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An 8-year-old boy accompanied by his mother presents to his PCP with a 4-day history of fever and rash.

An 8-year-old boy accompanied by his mother presents to his PCP with a 4-day history of fever and rash.

CLINICAL CASE DISCUSSION 2

Chief Complaint

“Fever and rash.”

History of Present Illness


An 8-year-old boy accompanied by his mother presents to his PCP with a 4-day history of fever and rash. His mother states the illness began with a runny nose, cough, and pinkeye. The rash started yesterday on his head and spread to his trunk and lower extremities. The patient denies emesis, diarrhea, headache, and photophobia. He is eating and drinking and is intermittently playful. No discharge noted from the eyes. No sore throat or lesions noted by his mother on his lips or in his mouth. He does not have a rash on the palms or soles of feet. His mother states they returned from a family vacation to Europe about 10 days ago. The patient is homeschooled. No other family members or friends have similar symptoms



Review of Systems



A ROS is positive for fatigue. It is negative for nausea, abdominal pain, blood in stool, or changes in urination. No chills or myalgias noted. No chest pain or SOB noted.



Relevant History



His mother was G1P1 and describes a normal pregnancy, labor, and delivery. The child has no surgical history or chronic medical conditions. He had a febrile seizure when he was 9 months old. He was seen in an ED for the seizure, and a subsequent workup was negative. He has had no further seizures. He received vaccines from birth to 6 months, but after the seizure, the mother refused vaccines, fearing they will trigger another seizure. The child lives with his parents and has no siblings. There is no family history of seizure disorders.



Allergies

No known drug allergies; no known food allergies.



Medications

None.







Physical Examination



Vitals: T 39.5°C (103.2°F), P 105, R 16, BP 98/59, HT 127 cm (50 in.), WT 25.4 kg (56 lbs), BMI 15.7.

General: Well appearing, appropriately responsive, in no acute distress.

Skin, Hair, and Nails: Erythematous, blanching macular-papular rash from hairline to toes. Coalesces on trunk. No petechiae. No involvement of palms or soles.

Eyes: Conjunctiva red bilaterally. No tearing or purulent discharge noted.

ENT/Mouth: Nose with erythematous turbinates and clear-yellow discharge. Post-nasal drip noted. No posterior oropharynx erythema or exudate. Small white spots on erythematous base noted on buccal mucosa. TMs pearly gray and mobile bilaterally.

Neck: Mild anterior cervical lymphadenopathy noted. No thyromegaly or tenderness to palpation.

Chest: No increased work of breathing. Mild cough noted.

Lungs: Breath sounds equal bilaterally. No wheezes, rhonchi, rales.

Heart: RRR. No murmurs noted. Peripheral pulses 2+ and equal.

Abdomen: Soft, non-tender, and non-distended. No hepatosplenomegaly noted.

Neurologic: A&O×3. No nuchal rigidity. Strength 5/5 for upper and lower extremities. DTR 2+ and equal bilaterally in the upper and lower extremities. Cranial nerves II to XII intact.



Clinical Discussion Questions



1) Give three (3) differential diagnosis? (Explain how you ruled in and ruled out each differential diagnosis.)
2) What is the most likely diagnosis? (Explain how you arrived with your diagnosis)
3) Demonstrate your understanding about the pathophysiology in regard to the most likely diagnosis.
4) What are the next appropriate steps in management? (Management should be confined to an outpatient setting, this includes proper referral if needed).

Discussion Question.
Question 1 (3 pts.)
Question 2 (3 pts.)
Question 3 (2 pts.)
Question 4 (2 pts.)
-Fully/completely answers questions comprehensively.
Criteria:
1)Understanding of the Subject Matter
Structure.
2) Organization and Structure.
3) Introduction, body & conclusion.
4) APA Format.
5) Proper references. 3 references within 4-5 yearsz
Paper Format: APA

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An 8-year-old boy accompanied by his mother presents to his PCP with a 4-day history of fever and rash.

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