXR: perihilar haziness
CT Brain (plain): no obvious acute infarct or haemorrhage, no space occupying lesion, no

hydrocephalus, normal grey-white differentiation
Impression:
1st episode of febrile convulsion
Explained diagnosis and condition to parents.
Mx:
Single airborne isolation until COVID-19 results negative
DAT
Routine obs Q4H
Convulsion chart
NPA x resp viruses
NPS and Throat swab x COVID-19
Blood x CBCd/c, LRFT, CaPO4, glucose, Mg, C/ST (Set HB)
NPA x resp virus
Urine multistix
Panadol 150mg PO Q4H PRN
Inform if convulsion recurs
9
GE (with anal rash)
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E admitted for D_ fever and diarrhea
Fever since 2/7/2020 night
Max temp up to 39.2'C (tympanic)
No chills or rigors
Diarrhea since 2/7/2020 morning with loose greenish stool, no blood/ mucus
Intially loose then more watery after intake of Zinnat from private
Increase in frequency, 13x of small amount in each nappy today
Usual 2x BO/day
1 episode of vomiting after ingestion of medication
Mother complaint rash in patient's anal region
Fatigue and less playful
Seen by GP yesterday
Given antibiotics (zinnat), antipyretics, antidiarrheal drug and cream for rash
Usually on EBF 6x + supp AF 120ml/day
Yesterday appetite same
Switched to Soy milk since this afternoon and decrease in oral intake
UO unknown due to mixed with stool, heavy diaper
Last PU upon admission
No cough/sputum/RN/sore throat
No SOB/ noisy breathing
No vomiting
No foul smelling/ turbid/ hematuria
No ear tugging
TOCC -ve
Lives with mother, uncle, maternal grandmother (all no recent illness)
No recent travel Hx
PE
BW: kg (th centile)
BH: cm (th centile)
HC: cm (th centile)
10
Temp: 'C
HR: /min BP: mmHg
SpO2: %RA RR: /min
Moist mucosa, warm peripheries
AFNT, no sunken fontanelle
Throat not congested, no exudate/ vesicles
Neck soft
No Rash
No enlarged cervical LN
HS normal, no murmur
Chest AE well, no creps/ wheeze
Abdomen soft, non-tender, no hepatosplenomegaly, BS active
Sore buttock+, no anal fissure
No imaging
Imp: Viral GE, not dehydrated
Mx
Single isolation till COVID -ve
DAT, encourage oral intake
routine obs Q4H
Chart IO
NPS + TS x COVID
NPS x resp virus
Urine multistix
Stool c/st, virus
panadol 100mg po Q4H prn
Zinc cream TDS to buttock
ORS po prn
For IVF if poor oral intake 
11
Prolonged fever
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E' admitted for prolonged fever & GE symptoms
On & off fever since ___, ~_ weeks
Temp up to ___ (tympanic)
No chills or rigors
Cough + RN +
No sputum / hemoptysis / night sweats
No sore throat / SOB
No urinary symptoms
No rash / red lip, no limb edema / joint swelling
Seen GP twice, given antipyretics but fever persisted
Attended private pediatrician, given antipyretics and antibiotics
Private CXR yesterday, told L lung haziness
Developed diarrhea & vomiting since last night, BO 4-5x, brownish loose to watery stool, with
mucus, no blood or melena
Vomiting 2-3x, bile stained fluids, no blood
Associated with abdominal bloating, but no abdominal pain
No fatigue, myalgia or limb weakness
No suspicious food intake
No GE symptoms in family
Appetite fair, sometimes reduced to half of usual
Fluid intake satisfactory
TOCC: -ve
No contact with confirmed cases / known sick contact
No poultry contact
Social:
Lives with parents
F1 student, mainstream school, MOS St Joseph
PE:
12
BW: kg (th centile)
BH: cm (th centile)
HC: cm (th centile)
Temp: 'C
HR: /min BP: mmHg
SpO2: %RA RR: /min
[PE as above - refer to fever (general)]
Ix:
CXR: clear, no definite consolidation
Impression: viral illness / GE
Mx:
DAT, encourage oral rehydration
Routine obs Q4H
Chart I/O
Recheck HR once
NPS x resp viruses
NPS + Throat Swab x COVID-19
Urine Multistix
Stool: C/ST, viruses
Blood x CBC LRFT CaPO4 CRP C/ST
PO Panadol 500 mg Q4H PRN 
13
Kawasaki
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E- Admitted x Fever (D4-5)
Fever since 4/7/2020 (Sat) 5AM, noted warm to touch by mother
Temp up to 38.3C (forehand)
No Chills/Rigors
Widespread MP polymorphic rash since yesterday, start in chest and spread to limbs
Non-pruritic, non-vesicular
BCG scar reactivation
Red lips, red tongue
Conjunvtivits
Attended PWH AED on 4/7/2020 (Sat) evening 11PM for D1 fever.
Given panadol syrup, and advised to seek medical attention if fever persists.
Monday swinging fever, 37-38C.
Activity: Irritable and poor sleep
No Dry cough/ RN / Sore throat
No SOB / some noisy breathing
No vomiting / Diarrhea (1 x green stool ystd, no blood or mucus, self-resolved)
No foul-smelling urine / haematuria/tea-colorued urine
No jaundice
No coryzal symptoms
No GE symptoms, no V/D/abdominal pain
Oral intake
Baseline: EBF x 10 min/meal, feed every 3 hours . Supplement with formula milk if needed.
Now: 50% of normal feedtime. Refuse formula milk supplementation.
Urine output: 8-10 nappy changes/day. Maintained.
BO normal.
TOCC:
No sick contact
Social:
Lives with parents, sister (7y/o)
14
<PE>
[Refer to fever (general)]
CXR done at AED:
Imp: Kawasaki's Disease
Features: Prolonged fever (D4-5), polymorphic MP rash, BCG reactivation, conjunctival injection,
mucosal changes
Mx:
Single isolation room until COVID-19 -ve
DAT
Routine Obs
NPS x resp viruses
NPS + TS x CoVID-19
Urine MS
ECG with long lead II, consult Cardiology for Echocardiogram
Blood x CBC, L/RFT, CaPO4, CRP, C/ST
Panadol 70mg Q4H PO PRN
IVIG (Intragam P Infusion) 16g (2 gram/kg) over 12 hours
Aspirin (42mg/kg/day) (High dose: 80mg/kg.day -> taper to 30mg/kg/day)
ECG done: sinus rhythm (165bpm), QTc 380ms, no ST changes 
15
Syncope
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
Admited for __ episode of syncope
Syncope during school orientation today at around 3pm
Was walking, then smell something unuasal (was passing chemistry lab)
Then felt dizzy and LOC afterwards
Unresponsive
Wtinessed by teacher and classmate
Lasted for ~3-4 mins
Told pale looking
No twitching/drooling/uprolling of eyeball/incontinence during LOC
Woke after 3-4 mins but felt tired, no residual neurological symptoms
Deny HI/injury
Escort by teacher to rest room
Then 2nd episode of syncope happened
Sudden onset LOC again, witnessed by teacher and classmate
Unknown duration
No twitching/drooling/uprolling of eyeball/incontinence during LOC
Escort to rest room with wheelchair afterwards
But felt tired. No residual neurological symptoms
Fully awake on arrival of ambulance (not sure exact duration)
No preceeding symptoms
No chest pain/SOB/headache/vertigo
Did not miss meal, had breakfast and dinner
Enough sleep for >8hr
Deny alcohol/illicit drug intake
Afebrile all along
No coryzal symptoms/GI/GE symptoms
Menarche 8/2020(early August)
Last for 7 days, heaviest flow day on D2-3
Dysmenorrhea+
Mild dizziness during mensturation
No personal history of syncope/LOC
16
No postural dizziness previously
No family history of epilepsy/cardiovascular disease
No famioy history of sudden death
TOCC-ve
Ix done in AED
- Temp 36.6'c BP 88/53 P 84 SpO2 96% RA
- Hstix 5.2
- Hemocue 13.4
- Urine PT -ve
- CXR clear, no consolidation
- CTB: no SOL/MLS/ICH
- ECG: SR 78bpm, PR normal, QTc (calculated): 430ms
PE
BW: kg (th centile)
BH: cm (th centile)
HC: cm (th centile)
Temp: 'C
HR: /min BP: mmHg
SpO2: %RA RR: /min
GCS full
Well hydration and perfused
Pulse ~100bpm, regular, no RR delay
Apex 5th ICS, not displaced
HS normal no murmur
No carotid bruit
Abdomen soft, no T/G/R
No hepatopslenomegaly
No rash
Neurology exam:
GCS full
Orient to place and space
PEARL
EOM full
No facial asymmetry
CN intact
4 limbs power full 5/5
5 | 5
5 | 5
All reflexes present and symmetrical , not brisk
No ankle clonus
Bilateral plantar equivocal
Sensation intact
Propioception normal
Gait normal
Imp: ? Vasovagal syncope
Mx
DAT
Routine obs
Postural BP x 1
17
Blood x CBC LRFT CaPO4 CRP Mg RG Trop T 
18
Breakthrough seizure
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E adm x breakthrough seizure
episode of afebrile convulsion
(Details of the event)
am / pm today at home
Witnessed by
Any UL/LL extension
Any increase in muscle tone
seizure with
- uprolling eyeballs
- 4 limbs twitching
- face cyanosis
- LOC
- drooling of saliva
- no tongue biting
- no incontinence
- no head injury
(Any intervention by family members)
Last for , aborted spontaneously
Any post ictal drowsiness for mins
Regained full consciousness after
Could recognize
Back to normal self on ambulance
no crying all the way to AED
No prodrome / aura before seizure
No chest discomfort / palpitation
No stress / mood changes
No change in appetite / skipped meals
No sleep deprivation
Any rhythmic jerk movement noted
Any current anti-epileptics, compliance
Development
No Fhx of epilepsy/febrile convulsion in childhood/ neurological illness
no fever / URTI / GE symptoms
19
no rash
no recent head injury
no focal neurological deficit
no foul smelling urine
no neck stiffness
PE (also neurology)
...
No neurocutaneous stigmata
4 limb tone, jerk
Imp: breakthrough seizure
Mx
DAT
Obs Q4H
SaO2 monitor
Convulsion chart
CBC d/c LRFT CaPO4 Mg RG + set HB if possible
ECG with long lead II
Resume usual meds
Consult neuro x EEG mane
Acute seizure management and precautions, need of supervision during risky activity explained.  
20
Afebrile convulsion
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E adm x 1st episode of afebrile convulsion
