Prepared By: Sarra'a Fawaz Abbas

Prepared by:
Sarra’a Fawaz Abbas
6th year
Case history(1)
18 ,‫ زهراء فلح ظنة‬months old,lives in Al Hilla.
She was admitted on 24/7/2009
History was taken on 29/7/2009
The case is presented with frequent bloody stools for 5 days before
admission.
The condition started 7 days before admission as high intermittent fever
associated with sweating & chills but no abnormal movement, it occurred
about 7times per day, each attack lasting for 30 minutes then subsides by
sponging & antipyrole( syrup form) to the baseline then recur about 2 hours
later, not aggravated by anything, no special time to occur.
In the evening, she started to have frequent bowl motions, of small amount,
watery,yellowish foul smelling stool, mixed with mucus but no blood
initially & the patient cried when she passed it, it occurred 6 times
daily,related to meal& it didn’t occur at night.
It was associated with 3 attacks of non projectile vomiting of small amount
of undigested food,no specific odor, no blood, not related to meal & not
associated with crying & it stopped spontaneously in the first day.
In the next day , the color of the stool became greenish then on the third day
she had fresh blood mixed with the stool (the other characteristics are as
mentioned before).
During the illness she had decreased frequency & amount of urine which
was of normal color, not associated with crying & there was no puffiness of
the face.
The patient’s feeding, activity &sleep were disturbed.
The patient was taken to a hospital in Hilla & was admitted there for 2 days
where several blood tests & stool tests were performed & she received
intravenous fluid & injections but there was no improvement in her
condition so the mother brought her to Al Kadhimya teaching hospital where
blood tests, stool examination &culture were done but no urine tests were
done.
She was given IV fluid,metronidazole & ampicillin IV , nystatin & zinc
supplement.
The general condition improved on the 2nd day of admission in terms of
feeding, sleep & activity. The blood in stool stopped on the 2nd day too but
there was no change in the frequency & the fever till now.
System review:
Respiratory system: no cough, no shortness of breath, no noisy breathing.
Cardiovascular: no edema , no cyanosis , no pallor.
Nervous system: no abnormal movement , good hearing&vision.
Locomotor: no swelling in joints, no crying during movements & no
restriction of movement .
Integumentary system: no skin rashes & no itching.
Past medical history:

No similar condition before, no history of childhood communicable
diseases, no history of chronic illnesses or atopy, no previous hospital
admissions.
Past history:
The mother G4 P2A2(both abortions occurred in the 1st trimester due to
cervical incompetence) was in good health during pregnancy.
She received regular antenatal care but she wasn’t vaccinated, she had no
fever nor rash , she didn’t receive any medications .
No history of smoking or X ray exposure during pregnancy.
The baby is a product of uncomplicated normal vaginal delivery in hospital .

