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Online Case 3-23-11 Weds

Online Case 3-23-11 Weds - I HISTORY Patient Presentation A...

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I. HISTORY Patient Presentation A four-year-old African American male diagnosed with sickle cell disease in the newborn period was admitted to the hospital with abdominal pain. Two days prior to admission, he was seen in the emergency room for abdominal pain and sent out on pain medicine. What history, including symptoms, would be most helpful in evaluating this patient? Select all that apply. Prior episodes of abdominal pain Good choice. Response: Two episodes in the last year. COMMENT: A prior history of recurrent episodes especially over several months may reflect a chronic disease. Trauma Unlikely to explain these recurrent episodes of pain. History of other types of pain Good choice. Response: Bone pain and swollen, painful fingers (dactylitis). COMMENT: This is a recurrent problem with sickle cell disease. Fever Good choice. Response: He had a temperature of 101 degrees Fahrenheit yesterday. COMMENT: This could reflect an infection which could bring about a sickle cell crisis or precede a severe complication of sickle cell disease. Cough and shortness of breath Good choice. Response: He has been coughing 2-3 times a day and intermittently through the night. COMMENT: Important since it may precede pneumonia or reflect asthma, which may be more frequent in patients with sickle cell disease. Moreover, acute chest syndrome, a severe complication of sickle cell disease with high mortality, can develop quickly and be seen more frequently in patients with asthma. Medications Although this is usually asked of all patients, it does not seem important in explaining this child’s problem. Family history Good choice. Response: One cousin has sickle cell disease and one brother has Type 1 diabetes. COMMENT: In patients with sickle cell disease a family history of the disorder is important since it is transmitted as an autosomal recessive gene and several family members may be affected. A positive family history in this patient makes the diagnosis of sickle cell disease (which is present by history) much more likely. I. HISTORY
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What questions pertaining to the child’s past medical history would be most helpful to you? Select all that apply. Has he ever had a lung infection or pneumonia? Good choice. A child who has had a severe lung infection or pneumonia might have acute chest syndrome, and is more likely to have repeat episodes. Acute chest syndrome is defined by hypoxia, infiltrate on chest x-ray and leukocytosis. When did he learn to walk? Not relevant to the present illness. If the child looks grossly normal, questions regarding development are not indicated at this time. Does he have asthma? Good choice. Asthma is associated with a higher risk of developing acute chest syndrome in children with sickle cell disease.
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Online Case 3-23-11 Weds - I HISTORY Patient Presentation A...

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