Patient slept at around 1am tonight, with mother
Noted to have abnormal posturing on bed ~1:30am, lying prone and folded back, 4 limbs not
seen (under duvet), unresponsive to wakening
Carried by mother to living room, and turned on light
Noted eyes partly opened, uprolling eyeballs
Face pale, lips cyaontic
Clenched teeth
UL stiff with mild twitching, not tonic clonic, uncertain about LL twitching
No drooling of saliva, tongue biting or incontinence
Stopped at around 1 min later, spontaneously
Vomited once, small amount of whitish fluid (taken yogurt before sleep), non-bilious, no coffee
ground
Attended A&E immediately
Post-ictal drowsiness x 1 hour
Able to recognize parents in A&E while seeing doctor
No focal neurological deficit noted
C/o of headache in A&E, nature and grade uncertain
No dizziness/blurring of vision
No history of head injury
No fever
No URI symptoms
No diarrhoea/GE symptoms
No urinary symptoms
No rash
Development:
GM: Can play scooter, catch bouncing ball, walks and runs and up and down stairs without
problem
FM: draws square, use scissors
Social: wash face and brush teeth on his own, uses fork and spoon well, not yet chopsticks
Language: can speak complete sentences, partial stories
No concern over hearing and vision
21
No Fhx of epilepsy/ febrile convulsion in childhood/ neurological illness
PE:
BW: 13.5kg (3-10th centile)
Temp: 36.2'C
HR: 95/min BP: 117/76mmHg
SpO2: not recorded RR: 24/min
Irritable but consoable
Can identify mother, tell it is night time, cannot tell place
Pupils exam difficult, patient struggling vigorously
but EOM full, no nystagmus noted
No facial asymmetry
4 limbs tone and reflexes normal
Uncooperative for power examination but quite strong
Bil plantars withdrawal
No ankle clonus
Well perfused
Hydration normal
No red eyes
Neck soft, no meningism
Chest clear, AE equal, no distress
HS normal no murmur
Abdomen soft, non distended, no organomegaly, T-G-R-, BS +ve
No rash
No neurocutaneous stigmata
No dysmorphism
No imaging
Imp: 1st episode of afebrile convulsion
Mx
DAT
Obs Q4H
Cardiac and SpO2 monitor
Convulsion chart
Blood x CBCd/c, LRFT, CaPO4, Mg, RG, NH3, lactate, carnitine, acylcarnitine, PAA, HLA-B1502 +
set HB if possible
Urine m/s, toxicology, metabolic screen
ECG + long lead II
CT brain with oral sedation
Consult neuro x EEG 
22
Allergy
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E' admitted for allergic reaction
Had tonight at around
Patient usually doesn't eat / no previous trial
Then developed generalised urticaria in trunk, limbs, and face.
No SOB or stridor
No periorbital or neck swelling
1st episode of allergic reaction to food.
Patient was brought to local GP in view of generalised rash. GP referred patient to PWH A&E
immediatly. Patient arrived A&E at
Managed in A&E HDU.
Given one dose of IM Adrenaline 1:1000 mg at
Also given one dose of IM Piriton mg at
Most of the urticaria resolved shortly after injections.
No recent fever
No recent insect bites
No family history of atopy or allergic reaction
No personal history of atopy
No other food allergy
History of diarrhea in childhood (heriditary angioedema)
PE: {growth chart}
BW: kg ( th centile)
HC: cm ( th centile)
BSA: m2
Temp: 'C
HR: / min BP: mmHg
SpO2: % room air RR: / min
Alert and GC well
Not in resp distress, no stridor
No angioedema
No neck swelling
Well perfused, CR <1 second
Generalised faint urticaria rash over
Maculopapular rash and faint urticaria over trunk
23
Mild urticaria over forehead
Chest clear, no added sounds
HS normal no murmur
Abdomen soft, not distended, non tender, no organomegaly.
CXR: clear
Impression: Suspected allergy
Mx:
DAT
HR and SpO2 monitoring
Urine multistix
Bloods x routine bloods, CRP, ESR, C3/4, tryptase
LA Calamine lotion TDS PRN to urticaria
PO Piriton 3mg TDS regular for 1 day
Avoid at this juncture
Resume usual medications
Consider consult allergy team for skin prick test 
24
Hematological malignancy (ie case of unexplained
anemia)
M/31m
NKDA
Informant: Mother
Main Carer: Maternal Grandma
Birth History:
-----------------------------------------------------
Born full term, via NSD in Union Hospital
AN / PN uneventful
Immunization up to date
Development unremarkable
Good past health
G6PD status: unknown
===================================================
E admitted for fever for 4 days and pallor for 2 weeks
Fever since 15/8/2020, D4 fever
Temp up to 38.1'C (tympanic)
No chills / rigors
On and off oral ulcers at gum for the past 2 months
Each episode have 1 ulcer, no major bleeding or pus from aphthous ulcer
No obvious gum bleeding
Foul smelling urine on D1 illness (15/8/2020)
Urine multistix performed at Union Hospital A&E: normal.Told UTI was unlikely.
No cough / RN / sore throat
No SOB
No vomiting / diarrhea
No rash
Mild jaundice noted
Anaemia:
G6PD status unknown (mother don't remember)
Drugs: Taken panadol for past 5 days. Also taken TCM Bo Ying Dan on 16/8/2020 afternoon
because of persistent fever.
Dark brownish urine for past 3 days, especially in the morning.
Dark to light yellow urine during the day.
No gross haematuria
No GI bleeding
No trauma history
No vomiting
Exercise tolerance decreased subjectively, need to take a nap at 10am.
Usually takes nap at 11:30 am.
No SOB
No excessive sweating
B-symptoms:
Night sweats present, but Mother said patient had night sweats since birth
No subjective weight loss
No bone pain
Appetite normal
25
Feeding tolerated
U/O: maintained, dark coloured urine in the morning
Remained active and playful
Family History:
-------------------------------------------
Only child. No siblings.
Father does not have thalassemia. Checked before having children.
Mother did not check Hb pattern
No other family history of thalaessaemia
Maternal grandma has known lung CA on oral targeted therapy, now complicated with LL
cellulitis, on IV antibiotics.
Attended Union Hopsital A&E on 15/8/2020 for D1 fever.
Given antipyretics but no antibiotics, fever did not resolve.
In view of persistent fever, seen private GP today.
GP noted: pallor, hepatomegaly 1cm below costal margin, no splenomegaly.
Referred to PWH A&E to rule out haematological malignancy.
Checked H'cue at A&E: 4.2
TOCC:
Maternal Grandma has known lung CA on oral targeted therapy, now complicated with LL
cellulitis, on IV antibiotics.
Main Carer: Maternal Grandma
No other sick contact
No poultry contact
PE:
-----------------------------------------------------------
BW: 13.9 kg (75th centile)
BH not recorded
HC: 48cm (10-25th centile)
Temp: 36.5'C
HR: 118/min BP: 115/58mmHg
SpO2: 98%RA RR: 26/min
GC well, alert, no facial dysmorphism
No Colley's facies
Mild jaundice, pallor
Hydration good, oral mucosa moist
Capillary refill <1 seconds
Warm peripheries
Not in resp distress
No conjunctivitis
No gum bleeding, no oral ulcer
No cervical or axillary lymphadenopathy
Bilateral groin lymph nodes palpable, one LN on each side, non tender, 0.5x0.5cm each.
Neck soft
Ears: waxy
No finger clubbing
Chest clear, AE good and equal
HS normal, soft grade 2 ESM over LLSB, no radiation
Abdomen soft, not distended, non tender, hepatomegaly 2cm below costal margin, no
splenomegaly, no mass, bowel sounds active
No rash or petechiae or bruises
26
CXR: bilataral perihilar haziness, no cardiomegaly
Impression:
---------------------------------------------------
1) Anaemia for investigation.To rule out haematological disorder.
2) Heart murmur, ?flow murmur, not in heart failure.
Mx:
------------------------------------------------------
DAT
Cardiac monitor
BP/P Q4H
Chart I/O
Routine obs
NPS x resp viruses
NPS + TS x COVID-19
Urine multistix
Blood: CBC d/c, film comment, reticulocyte, LDH, urate, CK, haptoglobin, Fe profile, Ferritin, Hb
pattern, T&S
Clotting, EBV serology
LRFT, CaPO4, CRP, C/ST
(Set HB)
PO Panadol 150mg Q4H PRN
For blood transfusion if anaemic, sign blood transfusion consent.
Trace G6PD result (birth record, MCHC health book)
Review heart murmur mane
27
Petechiae
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E' admitted x generalized petechiae
Noted petechiae over bilateral LL this morning, then extended to trunk, upper limbs and face
No easy bruising / gum bleeding / epistaxis
No excessive crying
More irritable than usual but consolable
Appetite satisfactory, 5 meals of 150-160oz breastmilk per day
No change in diet of mother, no OTC meds taken
UO and BO normal
Afebrile
No URI / GE symptoms
No family history of hematological disease
Attended private paediatrician today for petechiae and referred to A&E
PE:
BW 5.24kg (50th-75th centile)
BH 55.5cm (25th centile)
HC 37.5cm (10th-25th centile)
Temp: 37'C
HR: 137 /min BP (could not check as baby struggling)
SpO2: 100% RA RR: 32 /min
Imp: ?ITP
Mx
DAT
Routine obs Q4H
Recheck BP x 1
Urine multistix
Blood x CBCd/c (urgent), film comment, T&S, CRP, LRFT, Ig pattern, clotting profile, ANA
28
UTI
[Age]
NKDA
Birth weight kg
AN / PN uneventful
GM:
FM:
Social:
Language:
===================
E admit x dysuria and loin pain
Complained of dull abdominal pain since
Pain over central periumbilical area / epigastric region / loin regions on both sides
Associated with dysuria and urinary frequency (every few minutes)
Also noted turbid urine afterwards, whitish milky urine, no blood
no fever / chills / rigors
no URI symptoms
no nausea / vomiting / diarrhea
