General medicine case

December 12, 2021

 A 13 year old boy with fever and swelling over neck since 15 days

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Case:

A 13 year old boy with swelling over neck since 15 days and fever since 10 days.

Date of admission: 10/12/21 morning

History of present illness:

Patient was apparently asymptomatic 20 days back and then  he   developed a swelling on the neck 15 days ago  and fever since 10 days.

Patient's mother works at a poultry and his father is a car driver.

The boy was studying 7th standard and was joined in hostel 20 days back. 10 days back when the boy had neck swellings and fever they visited a local hospital where it was diagnosed as  food poisoning.

The boy's daily routine in hostel was to wake up by 4 o'clock in the morning and make rounds in the ground and getting back by 6.30 and used to have milk and gets ready for classes.By 8 o' clock he goes to school and at 4 pm after school they had 2 hrs of games but the boy was not interested in playing with them so he used to sleep in the classroom until 6 o' clock and after that they used to have dinner by 8 o' clock and then study hours until 9.30 pm and then goes to bed.

The boy stayed in hostel for 17 days in chikatimamidi and during those days his father used to visit him where he used to take the boy to bakery. Before the appearance of neck swellings the boy went to bakery 10 days back.

The boy went to poultry where his mother works 6 to 7 days back for helping his mother in her work.

Patient had cat as a pet since 5 years.He used to play with it daily.He had scratches over abdomen dy

The neck swellings are initially small in size and had grown to present size gradually.

The boy started getting pain in the neck swellings not immediately but after 6 days of appearance of swellings.

The fever was intermittent and recur every 2 days.

He had difficulty in swallowing since a day before admission.

Since 5 days patient was only on chapati .

Since 5 days the patient had severe fatigue.

Past history 

No h/o HTN/DM/Epilepsy/TB/Thyroid disorders

Personal history 

Diet : mixed

Appetite : loss of appetite since 4 days.

Bladder and bowel movements:normal

Sleep : disturbances since 4 days

Family history

No history of DM/HTN/CVA/CAD/Asthma/thyroid disorders

No similar complaints in the family previously. 

Treatment history 

Not significant. 

General examination

Patient is conscious, coherent and cooperative.

Oriented to time,place and person.

No pallor, history of icterus previously but not now,no cyanosis,no clubbing,no lymphadenopathy. 

Vitals

Bp :110/70 mm hg

PR:136 bpm

RR: 20 cpm

Spo2: 96% 

GRBS:116 mg/dl

Temperature: 103'F

Systemic examination:

CARDIOVASCULAR SYSTEM:

Inspection:

Chest wall is bilaterally symmetrical.

No precordial bulge.

Palpation:

JVP: normal

Auscutation:

Normal with regular heartbeat

S1, S2 heard

No murmurs 

RESPIRATORY SYSTEM-

Position of trachea: central

Normal Bilateral air entry

No AV sounds

PER ABDOMEN:

Normal. No mass is palpable. 

No organomegaly

CENTRAL NERVOUS SYSTEM:

Patient is Conscious, coherent and cooperative.

Provisional diagnosis:

 Irreducible indirect incomplete inguinal hernia.

Provisional diagnosis:

Pyrexia under evaluation

Suspecting its due to cat scratch???

Investigations:

Blood urea :30 mg/dl

Blood parasites: negative

Cat scratch over the abdomen:

Neck swellings:

Fever chart:

Ultrasound report:

ECG:

Chest X -Ray:

Treatment:

10/12/21

Inj. PCM 450 mg/IV/sos

Tab. Pan 20 mg/po/od

IVF NS,RL @ 100ml/hr

Tab. Dolo 500 mg /po/tid

Plenty of oral fluids

Tepid sponging 4 th hrly

BP/PR/Temp 4th hrly

11/12/21

Inj. PCM 450 mg/IV/sos

Tab. Pan 20 mg/po/od

IVF NS,RL @ 100ml/hr

Tab. Dolo 500 mg /po/tid

Plenty of oral fluids

Tepid sponging 4 th hrly

BP/PR/Temp 4th hrly

Inj. Proflaxacin 500 mg/bd/iv

Strict i/o charting

Tab. Azithromycin 500 mg/po/OD