She was not cyanosed at birth, cried immediately,& she was not dyspneac
after birth 7 didn’t need admission to nursery care unit.
She passed motion &urine in the 1st day of life.
The baby had jaundice in the 2nd week of life,that resolved after40 days of
life but didn’t need admission.
Developmental history:
Gross motor: the baby can walk on her own since 15 months of age.
Fine motor:
Speech:she says mama & dada.
Social: she enjoys playing with other children.
Feeding history:
The baby is on breast feeding, solid food was introduced on the 6th month of
age, & now she eats like other family members.
Vaccination history:
Full vaccination up to her age. No BCG scar.
Family history:
The mother is 35 years old ,graduate of primary school, healthy.
The father is 41 years old, graduate of secondary school. they are cousins.
1 brother 19 years old, healthy.
There are no similar illnesses in family members, no history of atopy or
chronic conditions.
Social history:
They live in an urban area.
Crowding index: 4/1.
They drink bottled water ,they have no pets .
The father is smoker.
Examination:
Respiratory rate: 44
Pulse rate:137
Temperature 37.3 by axillary method
Blood pressure: no suitable cuff.
Weight=9.5kg
Length: 77cm
Occipitofrontal circumference: 48cm
General examination:
The child is sitting comfortably in bed. She’s conscious,alert not in distress,
not dyspneac, not tachypneac,no pallor, no cyanosis, no jaundice no
clubbing, no edema, no lymphadenopathy.
Peripheral pulses are palpable, regular rhythm, good volume, no
radiofemoral delay.
Head examination:
The head is normal in size & shape, uniform , no abnormal swellings or
depressions. The fontanels are closed.
The eyes are normal in shape, equal in size, the pupils are equal in size &
reactive to light.
The ears are normal in size & shape,not low set, there’s no discharge or rash
in them.
The tongue is normal in size & shape, moves in all directions, moist,pink in
color,no rash or ulcers.
There is no cleft in lip or palate.
Neck examination:
The neck is normal in size & shape, there’s no visible pulsations or dilated
veins,no obvious swelling, no palpable lymph nodes or thyroid.
Chest examination:
Inspection:
The chest is symmetrical in shape, no obvious anomalies, no depression of
the sternum, no visible pulsations, no scars, moves regularly with
respiration, no intercostals muscle recessions.
Palpation:
No palpable masses or tenderness. The trachea is central in position. The
apex beat is located in 5th intercostals space, midclavicular line. Chest
expansion is symmetrical. Vocal fremitus is symmetrical.
No palpable pulsations.
Percussion:
Resonant percussion notes allover the chest. Liver dullness starts in the fifth
intercostal space.
Auscultation:
Good air entry, harsh vesicular breathing, no added sounds, vocal resonance
is present & equal allover the chest.
The heart has normal double rhythm, no added sounds or murmurs.
Abdominal examination:
Inspection:
The abdomen is flat, symmetrical, moves regularly with respiration. There
are no visible swellings, peristalsis or pulsations or distended veins.
The umbilicus is inverted ,normal in position.
Hernial orifices: no visible swelling, cough reflex not done.
Palpation:
The abdomen is soft, no superficial masses or tenderness.
No organomegally.
Percussion:
No shifting dullness or transmitted thrill.
Auscultation:
Bowl sounds are regular, not exaggerated or diminished. No murmurs over
the loin.
Genitalia & anus:

The genitalia are normal in size & shape. No discharge.
The anus is normal in location, size & shape, patent. No fissure,no
hemorrhoids,no rectal prolapse.
Neurological examination:
The child is conscious, alert.
Cranial nerve examination:all cranial nerves are normal bilaterally.

Motor system:
No abnormal movements, no muscular atrophy or hypertrophy.
Normal tone & strength in both upper & lower limbs.
Coordination could not be tested.
Deep tendon reflexes are present, not diminished or exaggerated &
symmetrical.
Flexor plantar response.
Differential diagnosis:
Amoebic dysentery.
Shigellosis.
Enterohemorrhagic E.coli infection.
Investigations:
General stool examination & culture, general urine examination & culture,
renal function test & serum electrolytes(to check hydration state).
Case 27 months old male, lives in al Doul’ae. The history is taken from his
mother.
Admitted on 29/7/2009
History taken at 30/7/2009
Presented with visible bulging of the anterior part of the head of 2 day
duration.
The case started 3 days before admission as mild intermittent fever with
runny nose & itching in both ears. The fever gradually progressed in severity
to disturb the baby’s sleep. The frequency was 4-5 times daily, mostly at
night, it would last for about an hour, then relieved by sponging &
antipyrole syrup. it was associated with sweating but no chills, no abnormal
movements & no vomiting . there was no associated cough, no shortness of
breath, no sneezing & no abnormal respiratory sounds.
The baby was taken to public clinic where he was given antipyrole syrup &
an injectable form of medication.
On the 2nd day , the mother noticed a tense bulging in the anterior part of the
head that increased gradually in size & increased during crying.
His activity, feeding & bowl motion were not disturbed.
The mother took the baby to a private clinic where she was advised to take
him to hospital.
In the hospital, blood tests & culture ,general urine examination & culture,
general stool examination, chestX ray & lumbar puncture were done to him.
He was given IV fluid,antipyrole syrup & injectable forms of medications.
Now his sleep & fever improved but the bulge is the same.
System review:
Gastrointestinal system:no change in bowl frequency, no vomiting, no
crying with defecation no blood with the stool.
Urinary system:no change in frequency or amount or color of urine, no
crying while passing urine, no puffiness of the face.
Cardiovascular: no edema , no cyanosis , no pallor.
Nervous system: no abnormal movement , good hearing&vision.
Locomotor: no swelling in joints, no crying during movements & no
restriction of movement .
Integumentary system: no skin rashes & no itching.