no rash
Appetite
Oral and water intake tolerated
BO normal, once every 1-2 days
TOCC -ve
PE: {growth chart}
BW: kg ( th centile)
HC: cm ( th centile)
Temp: 'C
HR: / min BP: mmHg
SpO2: % room air RR: / min
GC well, alert, not toxic
well perfused, not in distress
HS normal no murmur
Chest clear
Abd soft not distended, no palpable mass
Tenderness over central abdomen and both loin regions
No guarding/ rebound tenderness
No rash
Imp: ?UTI
Mx:
DAT
Routine obs Q4H
29
MSU / cath urine (depends on age) x multistix and c/st
Bloods x CBC d/c, LRFT, CRP, c/st
Augmentin 6.2ml BD PO if urine M/S +ve
If multistix WCC / nitrate +ve treat as UTI:
IV Ampicillin mg Q6H IV (~25mg/kg/dose)
IV Gentamicin mg Q24H (5mg/kg/dose)
CSU x m/s, C/ST
Inform if CRP or WCC ↑
30
PEDIATRICS (DAY WARD
CLINICAL ADMISSIONS) 
31
IVIG infusion
[Age]
NKDA
[PMH]
===================
Clinically admitted for IVIG infusion
No active complaint
Afebrile all along
Ix 27/6
Hb 13.7 platelet 140
WCC 4.2 ANC 3.1
IgA <0.05↓ IgG 7.89 IgM 0.06↓
CRP <0.6
LRFT normal
PE
BW 39.35kg
Temp 36.2'c
BP 115/83 P 88
SpO2 96% RA RR 20
HS normal no murmur
Abdomen soft
Eczema over bilateral LL
No sign of infection
Mx:
Blood x CBC, LRFT, CaPO4, CRP, Ig pattern
IVIG 15 gram over 4 hours
Home after infusion if remains well
Readmit 4/52
32
Palivizumab injection
[Age]
NKDA
[PMH]
===================
C admitted for 4th palivizumab injection
No URTI / fever
No active complaints
Mixed feeding 150ml x 7, rarely regurgitation now
No projectile vomiting
BO and urine output unremarkable
Exam:
BW 5.47 kg (25-50% for PCA)
BL 62.3 cm
HC 42 cm
Vitals normal
Afebrile
AFNT
Well perfused
HS normal no murmur
Chest clear, no sucking
Abd soft non-distended, no organomegaly
Imp: Exprem, BPD, for 4th palivizumab injection
IM palivizumab (15mg/kg) 85mg given once, uneventful 
33
Infliximab infusion
[Age]
NKDA
[PMH]
===================
No fever.
Appetite good.
Occasional abdominal pain about once per week.
No diarrhoea.
No blood/mucus in stool.
Normal formed stool, BO everyday.
No nausea/ vomiting/ oral ulcer.
No anal pain, no discharge.
P/E:
Afebrile, BP 112/64, HR 77/min.
Weight gain+
No pallor/jaundice.
No oral ulcer.
No respiratory distress.
Chest clear.
CVS normal, no murmur.
Abdomen soft, non-tender, not distended.
Mx:
DAT
Blood for CBCd/c, CRP, ESR, LRFT, CaPO4 + set hep block
Infliximab 200mg IV infusion as per protocol
Home afterwards if well
FU GI clinic as scheduled
Medications own stock
Readmit 8 weeks
34
Thalassemia blood transfusion
[Age]
NKDA
[PMH]
===================
Clinical admission for regular blood transfusion.
See progress sheet.
Well and no fever.
PE:
BW kg, 25th
BH 125.2cm, 10th
Afebrile, stable vitals
General condition good
Pallor+, tinge of jaundice.
Abdo soft, liver 2cm soft, spleen 1 cm.
Chest clear
Heart sounds dual no murmur, apex not displaced.
Management:
DAT
Blood x CBCd/c LRFT CaPO4 ferritin Type and Screen + set hep block
Urine x multistix
____ ml packed cells over 5 hours with IV lasix in middle of transfusion
Annual checkup next admission as planned 
35
BAER
[Age]
NKDA
[PMH]
===================
Clinically admitted for BAEP exam
Feeding tolerated
Urine and bowel opening satisfactory
Last meal: 2am, milk
PE:
BW: 4.26 kg
BH: 55.2 cm
HC: 36.5 cm
Vitals stable, afebrile
Thriving
Well perfused
AFNT
Chest not in distress
HS normal no murmur
Abdomen soft not distended no hepatomegaly
Imp: Failed hearing test, for BAEP exam today
Mx:
NPO during sedation
HR and SpO2 monitoring during sedation
PO Chloral Hydrate 300 mg once 30 min before exam (70mg/kg/dose)
Allow feeding when fully awake
Home if feed well
FU as scheduled  
36
DMSA / MAG3
[Age]
NKDA
[PMH]
===================
Clinically admitted for DMSA
No intercurrent illness
No fever
Feeding well, eating solid meals
good compliance to trimethoprim
P/E:
BW: 9.92 kg
Temp: 36.9'C
HR: 133 /min BP: 114/75 mmhg
RR: 26 /min SpO2: 99% on room air
GC well
Conscious and alert
Well-perfused, hydration normal
HS dual, no murmur
Abdomen soft, non-tender, no mass
Impression: history of 3 UTIs, bilateral grade II VUR for DMSA
Management:
NPO for choral hydrate sedation
Set HB
PO Chloral hydrate 700mg, 30 minutes before DMSA exam
Home after fully awake and milk tolerated
FU renal clinic on 31/7/2020 as scheduled
Continue same trimethoprim
====================================
MAG3
Clinically admitted for MAG 3
Well and afebrile since discharge
Feeding tolerated
No coryzal/ GI symptoms
TOCC -ve
Good compliance to antibiotics
P/E:
BW 6.39kg (from 3rd to 3-10th centile)
BP 87/58 mmHg AR 138bpm
SpO2 100% RA
RR 34
Temp 36.8’C
Active and cheerful, well perfused, not in distress
37
Chest clear
HS normal, soft ESM
Abd soft, not distended, no organomegaly
MP rash over face and body
Mx:
NPO
For MAG3 today
PO chlroal hydrate as charted
Resume feed when back from MAG3 and awake
Home and FU Renal 31/07/2020 
38
MRI brain
Clinically admitted for MRI Brain (plain)
No intercurrent illness
No fever
Feeding well
Last meal: 8pm last night
Had sip of water this morning
P/E:
BW: 16.75 kg
Temp 37'C
BH: 106.3 cm
HR: 100/min BP: 107/72
SpO2: 99% RA RR: 22/min
GC well
Conscious and alert
Facial dysmorphism
Hyperterlorism
Well-perfused, hydration normal
Neck soft
HS dual, no murmur
Abdomen soft, non-tender, no mass / organomegaly, bowel sounds active
Impression: MRI Brain (plain)
Developmental delay
Known Axenfeld-Riegar Syndrome
Management:
------------------------------------
Set HB
PO Chloral hydrate 1250mg ONCE (30 minutes before MRI exam)
HR and SpO2 monitoring during sedation
Allow feed when awake after exam
If feeding well, allow home
FU as scheduled 
39
CT brain
Clinically admitted for CT temporal scan
No recent illness
Good compliance to hearing aid
Progress noted in SCCC
GM and FM no concern
Language - can express needs in short sentences e.g. "I like car", "I want this", A-Z, 1-50
PE:
BW: 18.1kg (10-25th centile)
BH: 107.2cm (3rd-10th centile)
Temp: 37.1C
HR: 104 / min BP: 101/51
SpO2: 99% RA RR: 30/min
AFNT, well perfused
Chest clear
HS normal no murmur
Abd soft not distended
IMP: bilateral hearing impairment, plan for bilateral CI, today for CT temporal assessment
Management:
Set HB
PO Chloral hydrate before CT exam
Home after fully awake
FU as scheduled 
40
Entriflex change
Clinically admitted x change of entriflex
Entriflex last inserted on 21/4/2020
Well, no active complaints
Vitals stable afebrile
Physical exam unremarkable
Mx:
Fr8 entriflex inserted via left nostril, tied at 40cm
Home if entriflex in situ
Readmit ~ 1/12 for next change 
41
Drug overdose
Informant: patient, elder cousin, mother
16/F
NKDA
FT NSD in KWH
Good past health
Vaccination up to date
Studying in F6
===================
E adm x drug overdose
Brought to A&E by ______
Unwitnessed event
At home with domestic helper, but unwitnessed event
Taken 30 tabs of 5mg melatonin and 6 tabs of 0.25mg Nalion (Alprazolam) today at 2pm in her
own room
Then fell asleep on her bed
Denied coingestion of other drugs
Claimed DO due to low mood and for self harm, but did not intend to perform suicide
Woke up to find elder cousin and boyfriend at bedside (patient messaged cousin about intention
to overdose before hand)
Brought to A&E at around 6pm
Collateral hx from cousin and boyfriend:
Found patient sleeping on her bed
Patient drowsy but arousable
No definite LOC
No convulsion
Bitemporal headache, throbbing in nature, grade 7/10
Dizziness since she woke up, non-vertigo, mainly light headedness
Mild blurring of vision (mild myopia, not wearing glasses)
?Slurred speech (self perceived)
Did not walk since drug overdose, was carried to ambulance by boyfriend
Generalized weakness
No numbness
No fever all along
No URI/GE/UTI symptoms
LMP 1 week ago
Psychiatric history:
Low mood for recent 1 year
Suicidal ideation, thinking about burning coal, no thoughts about JFH
Self harm by cutting wrist
Frequent crying, Insomnia, loss of interest, occasional loss of appetite
Previously mother wanted to bring patient for medical attention
FU private psychiatrist since last year, prescribed SSRI and sedatives before
Last seen 3 months ago, defaulted FU due to COVID
Prescribed Alprazolam and ?sleeping pills
Fair compliance only
According to mother, patient's mood fluctuates but seems to be improved after meds
According to patient, sleeping pills already used up, so she bought OTC melatonin herself
Has been taking 1-2 tabs of melatonin usually, previously also taken 30 tabs in one go
Stopped alprazolam 1-2 weeks ago
42
No known family history of psychiatric illness
Social history:
Studying in F6 in Yow Kam Yuen College
Academic performance fair, did not need to repeat, did not fail subjects
Lives with father, mother and domestic helper
Fair relationship with parents
Courtship with boyfriend age 20 years old, for ~4-5 months, occasional quarrel
Non-smoker, non-drinker
Denied illegal drug intake
Attended A&E ~6pm
BP 117/89 mmHg HR 66
Spo2 100% RA RR 14/min
No desaturation or hypotension
GCS full all along
No treatment given
PE:
BW 45.1kg
BH 158cm
BP 99/65mmHg HR 74/mi
SpO2 100% RA RR 24/min
Temp 36.8
GCS E4V5M6
Oriented to time place person
Well perfused
Hydration normal
No distress
PEARL 3mm bilaterally
EOM full, no nystagmus, diplopia on left lateral gaze
No facial asymmetry
CN grossly intact
5|5
5|5
↓ ↓
Tone and reflexes normal over 4 limbs
