Multisystem Processes & Disorders


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P9_F1.jpg"}},{"insert":"\n\n"},{"insert":"It is almost the end of April, and close to 12 months since the start of your residency.\r\n \r\nYou feel proud to have survived an entire year ....\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P9_F2.jpg"}},{"insert":"\n\n"},{"insert":"Your pager suddenly vibrates.\r\n\r\n\u0022Ugh, the ER. Must be a new admission\u0022, you think to yourself, coming back to the reality that the hard work is not over yet.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P9_F3.jpg"}},{"insert":"\n\n"},{"insert":"In the ER, the on-call physician briefs you about the patient: David, a 10-year-old African-American male accompanied by his mother, who is complaining that her child has been having abdominal pain.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P9_F4.jpg"}},{"insert":"\n\n"},{"insert":"When you see the patient yourself, he is pressing his abdomen with his hands and crying.\r\n\r\nYou try to pacify the child, while simultaneously obtaining a history from his mother.\n\nDavid\u0027s mother informs you that he has been having abdominal pain on-and-off for the past few months, but she feels that it has worsened the last few days.\r\n \r\nShe also tells you that she noticed that David has been irritable and aggressive for a few months and that she received multiple calls from his school about such behavior as well.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P9_F5.jpg"}},{"insert":"\n\n"},{"insert":"On physical examination, David appears irritable, with mild skin pallor. His mucous membranes are humid and mildly pale.\n\nOn auscultation, both lung fields sound clear and the cardiac sounds are normal. On abdominal examination, everything seems fine, except for the diffuse tenderness. The rest of the examination is unremarkable.\n\nHe weighs 36 kg (75th percentile) and his height is 139 cm (50th percentile). His vitals are as follows: temperature 36.8 \u00b0C, heart rate 97 bpm, respiratory rate 20 cycles\/min, BP 100\/70 mmHg.\n"}]}