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Case of H.C.

Case of H.C. Pedia -Ortho SGD. General Data. H.C. 6 years old Male From Urdaneta R flank mass and R inguinal mass. History of Present Illness. Diagnosed case of Pott’s disease since March 2009, currently on his 3 rd month of treatment with HRZE

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Case of H.C.

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  1. Case of H.C. Pedia-Ortho SGD

  2. General Data • H.C. • 6 years old • Male • From Urdaneta • R flank mass and R inguinal mass

  3. History of Present Illness • Diagnosed case of Pott’s disease since March 2009, currently on his 3rd month of treatment with HRZE • Patient was referred to Rehab for fabrication of TLSO brace, because patient will need brace immediately post-op

  4. 8 mos PTA (Nov 2008) • Patient’s mother noted 1x1cm mass on the R lower lumbar area. The mass was movable, fluctuant and non-tender. No consult was done.

  5. 7mos PTA • The mass was noted to be enlarging, occupying the lower lumbar area, with associated 50% weight loss and anorexia, occasional cough, undocumented fever (Paracetamol) and night sweats.

  6. 3mos PTA • Continuous increase in size of the mass and fever prompted consult to a private doctor. Chest X-ray was done which revealed PTB. Patient was started on Anti-Koch’s medications (HRZE)

  7. 1week PTA • Patient’s mother noted the presence of • 3x4cm soft, non-tender, non pulsatile R inguinal mass • 6x5cm soft, non-tender non-fluctuant R flank mass • Patient was brought to the ER and was advised for admission

  8. Review of Systems (+) fever (+) unprod cough (-) abd’l pain (+) weight loss (-) colds (-) BM changes (+) anorexia (-) dyspnea (-) GU changes (-) headache (-) orthopnea (-) dysuria (-) nausea (-) chest pain (-) vomiting (-) easy fatigability (-) BOV (-) easy bruisability

  9. Past Medical History • (-) previous hospitalization • (-) allergies • (-) other illness

  10. Family Medical History • (-) DM, BA, HD, thyroid disease • (+) HPTN- maternal

  11. Birth and Maternal History • Born FT to a then 26y/o mother G2P1(1001) via NSVD in a lying-in clinic assisted by a midwife. With regular PNCU’s c/o local health center. Mother denies any maternal illness, (-) fetomaternal complications. • Patient was born with good cry and good suck

  12. Personal and Social History • Middle child, w/ 10yo brother and 3yo younger brother • Mother 32yo, housewife • Father 35yo, tricycle driver

  13. Nutritional History • Patient was exclusively breastfed until about 1 year of age • (+) complimentary feeding started at 6-8 months old

  14. Immunization History • BCG • DPT 3doses • OPV 3 doses • Hep B 3 doses • Measles • c/o Local Health Center

  15. Developmental History • Generally at par with age • Grade 1 student

  16. Physical Examination

  17. General • Alert, awake, conscious, not in cardiorespiratory distress • HR= 140’s • RR= 38 • T= 38.4 C

  18. HEENT • Slightly pale palpebral conjunctivae, anicteric sclerae, (-) NVE • (+) multiple CLAD

  19. Chest and Lungs • Clear breath sounds • (-) use of accessory muscles • (-) suprasternal/ intercostal retractions

  20. Heart • Adynamic precordium • Distinct heart sounds • (-) heaves, thrills,murmurs

  21. Abdomen • Firm and globular abdomen • NABS • Non-tender, (-) masses • Non-palpable liver edge, intact Traube’s space

  22. Extremities • Pulses full and equal, CRT<2s • DTR’s: normoreflexive • Full ROM’s • MMT: • C5-T1: 5/5 • L2-S1: 5/5 • Sensory: (-) sensory deficits • C5-T1: 100% • L2-S1: 100%

  23. Present Working Impression Pott’s Disease, ongoing treatment Abscess R paravertebral area with psoas extension • s/p Anterior Debridement, Decompression and Interbody Fusion T11-L1 (7/6/09, PGH)

  24. Medications on Board • Isoniazid • Rifampicin • Paracetamol PRN • Clindamycin

  25. Thank you!

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