No ankle clonus
No cerebellar signs
Unsteady gait, not particularly ataxic
Unable to test tandem gait
HS normal no murmur
Abd soft, T-G-R-, not distended, no organomegaly, BS active
Eczema over bilateral UL flexor areas and face
Cut wounds over both wrists
Ix
PT done -ve
Hb 12.4 WCC 5.4 PLT 266
Glucose 4.6
TnT <14.0
LRFT, CaPO4 grossly hemolysed
PT 11.4 INR 1.01 APTT 40.6
Paracetamol, ethanol, salicylate T/F
CXR: no consolidation, bil breast shadow
ECG: sinus rhythm, 53bpm, no ST/T changes, QTc 373ms
43
Mx
Suicidal precaution and fall precaution
DAT
Routine obs
Cardiac and SpO2 monitor
Neuro obs Q1H x 4 then Q4H
Urine toxicology, m/s, PT
Blood x LRFT CaPO4
Contact poison centre
Consult CP, child psy mane
44
MSE
Mental state examination:
Calm and settled, good eye contact, social smile
Not anxious looking
No psychomotor retardation
Mood euthymic affect congruent
Speech circumstantial, largely C/R, poor in expressing herself
Not psychotic
Not suicidal
hair to shoulder length, dyed in dark olive
on ? color con, and nail art
on make up long eyelash
mood on low side, would broke into tears, yet able to resume talking reasonably soon
slightly histronic in body language
affect reactive
some social smile and was polite
speech C&R, mixed with English speaking
non aggressive
non psychotic
denied further deathwish if she could end her pregnancy as it was her major stressor
HEADSS framework (for adolescents)
Home
- living with parents, elder sister, maternal aunt
- father, 50, construction officer
- mother, 50, sales
- elder sister, 20, university student
- fair relationship with parents all alnog, but started to have more frequent quarrels in recent 6
months, as TinWai went go at night to meet her boyfriend more frequently
- poor relationship with elder sister
Education
- F.3, POH 80th Anniversary Tang Ying Hei College
- below average academic results, only passed English in previous tests
- enjoy studying English
- fair relationship with classmates, but poor relationship with teachers
- low attendance for zoom lectures in recent 0.5 years, and stopped going to school since Oct
- parents planning to find private school/ VTC for TinWai
Activities
- enjoy learning & doing make up
- enjoy hanging out with primary & secondary school friends
Drugs
- drink alcohol since 1/2020, 1-2 times/mth, half a can of beer each time
- smoking since end of 2019, 1-2 electonic cigarrete/day
- ilicit drug use +ve, inhaled drugs, unsure abt exact name of drungs, usu took in public parks
with boyfriend & his friends
Mood
- stable mood
- Hx of wrist slashing since F.1, last act in 10/2020
- no other act of self-harm
- all along no suicidal ideation/ act 
45
O&G 
46
Labor
NKDA
NSND
GPH
P___
Gestation ____
SVD x 1 UCH 2018
AN UCH
AN bloods normal
1TDS -ve
Private morphology scan told normal
SG
GBS
__________
E admitted x labor
Irregular UC since ___, Q__mins
Show at __
No leaking sensation / gush of fluid
PE:
BP , P
Afebrile
Abd:
Soft non tender
Cephalic
T/S
3/5 ab
CTG reactive
UC Q 10mins not felt
PV:
Os closed
(HVS, GBS taken)
If suspected leaking:
Cough test -ve
No liquor seen
Leaking not confirmed
Imp: Early labour
< LABOUR >
PV
2 F PTU
Membrane +ve
S -2
AROM done, clear liquor
Imp: SROM
PPROM:
Placenta swab, histology
MSU
HVS
Fibroid (large): CBC, T&S
47
Mx:
To ward 4B
Observe for progress
Start IV abx for GBS when in labor
(HVS, GBS)
Allow labour when in labour
CBC, LRFT, Amylase, T&S
Keep HB
Mx (if established labor):
Stay labour ward
Observe for progress
Start IV abx for GBS when in labor 
48
Antenatal
Past medical History (if any)
Para ___
SVD in ____, BW ____
Previous C/S for ____ in _____
Mat ___w ___ d
AN in UCH / TKOH/ MCH
AN blood normal
1st / 2nd tri DS –ve/ NIPT low risk
Morphology scan normal, placenta ____ not low
RG / OGTT ____
GBS-ve
Previous admissions and details
__________
Admitted for
- show at ___ (time)
- leaking at ____ (time) (ask if gush of water from vagina or just leaking sensation)
- UC Q__mins since ___ (time)
- FM active
P/E:
BP ____ P_____ Afebrile
Urine albumin –ve
Ut T/S ceph __/5 AB
PV at ____:
os closed / __F / __cm
long tubular / short tubular / PTU / FTU
Vx / Br
S-2 / S-3…..
membranes felt / not felt
cord, placenta
(for suspected leaking)
Speculum: pool of clear liquor in posterior fornix, cough test +ve (leaking confirmed)
Speculum: whitish discharge only, no liquor seen, cough test –ve (HVS taken, leaking not
confirmed)
CTG: reactive, UC Q__mins
Early labour / Leaking confirmed ------------------------> DAT, To AN ward 
49
Decreased fetal movement
Hx:
Describe the FM clearly – usual frequency, when started to note decreased FM, frequency/
amplitude change
Risk factors:
Abd trauma
FGR
SGA fetus
Placental insufficiency
Congenital malformation
PE:
Measure the SFH (symphysial fundal height)
- see the CTG carefully -> DAT if CTG reactive
• Look for Ut < date, (measure SFH by tape)
• Look for risk factors for IUGR (previous IUGR/IUD, HT, DM, Obese, Smoking…etc)
Preterm
-check any date problem (any dating scan?)
- Hx: Hx of abd trauma/ coitus
Any abnormal PV discharge
Any urinary/ bowel symptoms
-better inform MO when there is preterm labour / PPROM
- note presentation
- if PPROM/ TPL, take HVS, MSU, GBS
- whether start steroids / tocolytics /antibiotics
ask MO (read Dept guideline as reference)
Abd pain cx pregnancy
Hx:
look out for any regular UC
Compare with CTG for any UC.
If have regular UC --> TPL, inform MO
Perform spec: ascertain os closed
Check CBC, LRFT, MSU
USG not necessary if for abd pain Cx preg
Antepartum hemorrhage
Hx:
Unprovoked fresh/ brownish PVB/ spotting/ soaked ?minipad/ pads
Hx of coitus/ abd trauma
Spec:
Os closed/ open, no polyp/ ectropion, no active oozing from os
Mx:
(Heavy PVB)
NPO
CBC, T&S
(If no heavy PVB)
DAT
To 4B
USG mane  
50
BP monitoring
Hx:
No pre-existing hypertension/ renal disease
No family history of young onset hypertension
PE:
BP / P
Urine albumin
Jerks normal
No ankle clonus
Mx
DAT
BP monitoring
Bld x CBC, LRFT, clotting, urate
Spot Ur Pr/Cr ratio/
24hr UP+ CrCl
(please choose from
departmental Ix for the correct Ix)
Elective C/S
<AN history as above>
“C” admitted for El LSCS x previous C/S / x breech / x PP….etc
no s/s of labour
FM active
P/E:
BP
urine albumin
Ut T/S ______
CTG:
Mx
Keep NPO (same day)
CBP,T&S
Augmentin 1.2g IV x1 after delivery
Follow anaes premed 
51
Gynaecological hx taking
F/
NSND NKDA
Married
PMH:
Para
(if recurrent miscarriage - do workup ACA, LA, TFT)
Contraception:
Last PS
Past gyn hx -ve
Planned and wanted pregnancy
Mat weeks by date
Mat weeks by PT
LMP:
Regular days per cycle, lasts days
No dysmenorrhea
Normal flow
No IMB / PCB
1st PT +ve by self
2nd PT +ve by private clinic
No –ve PT
No USG done in private clinic
Not yet booked antenatal
Plan book AN in UCH 
52
Threatened abortion
F/
NSND
NKDA
Past Medical History
Para +
SVD in , BW
STOP in
MTOP in
Contraception
PS
Past gyn hx -ve
Planned and wanted pregnancy
Mat + week by date ( week by PT)
LMP:
Regular days per cycle, last days
No dysmenorrhea
Normal flow
No IMB / PCB
1st PT +ve by self on
2nd PT +ve by clinic on
No –ve PT
USG in private on (date)/ at wks showed IU sac/ fetal pole/ CRL cm = ?wks)/ fetal heart
positive/ negative
__________
“E” admitted for ___________
PV bleeding/ spotting since
Soaked minipads/ daytime pads/ nightime pads/ underpants/ pants
Fully soaked/ ? soaked/ 1/3 soaked/ Centrally soaked
Fresh blood/ Brownish
No clots/ tissue mass passed
No abd pain
No abnormal PVD/ vulval itchiness (**only symptomatic patients that we need to take HVS)
PU/BO well
PE:
Afebrile
BP / P
Abd soft, no T/G/R
Speculum/ PV (No PV if 2nd tri TA)
V/V ___ml blood in vagina/ blood stained/ no blood/ discharge
Cx os closed/ open, no TM/ polyp, any excitation
Ut AV/RV, NS/ wk size
Adnexa clear/ excitation/ adnexal mass
Imp:TA
Mx:
DAT
Fast after 0500 (no need fast 0500 if Doptone +ve)
USG pelvis mane
Pad record
+/- HVS (only if patient complained of abnormal PVD)
+/- CBC, LRFT, amylase (if patient complained of abd pain) 
53
Hyperemesis gravidarum
Mx:
DAT
Chart IO
CBP, LRFT, pTFT
MSU
USG pelvis
Urine ketone daily (+/- body weight daily)
Avomin 25mg TDS prn
If unresponsive to avomine:
Maxolon 50mg Q6-8H IV prn
Thiamine 50mg Daily
Menorrhagia
Anaemic symptoms: dizziness/ SOB/ palpitations
Thyroid symptoms: hand tremor/ fatigue
If symptomatic anaemia:
No PRB/ malena/haematuria
No bleeding tendency
Not vegetarian
Mx:
DAT
Pad record
Bloods x CBC, LRFT, clotting, amylase +/- T&S
Bloods x ferritin, HbP (if prev HbP results not available, and all prev MCV are low), TFT
FOB x 2
USG mane (please clearly state VIRGIN if virgin)
Transamin 500mg QID PO prn
Ponstan 500mg TDS PO prn
+/- FeSO4 + Vit C
+/- Urine PT (for women at reproductive age, presented with PVB, to r/o miscarriage)
+/- HVS
+/- MSU
You can also learn how to start NE ! – NE 5mg TDS po
If on discharge: Norethisterone (advanced options choose cyclic) 5mg TDS po D5-25
3 cycles
Bartholin’s abscess
Mx:
DAT
FAMN (for Marsupialization or I&D next day)
Bloods x fasting glucose
Ampicillin + Cloxacillin 500mg QID PO
Panadol for pain
Gaped episiotomy wound
* on BF or AF
* remove redundant stitches
Mx:
DAT
54
Dressing daily / BD / TDS
Wound swab
HVS if foul smelling PVD/lochia
Ampicillin 500mg QID
Cloxacillin 500mg QID
Pelvic inflammatory disease