No similar condition before, no history of childhood communicable
diseases, no history of chronic illnesses or atopy, no previous hospital
admissions.
Past history:
The mother G2 P2A0was in good health during pregnancy.
She received regular antenatal care & was vaccinated during pregnancy, she
had no fever nor rash , she didn’t receive any medications .
No history of smoking or X ray exposure during pregnancy.
The baby is a product of cesarean section due to 10 days postmaturity.

He was not cyanosed at birth, cried immediately,& he was not dyspneac
after birth &didn’t need admission to nursery care unit.
He passed motion &urine in the 1st day of life.
The baby had jaundice in the 2nd day of life,that resolved after4 days &
didn’t need admission.
Gross motor: the baby can sit with support.
Fine motor: he can grasp objects.
Speech: he says ma & da only.
Social: he cries when his mother is gone.
Feeding history:
The baby is on bottle feeding he receives about 7 feeds/day each with 5 oz.,
good preparation but poor sterilization., solid food was introduced on the 6th
month of age.
Full vaccination up to his age. BCG scar is present.
Family history:
The mother is 28years old ,graduate of secondary school, healthy.
The father is 31 years old, graduate of trading colledge.They are not
relatives.
1 brother 4 years old, healthy.
There are no similar illnesses in family members, no history of chronic
conditions.
They have a history of atopy in 2nd degree relatives.
Social history:
They live in an urban area.
They drink filtered tap water ,they have 2 hens .
Examination:
Pulse rate:135
Temperature 37 by axillary method
Head circumference:43 cm
Weight: 6.5 kg
Length 68 cm
The child is sitting comfortably in bed. He’s conscious,alert not in distress,
radiofemoral delay.
Head examination:
The head is normal in size & shape, uniform. The anterior fontanel is tense
& bulging measuring 2*2cm.
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
Palpation:
Percussion:
intercostal space.
Auscultation:
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:


Motor system:
symmetrical.
Superficial & deep sensations are normal.
Meningitis, hypervitaminosis D or A.
Investigations:
Lumbar puncture & CSF examination & culture, complete blood count &
blood culture, general urine examination & culture.
Case3
‫زينب علي حسين‬
Resident of ‫سبع البور‬
She’s 7 years old
Admitted on 26/7/2009history taken on 27/7/2009
She’s presented with increased frequency & amount of urination of 1
week duration.
The case started a week ago as increase in frequency of urination from 3
times/day & once at night to 10 times/day &3 times/night associated with
urgency, burning sensation & bed wetting( she was previously continent).
The urine was of large amount,bad odor & normal color.
The condition was associated with mild continuous loin pain on both sides
not radiated to any area, no aggravating or relieving factor, no special time
to occur , the character couldn’t be described by the patient.
3 days later she developed puffiness around her eyes.
The condition was associated with increased thirst& appetite & decrease in
the weight & activity of the child& disturbed sleep but bowl habit was not
disturbed.
No associated fever.
On admission several blood tests & urine tests & culture were done.
She was given IV fluid & injections& subcutaneous insulin injections.
Now her activity & sleep improved, the frequency of urination dropped to 7
times/day& 2 times/night.
System review:
abdominal pain,no blood with the stool.
Respiratory system:no shortness of breath, no cough, no chest pain,no
abnormal respiratory sounds.
Cardiovascular: no edema , no cyanosis , no pallor, no palpitation.
Nervous system: no headache, no abnormal movement , good
hearing&vision.
Locomotor: no swelling in joints, no restriction of movement .
Integumentary system: no skin rashes,there is vulval itching.

