1 Mohammad, a 16 year old male was sent to the emergency department accompanied by his family with a chief complaint of sudden weakness and trouble breathing after eating his friend's birthday cake 1 hours prior to admission, His mother reported his breathing got worse, elevation and rest doesn't seem to help. He also reports palpitation of his chest minutes after eating the cake. He has no symptoms of nausea and vomiting, no history of smoking or alcohol consumption. His mother reported a history of milk and egg allergies. Family history: His father has a well controlled asthma Physical Examination General Appearances —_ : Severely ill Consciousness Somnolen (E3M5V4) Vital signs : Blood pressure 70/50 mmHg Heart rate :60 BPM Respiratory rate 33x/min Temperature 36.7°C Oxygen Saturation : 92% Anthropometric Data Weight 55 kg Height 1165 em Head & Face Examination + Periorbital erythema and edema, conjunctival erythema, and tearing. + Oral examination: Swelling of lips, tongue, and uvula Neck = SVP: 542 emHz0 + Nolymph node enlargement detected at palpation Thorax + Lungs: © Inspection: Symmetrical, chest retraction Additional Breath Sound: hoarseness, dysphonia, stridor. © Palpation — : Symmetrical, bilateral lung movement (+) © Percussion : Sonor © Auscultation : Vesicular, ronchi (-), wheezing (-) * Heart Inspection —: Ictus cordis (-) Palpation _: Ictus cordis palpated at ICS 5 sinistra 2 Percussion + Left heart border: linea mid-clavioula sinistra ICS 5 * Right heart border: linea parasternalis dextra ICS 5 + Top heart border: linea parasternalis sinistra ICS 2+ Auscultation : $1 (+), S2 ( Abdomen: Within normal limits. Extremities «Skin: Generalized urticaria and angioedema * Acral: cald and clammy + Capillary refil time: elongated. ADDITIONAL EXAMINATION Laboratory Examination * Blood Gas Analysis © pH 27.28 © PCO2 46 mmHg 2 HCO3- — : 15 mEq/L 2 PO2 92 mmHg © Blood Chemistry Profile 2 Random blood glucose: 166 mg/dL. 2 BUN (Blood-Urea Nitrogen): 9 mg/dL co Serum Creatinine: 0.7 mg/dL © Serology test S2 splitting (+), murmur (-), gallop (-) © Plasma histamine level: 15 nm/ml (<10 nmimi) © Serum tryptase 20 nmiml (1 - 11.4 nm/ml) © Complete Blood Count TD peMERIKSAAN PENUNUANG Hematologic | Result | Reference Values Units Indicator Hemoglobin | 130 13.46 ois Hematoerte | 390 2048 % Leukocyte 90 354-908 ‘Thousands Enirocyte 48 4356 Millon Trombocyte | 361 165-418 ‘Thousands ‘if Count ~ Basofl 0 02 % Eoainof 8 06 % Banded ° 08 % Segmented | 60 40-70 % Limos 2 2050 % Monosit 5 48 6 Mew 80 79.983 1. NCH 213 267-31.9 Pg MoHE 320 923359 oid+ ECG See Conclusion: Supraventricular tachycardia confirmed. Questions 1 2. Analyze and elaborate the problem from history taking, physical findings, and laboratory findings! State your Working the reasons. ignosis and Differential Diagnosis (min. 2) and explain . Explain how innate and adaptive immunity work Explain the type of hypersensitivity and the underlying pathophysiology of this scenario. State your treatment plan for this patient.