Acute abdomen history taking…….
Gynae hx eg LMP, menstrual cycle, contraception….. etc
Risk factors (eg. Multiple sexual partner, hx of STD / PID… etc) and write down too!
Speculum / PV:
-v/v: _____ (colour) discharge
-Cx: any excitation tenderness
-Ut size, AV/RV
-Adnexa: clear / excitation / adnexal mass
Mx:
DAT / NPO (if acute abdomen)
Bloods x CBP, LRFT, Amylase +/- T&S
Triple swabs (make sure ECS taken for chlamydia into special medium bottle)
MSU
USG pelvis mane
Augmentin 1g BD PO/ Augmentin 1.2g IV Q8H IV
Flagyl 400mg TDS PO / 500mg Q8H IV
Doxycycline 100mg PO BD or Azithromycin 1g PO once if vomit
Post LEEP bleeding
Hx:
bleeding (onset, amount… etc)
foul smelling PVD
fever, pain….
P/E:
Speculum: mild oozing at 3 o’clock, Monsel’s solution applied, haemostasis observed
Consider performing PE with MO
Remember to take HVS
Start oral Augmentin 1g BD
Persistent lochia
-lochia (amounts, any clots)
-any tissue mass passed
-any vasoactive substance intake (e.g. ginger-vinegar, chicken wine)
-any abd pain
-any fever
always ask if BF or AF
-PV as usual, remember to take HVS
-Fast 0500, USG mane
-Ddx: endometritis / RPOG 
55
SURGERY 
56
(Literally the most basic template you need for Surg)
[Age]
NKDA
[PMH]
Some MOs like to put the most recent CLN / OGD results here
=======
E admitted x _____
(Abdominal pain case)
______ (area - LLQ, RUQ, central etc) pain since _____
No radiation
(Surgeons don’t really care about nature of the pain and all that)
No nausea / vomiting (If vomiting - how much (can quantify by ml / bowls), content ie undigested
food / bile stained fluid / coffee grounds)
BO well, no PRB / tarry stools (If PRB - also ask about duration, presence of anemic symptoms)
No hematuria / dysuria
No fever (If fever - write down temp up to ____, note if chills and rigors +; see previous C/ST
results for Abx sensitivity)
PE:
Vitals (if lazy can just put down vitals stable, afebrile if patient really is stable, some MOs do this)
Abdomen:
(Here’s where you draw the diagram with a # to denote the site of pain, watch out for guarding
and rebound tenderness esp if patient came in for abdominal pain)
Ix in AED:
(Blood results etc)
CXR (if unremarkable): clear, no definite consolidation, no free gas 

