Pathology notes

Apr 16th, 2015
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GRAND ROUNDS22nd February, 2006Dr. N. SinghDr. O. IngaramoDr. S. ManuelHISTORY OF PRESENTILLNESSAn 8 m old boy was brought to the ER with ahistory of several episodes of epistaxis overthe last 12 hrs.The mother was also concerned about somescattered bruising on her sons forehead,occiput, elbows and flanks over the last 10days.DEVELOPMENT HISTORYSitting by himself, crawling, in walker.Imm HX: Delayed needs 6 mo vaccinations.PM Hx: 1. Enterococcal Meningitis @birth2. ALTE at 1 mo of age cyanoticepisode at home, apneas noticed duringhospitalization.FAMILY AND SOCIAL HISTORYNo h/o bleeding disorders.Single mother, lives with boyfriend in a trailerpark.No h/o substance abuse.Primary caretaker is mother.Infant also spends time in a daycare and withfather of boyfriend (esophageal cancer).PHYSICAL EXAMAfebrile, normal vital signs.Wt: 5th percentile; Length: 10th percentile; HC: 25thpercentile. Alert, interactive and in no distressHEENT: With some dried blood in nares.Neck: No Lymph nodes palpable.Chest: CTA B/LCVS-No murmurPHYSICAL EXAMAbd - No HSM (hepatosplenomegaly), Nomasses.Ext: FROM, No swelling in joints.Skin: Several areas of green-yellow areas ofbruising on the forehead, occiput, elbows andflanks.SUMMARYAn 8 m old boy with epistaxis over the last12 hrs.Bruising on forehead, occiput, elbows andflanks over the last 10 days.Enterococcal Meningitis @ birthALTE at 1 mo of age cyanotic episode athom

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