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