AXR (if unremarkable): no dilated bowels
Mx:
NPO except meds (true for most cases in Surgery, for urology can usually DAT though)
IVF 2D1S Q__H (some MOs prefer 1D1S, use 1/2:1/2 if DM or IFG, choose the rate based on
patient’s age and presence of renal / cardiac condition)
Routine obs
Chart IO
Chart BO color (if PRB case)
CXR, AXR (if no Ix done in AED - it happens)
Bloods x CBC, LRFT, clotting (baseline bloods), amylase (if abdominal pain)
MSU / CSU x R/M, C/ST (choose MSU/CSU at your own discretion based on patient’s GC and
willingness to cooperate lolz)
Resume usual meds
PO Panadol 1g Q6H prn
PO Tramadol 50mg Q6H prn
PO Pantoloc 40mg daily (if epigastric pain, if patient is already on Pepcidine rmb to off it first to
avoid therapeutic duplication)
57
Hematuria
[Age]
NKDA
[PMH]
========
E admitted x ___________
Noted hematuria since _________, beginning / end / entire stream
Painful / painless
Any blood clots / stones passed
Other urinary symptoms e.g. urinary frequency, dysuria
No abdominal / loin pain
No nausea / vomiting
BO well, no PRB / tarry stools
No fever
PE:
Ix in AED:
Mx:
DAT
Routine obs
Chart IO
Save urine x inspection
KUB (if not done already) 

