Author: Rebecca Humphreys, Andrew Maxted, Vikram Baicher / Editor: Sarah Edwards / Codes: NepC4, RC2, SLO5 / Published: 16/12/2022
You’re working in CED where you see Patrice, a 16-day-old baby boy, who is brought in by his dad.
The father is concerned because the baby has had a bit of a runny nose and on 2 occasions there has been a small amount of streaky blood in the coryza.
Patrice was born at 39 weeks by normal delivery. Antenatal scans were normal and he has been bottle fed around 3oz of standard formula milk every 3-4 hours. He has surpassed his birth weight.
The baby has no history of fevers, rashes, vomiting or diarrhoea. He’s had no pale, floppy or unresponsive spells and has generally been a content baby.
Patrice has a 3-year-old brother, who is in good health but has a cough, cold and runny nose.
On examination the baby appears well and is interacting appropriately. His respiratory rate is 24, saturations 98% in air, heart rate 124, femoral pulses normal, chest auscultation and heart sounds normal. His umbilicus looks normal and he has a soft tummy with no masses. The baby’s tone is normal, and you witness him take a bottle feed without any issues.
The father informs you that Patrice had his vitamin K injection after birth and has not had any bleeding from anywhere else other than his nose. There is no evidence of bleeding inside the nose.
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Question 1 of 3
1. Question
What is your diagnosis at this stage?
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Question 2 of 3
2. Question
A week later, Patrice is brought back in as his eyes are very puffy. Since you last saw the baby, he has had no further nose bleeding but his eyelids have become more swollen.
Three days after his last CED attendance, GP prescribed chloramphenicol eye drops were prescribed for a presumed conjunctivitis. However, his eyes kept getting increasingly puffy.
You examine Patrice again. He still appears well in himself; however, you notice that his whole face looks quite puffy and he has oedema up to his knees.
Respiratory and cardiovascular exams are unchanged and he has no hepatomegaly.
The father is concerned about a reaction or side effect to the chloramphenicol.
You note he has 4+ protein in his urine sample.
What is your diagnosis?
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Question 3 of 3
3. Question
You reflect on Patrice’s 2 presentations and are glad that he was brought back to CED. You talk to senior colleagues and wonder if the baby’s diagnosis may have been picked up sooner, they think not.
Baby’s father is keen to understand more about his son’s diagnosis including what will happen next and what this means for Patrice’s future.
Which of the following answers best describes the next steps in investigating and managing Patrice appropriately?
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Module Content
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3 responses
I like the emphasis on how subtle the early presentation might be.
good case review
Great Revision