Case Conference February 1, 2011 Geronimo RE, Go CM, Go CK, Go F, Go MR

JOP, 4 y/o, male CC: ANAL PRURITUS

History of Present Illness 3 Days Pruritus in anal region – at night No consult, no medications 1 Day Persistence of symptoms – awakened him at night CONSULT

Review of Systems General: No fever, no weight loss Skin: No rashes Respiratory: No dyspnea, no cough Cardiovascular: No chest pain Gastrointestinal: No abdominal pain, no diarrhea, no constipation Musculoskeletal: No limitation of movements Genitourinary: No dysuria, no hematuria Endocrine: No heat/cold intolerance Hematologic: No bleeding tendencies Nervous: No seizures

Developmental History At par with developmental age Emergence of primary teeth No incontinence, toilet trained, no head banging, phobias, night terrors, sleep disturbances

24 Hour Food Recall 1 serving of biscuit 1 serving of bread breakfast 1 servings of rice 1 serving of vegetables lunch none Snack 1 serving of chicken 2 serving of rice Dinner

Recommended Energy & Nutrient Intake CHOCHONFATCalories 1 servings of chicken servings of rice serving of biscuit serving of bread serving of vegetables TOTAL51 gms CHON985 kcal

Immunization Unrecalled Claimed to be complete

Past Medical History Parasitic infection – 3 y/o – Unrecalled medication – Local health center

Family Profile and History MemberAge/SexEducational Attainment OccupationHealth Status Father28/M2nd yr CollegeMerchandiserHealthy Mother25/FHigh SchoolHousewifeHealthy Sibling6/FKindergartenStudentHealthy Primary caregiver – mother Lives with – both parents and sister (-) HTN, DM, asthma, cancer, thyroid problems, blood dyscrasias, allergies

Socioeconomic and Environmental History House - concrete, well lit, well ventilated Pets - 53 pigeons There are no factories nearby Exposed to cigarette smoke - father Drinking water - water station Garbage collection – 1/week, not segregated

Physical Examination Awake, alert, ambulatory, not in cardiorespiratory distress, well nourished, well hydrated BP: 110/70 mmHg PR: 100 bpm RR: 26 cpm Temp: 36.5 C Wt: 15.9kg ( 0 = normal) Ht: 103cm (above +3 = tall) BMI: 17 (below -1 = normal) Wt for ht: z score: 0 (normal)

Physical Examination Warm, moist, good turgor, no blanching, no petichae, no rashes, no active dermatoses Normocephalic, black hair, fine texture, no nits/lice Pink palpebral conjunctiva, pupils 3-4 mm ERTL, EOMs full and equal

Physical Examination No tragal tenderness, no aural discharge, (+) retained cerumen AU, nonhyperemic external auditory canal, tympanic membrane intact Nasal septum midline, no nasal discharge, non hyperemic nasal mucosa, turbinates not congested, (+) nasal discharge Moist buccal mucosa, no lesions, non hyperemic posterior pharyngeal wall, tonsils not enlarged, (+) dental carries

Physical Examination Supple neck, no palpable cervical lymph nodes, thyroid gland not enlarged Symmetrical chest expansion, no retractions, clear breath sounds Adynamic precordium, apex beat at the 5 th LICS MCL, no murmurs Flabby abdomen, normoactive bowel sounds, soft, no masses, no tenderness Pulses full & equal, capillary refill <2 sec, no cyanosis, no edema (+) hyperemic anal region

Assessment t/c Enterobiasis, dental carries

Management Done For scotch tape swab Diet for age Refer to dental services Multivitamins 5ml once a day Update immunizations (BCG booster) Anticipatory guidance TCB w/ results

Follow up (after 6 days) Scotch tape swab – positive for enterobius vermicularis ova Assessment – Enterobius Vermicularis Parasitism Plans – Praziquantel pamoate 125mg/5ml, give 7 ml once then after 2 weeks