Bloods x CBC, RFT, clotting (don’t take LFT for uro case)
MSU / CSU x R/M, C/ST
Resume usual meds
58
Loin pain
(usually due to renal stone)
[Age]
NKDA
[PMH]
========
Loin pain since ____, radiates to ____ (sometimes radiates to ipsilateral groin)
No abdominal pain
No hematuria / stones passed
No dysuria / urinary frequency
No fever
PE:
(To denote loin pain they usually draw a # outside of the hexagon on the same side)
Ix in AED:
Mx:
DAT
Routine obs
Chart IO
KUB (if not done already)
Urgent NCCT x renal stone protocol (make sure to put down “to rule out renal stone” in clinical
information) 
Bloods x CBC, RFT, clotting
MSU / CSU x R/M, C/ST
Resume usual meds
59
AROU
[Age]
NKDA
[PMH]
========
Difficulty voiding since ______
Unable to void at all today
Suprapubic tenderness
No abdominal / loin pain otherwise
Foley inserted in AED 

First cath _____
No fever
PE:
(Also look at Foley output to see if clear / turbid, can also be pyridium stained (orange)
Ix in AED:
Mx:
DAT
Routine obs
Chart IO
Bloods x CBC, RFT, clotting
CSU x R/M, C/ST
Resume usual meds
60
Green OT
Mx:
Fluid diet
Routine obs Q4H
Chart I/O
TED stockings
CXR, ECG
Bloods x CBC, LRFT, clotting, T&S
Klean prep
Neomycin 1000mg Q4H x 3 doses
Flagyl 400mg Q4H x 3 doses
IV Augmentin 1.2g Q8H bring to OT
IV ICG 25mg bring to OT
Resume usual meds 
61
FBI
F/44y
NKDA
PMH:
1) HBsAg +ve, LFT normal FU QMH Med
Noted persistent thrombocytopenia during last FU, referred to PY Hematology, appt pending
2) IMB and ovarian cyst FU PY O&G
__________
E admitted x FBI
Had yellow croaker fish on 22/5/21, complained of FBI sensation afterwards
Did not seek immediate medical attention
↑ Central neck discomfort in recent few days, hence attended AED
No odynophagia / dysphagia
No nausea or vomiting
No holdup sensation
No hemoptysis / hematemesis
No neck swelling
Oral intake maintained
No abdominal pain
PU and BO well
No fever
PE:
BP 130/75 P 70
SpO2 98% on RA
Afebrile
GC well, alert, not in respiratory distress
No stridor
Neck:
No obvious swelling / subcutaneous emphysema
Non tender
Ix in AED:
X ray C spine: no obvious foreign body / pre-vertebral swelling
Mx:
NPO except meds
Routine obs
IVF 2D1S Q6H
Bloods x CBC, LRFT, clotting
Consider OGD on Monday 
62
PTX
22/M
NKDA
Unremarkable past health
===============================
"E" adm x 1st episode left spontaneous pneumothorax
Left chest pain since x 5/7 ago spontaneously
No trauma / injury / fall
Private CXR done today, found left pneumothorax
No cough / haemoptysis / sputum
No abdominal pain
No fever
Left 24Fr chest drain inserted in AED, markin 11cm
P/E
BP 115/75 P85
Temp 36.9
SpO2 98% on 2L O2
Left chest drain insitu, swinging +ve, bubbling +ve
Ix
CXR: left PTX, chest drain in situ at left lung apex, no trachea deviation / pleural effusion, right
side normal, clear, no free gas under diaphragm, no rib #
Mx
DAT
Obs Q4H
2L O2 today
ECG x 1
Blood x CBC RFT TnI CK
CXR mane before round
Chest physiotherapy
Incentive spirometry
PO panadol 1g q6h prn
PO arcoxia 90mg daily x 3/7
PO pantoloc 40mg daily x 3/7
63

