1. 1. BYDR RABIAPGR WEST MEDICAL WARD
2. 2. BIODATANAME-------------IHTASHAMAGE------------13OCCUPATION--------STUDENTMARRITAL STATUS ------UNMARRIEDRESIDENCE----------MUGHAL PURA LAHOREDOA ----------29/11/13MOA---------EMERGENCY
3. 3. PRESENTING COMPLAINTS FEVER -------3 DAYS SORE THROAT ----------------3 DAYS PAINFUL DISCRETE SWELLINGS IN NECK WITHDIFFICULTY IN MOVING NECK------------3 DAYS
4. 4. HOPCPATIENT WAS IN USUAL STATE OF HEALTH 3DAYS AGO WHEN HE DEVELOPED FEVER THATWAS SUDDEN IN ONSET, INTERMITTENT,HIGHGRADE RELEIVED BY MEDICATION FROMLOCAL DOCTOR.NO H/O RIGORS CHILLS ANDNIGHT SWEATS
5. 5. FEVER WAS ASSOCIATED WITH SORE THROATAND PRESENCE OF PAINFUL DISCRETESWELLINGS IN NECK.BECAUSE OF THESESWELLINGS PATIENT FELT DIFFICULTY INSPEAKING,EATING SOLIDS AND MOVING HISNECK FROM SIDE TO SIDE
6. 6. NO HISTORY OF HEADACHE PHOTOPHOBIA VOMITTING NECK RIGIDITY EAR DISCHARGE RETERO ORBITAL PAIN BODYACHES BLEEDING FROM ANY SITE OR RASH ANYWHEREON BODY
7. 7. NO HISTORY OF DIARRHEA CONSTIPATION FLANK PAIN BURNING MICTURATION DARK COLOURED URINE HAEMATURIA
8. 8. PERSONAL HISTORY SMOKER-VE ADDICT-VE DM VE HTN VE ASTHMA-VE TB-VE CONTACT WITH TB-VE
9. 9. PAST HISTORY NO HISTORY OF PREVIOUS ADMISSION INHOSPITSL OR ANY SERIOUS ILLNESSS
10. 10. FAMILY HISTORY INSIGNIFICANT DRUG HISTORY INSIGNIFICANT NO H/O BLOOD TRANSUFION IN LIFE
11. 11. DIFFERENTIALS INFECTIOUS MONONUCLEOSIS PERITONSILLAR ABSCESS LYMPHOMA ENTERIC FEVER
12. 12. GENERAL PHYSICAL EXAMINATIONA YOUNG BOY WELL ORIENTED IN TIME PLACEAND PERSON WITH GCS 15/15WITH VITALSBP 110/70 mm hgPULSE 90/MINTEMP 101R/R 17/MIN
13. 13. GENERAL PHYSICAL EXAMINATION PALLOR VE CYANOSIS-VE CLUBBING-VE LEUKONYCHIA-VE KOILONYCHIA-VE JVP NOT RAISED NO RASH ON THE BODY
14. 14. GENERAL PHYSICAL EXAMINATION PALLOR VE CYANOSIS-VE CLUBBING-VE LEUKONYCHIA-VE KOILONYCHIA-VE JVP NOT RAISED NO RASH ON THE BODY
15. 15. EXAMINATION OF NECK B/L PAINFUL DISCRETE FIRM OVAL 2X2 ANTERIORCERVICAL LYMPH NODES WITH NO PURULENTDISCHARGE NO OTHER LYMPH NODES PALPABLE AXILLARY LYMPH NODE VE INGUINAL LYMPH NODES-VE
16. 16. EXAMINATION OF ORAL CAVITY INSIGNIFICANT PALATAL PETCHIAE-VE APTHOUS ULCERS VE CANDIDIASIS-VE GUM BLEED-VE GINGIVITIS-VE
17. 17. GITINSPECTIONABDOMEN FLAT ,MOVING WITH RESPIRATIONUMBILICUS CIRCULAR AND INVERTEDNO VISIBLE PULSATIONS,STRIAE,SCAR MARKSOR PROMINENT VEINSHERNIAL ORIFICES INTACTPALPATION TENDERNESS IN LEFT HYPOCHONDRIUM SPLEEN PALPABLE 2 FINGER BREADTHBELOW COSTAL MARGIN
18. 18. NO OTHER VISCERA PALPABLEPERCUSSION FLUID THRILL VE SHIFTING DULNESS -VE AUSCULTATIONBOWEL SOUNDS +VENO BRUIT OR FRICTION AUDIBLE
19. 19. CVS INSPECTION PRECORDIUM IS OF NORMAL SHAPE AND NOVISIBLE PULSATIONS OR SCAR PALPATION APEX BEAT IN 5TH INTERCOSTAL SPACE MEDIALTO MIDCLAVICULAR LINE ,OF NORMALCHARACTER. NO OTHER SOUND PALPABLE AUSCULTATION BOTH HEART SOUDS OF NORMAL INTENSITY NO ADDED SOUNDS OR MURMUR
20. 20. RESPIRATIONINSPECTIONRESPIRATORY RATE OF 16/min SHAPENORMAL,ABDOMINOTHORCIC TYPE OFRESPIRATION,B/L EQUAL MOVEMENTPALPATIONTRACHEA CENTRAL, NO TENDERNESS ORCREPITUS,EQUAL MOVEMENT ON BOTHSIDES,EXPANSION OF CHEST IS 3cmPERCUSSIONUPPER BORDER OF LIVER IN 5TH INTERCOSTAL SPACE
21. 21. AUSCULTATIONBREATH SOUNDS VESICUAR AND OF NORMALINTENSITY,NO ADDED SOUND,VOCALRESONANCE EQUAL ON BOTH SIDES
22. 22. INVESTIGATIONS HB------10.7 WBC ---25.110 RBC---38110 RBC DISTRIBUTION WIDTH45.5 PLATELET COUNT -----21210RED CELL INDICESHCT34.9%MCV.91.6flMCH28.1pgMCHC..30.7g/dl
23. 23. DIFFERENTIALSNEUTROPHILS89.2%LYPHOCYTES9.4% IMMATURE CELLS METAMYLOCYTES VE MYLOCYTES ------------VE PROMYLOCYTES VE BLAST CELLS -VE
24. 24. LFTS BILIRUBIN----0.8 ALT33 AST---27 ALKALINE PHOSPHATASE215 TOTAL PROTEIN 6.8 ALBUMIN---3.6
25. 25. RFTS BLOOD GLUCOSE ---100 mg/dl UREA-------23 SERUM CREATININE------0.6ELECROLYTES SODIUM------135 POTASSIUM-----3.5
26. 26. HETEROPHIL ANTIBODY TEST -VE
27. 27. URINE COMPLETE SPECIFIC GRAVITY-----1.02 PUS CELLS ---1 -2 RBCS --nil PROTEINS--------nil KETONESnil
28. 28. Call to ENT department was written regarding patientsassesmnt.ACCORDING TO THEM THERE IS NOISSUE RELATEDTO EAR NOSE AND THROATT
29. 29. CHEST X RAY ------NORMAL
30. 30. CASE SUMMARY A YOUNG BOY PRESENTED WITH ACUTE H/O FEVER ,SORE THROAT ,PAINFUL DISCRETECERVICAL LYMPH NODES IN NECK WITH NOOTHER LYMPH NODES PALPABLE AND TENDSPLEENOMEGALY.PERIPHERAL BLOOD PICTURESHOWED NEUTROPHILIA
31. 31. Question Why patient has neutrophilia? Why patient has painful spleenomegaly? What other investigations we should go for? What can be the management policy