Department of Pediatrics

Doc. Quidato group

Ravi Arun
Ravi nagalakshmi
Ravi Keerthi vasani
Ravi Raju kumar
 General Data
• Name: Mr.P

• Sex: Male

• Age: 08 months

• D.O.B: 03 AUG 2018

• Address: Buhangin, Davao City

• Religious: Catholic
 General Data

• Date of Admission: 15 April 2019

• Date of interview: 15 April 2019

• Informant: Mother

• Reliability: 95%
 Chief Complaint
• FEVER - 3 days
 History of Present Illness

• 3 day PTA - High Grade Fever (39.80 C)

• Self Medication – Paracetamal (calpal)

100mg/1ml for 3days

• During Admission – Fever was low grade

(38.90C)
History of Present Illness

• Onset: 3 Days

• Duration: Continuous

• Characteristics: Intermittent

• No Aggravating and Alleviating Factor

• Timing: Day and Night

 History of Present Illness

• Associated symptoms – Convulsion

• A convulsion is a medical condition

where body muscles contract and relax
rapidly and repeatedly, resulting in an
uncontrolled shaking of the body.

• Also Known as Seizure!!!

 Past Medical History

Illness:
• Pneumonia:

Age: At 2nd month

Date: OCT 2018 for 3 days

Hospital: SPH, Davao city

 Past Medical History

Allergies:
NO ALLERGY

Medication:
Self Medication: Paracetamal (calpol)
100mg/1ml for 3days
 Past Medical History
Other:
No cold

No cough

No Diarrhoea

No Vomiting

No sweating
 Family History
• Illness:
 Paternal
 Hypertension

 Maternal
Asthma (at age of 9)

Cancer in Paternal Side

Birth & Pregnancy History
• Maternal:
Well Nourished and menarche at 13 yr old
OB score: G1P1A0
Normal prenatal check up

• Pregnancy:
Duration: 9 ½ month (38wks)
TERM baby born at 38th wk
Birth & Pregnancy History
• Labor & Delivery:
Normal Labor
Delivery: NSVD
NO post partum hemorrhage

• Neonatal:
Pinkish skin and Crying normally at birth
weight: 3kg (Normal)
 Growth and Development
At 8th month

• Fine motor: Thumb finger Grasp

• Communication and language: follows

1-step command with gesture

• Cognitive: Bangs 2 cubes, uncover toy

(after seeing it hidden)

• Parachute reflex - present

Growth and Development
• Behavior:
Rolls over, Crawls
Lift head
Sits briefly
Transfer object hand to hand
 enjoy mirror
Responds to change in emotional content
of social contact
Growth and Development
• Chart
Growth and Development
• Chart
 Immunization
Vaccine Dose Month

BCG 1 At birth

HEP - B 1 At birth

Rotarix 2 2mon, 4mon

Polio 3 3mon, 5mon, 7mon

DPT 3 3mon, 5mon, 7mon

*All above vaccine was taken in local health center

 Diet & Nutritional History

• Breast feeding – 3 time a day (from bith to

till)

• Complementary feeding – cerelac ( from

6th month)
Personal & Social History

• Father – Auto mechanic

• Mother – house wife

 Environmental History
• Clean house

• Well ventilated & non polluted

surrounding

• Father – smoking (1 pack) and drink

alcohol (occasionally)
 REVIEW OF SYSTEM

• General: with fever

• Skin: with rash

• Neurological system: with episodic

neurological symptoms
 Physical Examination

• General: Aware, alert & irritable mood

and good hygiene

• Length: 65 cm

• Height: 6.8 kg
 Physical Examination

• Head circumference: 45 cm

• Temperature: 37.50C

• Respiratory Rate: 38

• Heart Rate:129 BPM

 Physical Examination
Skin :
• soft warm to touch
• no lesions noted.
HEENT :
• Head
• Ear
• Eye
• Nose
• throat
 Physical Examination
Chest and lungs :
• I
• P
• P
• A
• Cardiovascular :
• I
• P
• P
• A
 Physical Examination
Abdomen :
• I
• A
• P
• P
Extremities:
• I : rashes in hands , no scars and
deformities.
• P : warm to touch
Physical Examination

Neurological:

• Normal sensory & motor response and reflex

• Hyper flextion and extension of leg and arm in

some time - seizure
 Physical Examination
Cranial nerves :

• CN I : olfactory nerve –Difficult to accessed in

infant

• CN II: pupils are round and equally reactive to

light. (optic blink reflex)

• CN III, IV, VI: Intact extra ocular movements of

eye (Doll eye maneuver)

• CN V: Normal Mastication and sensation of face

 Physical Examination
• CN VII: no facial asymmetry noted. Normal
facial expression

• CN VIII: Hearing intact ( blink eye in loud

sound)

• CN IX & CN X: Normal swallowing and

GAG reflex

• CN XI: Head Movement intact

• CN XII: Tongue Movement intact

 Differential diagnosis
• Febrile seizure – generalized simple

• Infantile Spasms

• meningitis
 Differential diagnosis
• Febrile Seizure:
Rule in Rule out

Fever No Family history

8th month

Seizure

irritablity

Hyper active (convulsion)

 Differential diagnosis
• Infantile Spasms – inc. corticotropin
Releasing Factor
Rule in Rule out

Fever EEG: Hypsarrthymia

8th month

Seizure

irritablity

Hyper active (convulsion)

 Differential diagnosis
• meningitis
Rule in Rule out
No
Fever Neck rigidity

8th month CSF culture

Seizure Brudzinski's and Kernig's sign

irritablity

Hyper active (convulsion)

 Impression
Generalized simple seizure
Generalized simple seizure
THANK YOU