Pediatrics (General Admissions) 5

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pediatrics (General Admissions) 5

Uploaded by

Copyright:

Available Formats

Contents

PEDIATRICS (GENERAL ADMISSIONS) 5

GE (with anal rash) 10

Hematological malignancy (ie case of unexplained anemia) 25

PEDIATRICS (DAY WARD CLINICAL ADMISSIONS) 31

Thalassemia blood transfusion 35

HEADSS framework (for adolescents) 45

Decreased fetal movement 50

Abd pain cx pregnancy 50

Gaped episiotomy wound 54

Pelvic inflammatory disease 55

Post LEEP bleeding 55

(Literally the most basic template you need for Surg) 57

a) IV augmentin 1.2g Q8H

- if eGFR 15-30: loading dose 1.2g, then 600mg Q12H

- if eGFR <15: loading dose 1.2g, then 600mg Q24H

- if eGFR 15-30: PO augmentin 375mg TDS

- if eGFR <15: PO augmentin 375mg BD

c) syrup augmentin 457mg/5ml 10ml BD

a) IV tazocin 4.5g in 100ml NS over 30 mins Q8H

a) IV levofloxacin 500mg over 60mins Q24H

- if eGFR 20-49: loading dose 500mg, then 250mg Q24H

- if eGFR 10-19: loading dose 500mg, then 250mg Q48H

b) PO levofloxacin 500mg daily (+/- 250mg)

a) IV ciprofloxacin 200mg or 400mg over 60 mins Q12H

- if eGFR 5-30: 200mg or 400mg over 60 mins Q18H to Q24H

- if eGFR 10-19: loading dose 500mg, then 250mg Q48H

b) PO ciprofloxacin 500mg (+/- 250mg) BD

- if eGFR 30-50: PO ciprofloxacin 250mg to 500mg Q12H

- if eGFR 5-29: PO ciprofloxacin 250mg to 500mg Q18H

IV contrast steroid cover:

- PO prednisolone 40mg 12 hours and 40mg 2 hours before examination

Meningitic dose (peds)

For meninigitic dose of IV ampicillin and IV cefotaxime

IV Ampicillin 300mg Q6H (50mg/kg/dose) Q6H

IV Cefotaxime 300mg (50mg/kg/dose) Q6H

- PO Norvasc 2.5mg or 5mg stat x1

- PO hydralazine 25mg stat x1

- IV labetalol 5mg IV stat or 100mg in 100ml NS (30ml/hr +/- 5ml/hr)

- PO fluimucil 200mg TDS

- PO bisolvon 8mg TDS (mucolytic)

- PO cocillana 10ml QID PO prn

- PO MES 10ml TDS PO prn (expectorants)

- PO Dequadin 500mg QID prn

- LA Thymol gargle MW 10mg TDS

- LA 0.2% Chlorhexidine MW 10ml TDS

- LA Bonjela TDS prn

- LA Thymol gargle MW 10mg tds

- LA aqueous cream TDS prn

- LA Eurax cream TDS prn

- PO piriton 4mg TDS prn

- PO atarax 25mg TDS prn

- PO piriton 4mg nocte prn

- PO imovane 3.75mg nocte prn

- PO colchicine 0.5mg TDS prn (omit if diarrhea)

- PO ativan 1mg TDS or BD

- PO thiamine 100mg daily (50mg if chronic drinker)

- IV thiamine 100mg Q8H if Wernickes

Informant: mother / father / self

NSD / VA / forceps / c-section at FT / weeks days in _____ hospital

Development normal so far (details if febrile convulsion / growth problem / syndromal)

No visual or hearing concern

Vaccination up to date (any flu vaccine)

Attended _ on __ for D_ fever.

Started in ___ and then spread to _ over _ days