| | 12 Case 12 scenario (child fever)
Doorway information about patient
You will be speaking with the mother of a 1-year-old with fever
Basic differential diagnosis
. Respiratory tract infection
. Ear infection
. Exanthematous disease
. Meningitis
. Urinary tract infection
. Gastroenteritis
—————
Case 12 sim.pt. instruction
This is a telephone encounter with the doctor , who is asking you questions on the phone input the child . If the doctor asks you about anything other than these , Just say “no,” or provide an answer that a normal patient might give.
You are a 28-year-old woman who calls for evaluation of fever in your 1-year-old child
History of present illness
. Onset of fever 2 days ago
. Fever to 38.9’C (102F)
. Associated symptoms include dry cough , picking at the right ear , and vomiting ingested food without diarrhea
. Had 1 episode of rhythmic jerking in both arms , with loss of urine ; afterward was silent and irritable for few minutes an then slept
. Dose met appear drowsy or lethargic but has not been feeling well
. Acetaminophen decreases the fever to 37.2’C (99F) transiently ; tepid sponge bathes also provide some relief
. 3 year old sibling has no symptoms
. No recent travel
Review of systems
. No rash
. Passing normal yellow urine but cries while urinating
Past medical history
. No prior medical conditions , surgeries , or hospitalizations
. Full-term delivery without complications
. Breastfed until 2 months old , then changed to formula
. Able to stand , hold objects in the hand , and say “Mama” and “ Dada”
. Childhood vaccinations are up to date
. At 9-month well-child visit , was at 75 percentile for height and 60 percentile for weight
. Chile lives at home with mother , father , and 3-year-old sibling
. Medications : Acetaminophen , liquid as needed
. Allergies : None
. Parents and siblings are all healthy
—————
Case 12 sim. pt. checklist
Following the encounter , check which of the following items were performed by the examinee
History of present illness/ review of systems
. Asked about the onset and severity of fever
. Asked whether the fever is continuous or intermittent with spontaneous return to baseline
. Asked whether the fever responds to any medications
. Asked about associated symptoms , including:
- Cough
- Ear discharge
- Nasal congestion / discharge
- Pain
- vomiting and diarrhea / bowel symptoms
- Urinary symptoms
- Rash
. Asked about association with seizures (and further details including description , onset , associated incontinence or urine / bowel)
. Asked about what happened after seizure : whether the child was irritable and if any body part was paralyzed
. Asked about any exposure to infected individuals and history of travel
Past medical /family/social history
. Asked about similar episodes i the past
. Asked about current medications and allergies
. Asked about past medical issues (ear infections , convulsions, urinary tract infections),surgeries , and hospitalizations
. Asked about motor and social development
. Asked about prenatal and perinatal history
. Asked about feeling habits
. Asked about family health (especially seizures)
Counseling
. Explained the possible diagnosis
. Explained further workup
. Advised to give fluid and antipyretic
. Discussed the need for a clinic visit for examination and testing
Communication skills and professional conduct
. introduced self and greeted you warmly
. Used your name to address you
. Paid attention to what you said and maintained good eye contact
. Asked opened questions
. Asked non-leading questions
. Asked one question at a time
. Listened to what you said without interrupting me
. Used plain English rather than technical jargon
. Used appropriate transition sentences
. Expressed empathy and gave appropriate reassurances
. Asked whether you have any concerns/questions
Differential diagnosis
. Febrile seizures
. Meningitis
. Acute otitis media
. Urinary tract infection
Diagnostic study/studies
. CBC with differential count and erythrocyte sedimentation rate
. Urinalysis
. Lumber puncture
—————
Case 12 clinical summary
Clinical Skills Evaluation
Case 12 Patient Note
The following represents a typical note for this patient encounter . the detail may vary depending on the information given by the simulated patient.
History : Describe the history you just obtained form this patient . Include only information (Pertinent positives and negatives) relevant to this patient’s problem(s).
. Telephone encounter with motor of 1-yo child with 2 days of fever to 38.9’C (102F),cough , and pulling at the right ear
. 2 episodes of vomiting but no diarrhea.
. 1 episodes of vomiting but no diarrhea.
. Crying when passing yellow urine
. No lethargy
. No previous infections or hospitalizations
. No sick contacts; sibling has no symptoms
. Birth history remarkable, normal developmental milestones.
. Immunizations up to date.
ROS : No recent travel or rashes
PMHx : None
PSHx : None
Meds : Acetaminophen
Allergies : None
FHx : Parents and sibling are healthy
Physical examinations : Describe any positive and negative findings relevant to this patient’s problem(s) . be careful to include only those parts of the examination performed in this encounter.
. Not done as this is a telephone encounter
Data interpretation : Based on what you have learned from the history and physical examination, list up to 3 diagnosis that might explain this patient’s complaint(s) . List your diagnoses from most to least likely . For some cases , fewer than 3 diagnosis will be appropriate . the , enter the positive and negative findings form the history and the physical examination (if present) that support each diagnosis . Finally , list initial diagnostic (if any) you would order for each listed diagnosis (eg,restricted physical examination maneuvers, laboratory tests , imaging ECG , etc).
Diagnosis #1 : Acute otitis media
History finding(s)
. Fever
. Pulling at right ear
Physical examination finding(s)
. None
Diagnosis #2 : Urinary tract infection
History finding(s)
. Fever
. Pain with urination
Physical examination finding(s)
. None
Diagnosis #3 : Febrile seizure
History finding(s)
. Fever
. Rhythmic tremor with fever that subside
. Shaking movements while passing urine
Physical examination finding(s)
. None
Diagnostic studies
. Office visit for ear examination
. Urinalysis
. CBC with differential
| | |
|
|
|
頂端 
加到"我的最愛"
主題管理：
總固頂 
取消總固頂 
Message
查看
搜尋
通訊錄
複製
引用
回覆
2018/08/15 03:30pm 
IP: 已設定保密