pharmacology conference
DESCRIPTION
PHARMACOLOGY CONFERENCE. Mendoza, Donne; Mendoza, Gracielle ; Mendoza, Trisha; Mindanao, Malvin Ace. MNL 4 months November 18, 2010 114 Hansens St. East Tapinac, Olongapo Catholic Filipino Informant: Parents Reliability: Good. ULCER OVER THE LEFT LABIA. Chief complaint:. - PowerPoint PPT PresentationTRANSCRIPT
Mendoza, Donne; Mendoza, Gracielle; Mendoza, Trisha;
Mindanao, Malvin Ace
PHARMACOLOGYPHARMACOLOGYCONFERENCECONFERENCE
• MNL• 4 months• November 18, 2010• 114 Hansens St. East Tapinac,
Olongapo
• Catholic• Filipino• Informant: Parents• Reliability: Good
ULCER OVER THE ULCER OVER THE LEFT LABIALEFT LABIA
Chief complaint:
GESTATIONAL HISTORY• born to a 31 year old production worker G2P1 (1001)
married to a 26 year old businessman. • took 7 tablets of Aspirin of unrecalled dosage when she
was 5 days delayed but stopped when she tested positive for pregnancy.
• regular prenatal check-up: 1 month AOG at a local hospital with a total of 10 visits.
• She only took folic acid as supplement. • She did not smoke, nor drink alcoholic beverages and was
not exposed to viral exanthems nor radiation. • Ultrasound at 1st and 3rd week and a congenital scan
showed normal results. • HBsAg screening was negative, no OGCT done.
BIRTH HISTORY
• Born at 38-39 weeks AOG• Live, singleton, delivered via LTCS under spinal anesthesia• APGAR score 8-9• Birth weight = 3.2 kg• Immediately roomed-in• Physical examination:
– Hemangioma over the left labia– (+) sacral dimpling– Polydactyly on both hands– (+) preauricular skin tag on the right ear
HISTORY OF PRESENT ILLNESS
3 weeks PTA
(+) rashes on the region of the hemangioma(+) change in sizeNo other symptoms notedConsult with a Pediatrician
- prescribed unrecalled ointment no resolution
2 weeks PTA
(+) ulceration of hemangiomaConsult with a Pediatrician
- prescribed Fusidic acid (1 week) no resolution
- Fusidic acid 2% and Cloxacillin
HISTORY OF PRESENT ILLNESS
1 week PTA
(+) pus on hemangiomaConsult with a surgeon who suggested consult at USTH
ADMISSION
REVIEW OF SYSTEMS
Cutaneous: (-) rashes, (-) pruritusHEENT: (-) nasoaural discharge, (-) eye discharge, (-)
sore throatRespiratory: (-) dyspnea, (-) chest painCardiovascular: (-) palpitations, (-) cyanosis, (-) easy
fatigabilityGastrointestinal: SEE HPI
REVIEW OF SYSTEMS
Genitourinary: (-) dysuria (-) hematuriaMusculoskeletal: (-) weakness, (-)swellingHematopoietic: (-) easy bruisability, (-) bleedingEndocrine: (-) polyuria, polydipsia, polyphagiaNervous/Behavior: (-) headache, (-) seizures, (-) loss of
consciousness
FEEDING HISTORY
• Not breastfed• Milk formula: Nan-one with 1:1 dilution
given 6x/day total of 709.7 mL (24oz) per day
• Total caloric value: 475 kcal/day
DEVELOPMENT/BEHAVIORAL HISTORY
Gross motorWith good head control
on sitting positionBegins to reach for toys
symmetrically
Fine motorMidline regard
LanguageCoos
Personal SocialLaughs
DEVELOPMENTAL MILESTONES
IMMUNIZATIONS
VACCINE DATEBCG December 15, 2010Hepatitis B January 4, 2011
February 1, 2011March 15, 2011
DTP/DTaP January 4, 2011February 1, 2011March 15, 2011
OPV January 4, 2011February 1, 2011March 15, 2011
PAST MEDICAL HISTORY
• 2 months: Bronchitis, given Salbutamol nebulization• No previous hospitalizations or surgeries
FAMILY HISTORY
• (+) HPN, DM, Bronchial asthma• (-) cancer, tuberculosis
FAMILY PROFILE
Relation Age Educational Attainment Occupation Health
Father 31 Nursing aid Businessmans/p
cholecystectomy, HPN, Asthma
Mother 27 Industrial technology
Production worker
Healthy
PERSONAL, SOCIOECONIMIC AND ENVIRONMENTAL HISTORY
• Concrete house with both parents, mother is the primary caregiver
• Well-ventilated, well-lit• Drinking water is distilled• Garbage is not segregated but collected twice a week• No nearby factories, with cats
PHYSICAL EXAMINATION
• Alert, awake, not in cardiorespiratory distress • VS: CR 142 bpm RR 36 cpm T 36.9 C• Wt 5 kg. (z= 0) • Lt. 64 cm (z= -2) • BMI 13.4 (z= below -1)
PHYSICAL EXAMINATION
• Warm, smooth skin, no active dermatoses• Pink palpebral conjunctiva, anicteric sclerae• (+) Preauricular skin tag, AD, no tragal tenderness,
non-hyperemic EAC, (+) retained cerumen, AU, intact tympanic membrane, no aural discharge AU
• Midline septum, turbinates not congested, no nasal discharge
• Moist buccal mucosa, non-hyperemic posterior pharyngeal wall
PHYSICAL EXAMINATION
• Supple neck, no palpable cervical lymphadenopathy• Symmetrical chest expansion, no retractions, clear
breath sounds• Adynamic precordium, apex beat 4th LICS MCL, no
heaves, thrills, murmurs• Globular abdomen, AC = 38cm, NABS, soft, non-
tender, no mass palpated
PHYSICAL EXAMINATION
• Pulses full and equal, no cyanosis, no edema, (+) polydactyly both hands, (+) sacral dimpling
• (+) hemangioma on the left labia, measuring 4 x 3 cm with an ulcerating lesion measuring 2 x 1 cm with whitish discharge
• DRE: tight sphincteric tone, no tenderness, no masses, brown fecal material on tactating finger, non-blood tinged
NEUROLOGIC EXAMINATION
• Mental Status: alert, awake• Cranial Nerves are intact: intact EOM; no ptosis; no jaw
deviation; smiles, open and close his eyes, no facial asymmetry; midline uvula, no tongue atrophy, no fasciculations, no deviation
• No Babinski, no nuchal rigidity• No motor or sensory deficit
SALIENT FEATURES
POSITIVE NEGATIVE
APPROACH TO DIAGNOSIS