CLERK-RESPIRATORY CASES

Differential dx : Asthma/Acute Bronchiolitis/Pneumonia/Croup/Pertussis

2 year old malay boy, Full Term / SVD

ANC : Uneventful

PNC:Uneventful

-Thid is 2nd hospitalization

- 1st hospitalization at 1 year old : AGE (acute gastroenteritis) admit x 2/7 at HRPZ

- Immunization up to age

- Presented with

·         Rapid breathing x 2/7

  - Worsening on day admission at 12 noon

 - Noted Chest indrawing                                                                                                                                                                                                                                                                                                                                                                                       

 - Chesty in nature

- No prolong bout cough (tro pertussis)

- No barking cough (TRO croup)

- Post-tusive vomiting x 2                                                                                                                                                                    (non billious, no blood, milk content)                                                                                                                           

·         Fever x 3/7

- Continous

- No rigor

- Temporarily relieved by syrup PCM 6 hourly

- Highest documented temperature 38.6 C at home

·         Runny Nose x 1/7

- Clear nose discharge

·         Associated with

- Lethargy - mother noted pt sleep all day, usually active and playful

- Reduce oral intake 1/7, usually take 6 bottle (4 onz), however today only take 2 onz

·         Otherwise

- Unsure about PU (passed urine) - claimed as usual

- No diarrhea

- Sick contact with brother had URTI x 1/52 (fever but already resolved)

- Not from dengue prone area                                                                                                                                                                                            

- No h/o travelling

- No water activity

✅  Interval Symptom (If we thinking of asthma, in patient had strong family history, had multiple admission or nebulization before)

- No daily symptoms

- No nocturnal symptoms

- No exercise induce sympoms

* Ada tak anak puan batuk- batuk atau bersin pada waktu pagi-pagi ketika dia sihat sebelum ni? Malam? Atau ketika dia kuat bermain?

- Patient no allergy rhinitis, but had eczema under HRPZ follow up

- Strong family history of asthma, both parent have allergy rhinitis, maternal auntie has asthma, brother has eczema

 - Multiple history of nebulization before, since 6 month old, about once every 2 month. No admission

- Trigger : URTI/Cold whether, cold drink/dust/cat

*Biasanya, apa yang membuatkan dia mudah nampak lelah atau batuk-batuk sebelum ni?  Contoh  jawapan : Oh doktor, biasa kalau dia selsema atau batuk, dia mudah kelihatan lelah (URTI adalah trigger factor untuknya)

- No cat or carpet at home                    

- Father smokers