No similar condition before.
The patient had measles last year & chicken pox at3 years of age but no
previous hospital admissions.
No history of chronic illnesses or atopy.
Past history:
The mother G6 P4A2was in good health during pregnancy.
She received regular antenatal care & was vaccinated during pregnancy, she
had no fever nor rash , she didn’t receive any medications .
The mother is a smoker.
No X ray exposure during pregnancy.
The child is a product of normal vaginal delivery at home.

She was not cyanosed at birth, cried immediately,& she was not dyspneac
after birth.
The child passed motion &urine in the 1st day of life.
The child had jaundice in the 2nd day of life,that resolved after4 days &
The patient has good school performance.
Feeding history:
The patient was bottle fed, now she eats various food items.
Full vaccination up to her age. BCG scar is present.
Family history:
The mother is 38years old ,graduate of primary school, healthy.
The father is 31 years old, graduate of primary school. They are relatives.
.
There are no similar illnesses in family members, no history of chronic
conditions.
They have no history of atopy .
Social history:
They live in rural area.
They drink wel water ,they have no pets .
The mother is smoker.
Examination:
Pulse rate:102
Weight: 22 kg
Height 127 cm
radiofemoral delay.
Head examination:
depressions.
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
Palpation:
Percussion:
intercostal space.
Auscultation:
Good air entry, vesicular breathing, no added sounds, vocal resonance is
present & equal allover the chest.
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:

The child is conscious, alert, has normal memory,fluent speech, oriented.

Motor system:
Coordination is good bilaterally.
symmetrical.
Diabetes mellitus, urinary tract infection, diabetes insipidus, psychogenic
polydypsia.
Investigations:
General urine examination & culture,urine&blood glucose,serum
electrolytes &renal function test.
Case4
‫علي حيدر عبد‬
Resident of ‫التاجي‬
4.5 years old
Admitted on 1/8/2009 History taken on3/8/2009
He was presented with cough of 3 day duration before admission.
The case started 6 days before admission as repeated sneezing & runny nose,
then 2 days later the child developed mild intermittent fever that occurred
mostly at night, lasts about 2 hours & recur each 4 hours, it was associated
with chills & feeling cold, but not associated with sweating nor abnormal
movements.it was relieved by antipyrole syrup & suppositories.
The family gave him IM injections twice daily for 4days without consulting
a doctor.
2days later, the child developed mild dry intermittent cough, that occurred
mostly during day time, about 3 episodes a day & each episode lasted about
1minute ,no aggravating or relieving factors .
The cough gradually increased in frequency & severity.
On the day of admission the cough became worse, it came in paroxysms that
lasted about 15 minutes & returned after about an hour.it became associated
with shortness of breath & redness of the face but no cyanosis, no abnormal
sounds & not followed by vomiting .
The child’s feeding, activity & sleep were disturbed during the illness but
his bowl motion was not changed.
On admission to the hospital, chest X ray, blood tests & culture, & general
urine analysis were done to the patient & he was given IV fluid & injections,
inhaler & 3medications in syrup form.
His appetite,sleep,activity improved on the second day of admission.
Fever subsided.the cough improved in frequency & severity since the second
day of admission.
System review:
abdominal pain,no blood with the stool.
Urinary system:no change in frequency or amount of urine, no dysuria, no
change in urine color,no blood with urine,no puffiness of the face.
Cardiovascular: no edema , no cyanosis , no pallor, no palpitation.
Nervous system: no headache, no abnormal movement , good
hearing&vision.
Integumentary system: no skin rashes,no itching.

The patient was admitted to hospital for tonsillectomy 1 year ago. He had
chicken pox at3 years of age. He was admitted for meningitis at 2.5 years,
however he had no complication of meningitis.
No history of chronic illnesses or atopy.
Past history:
The mother isG5 P5A0 .
She received no antenatal care & no vaccination
She had fever& urinary tract infection in the third trimester, she received
oral medication for it.
No hypertension or diabetes during pregnancy.
She was exposed to smoke from her husband during pregnancy.
No X ray exposure during pregnancy.
The child is a product of normal vaginal delivery at home.His birth weight

was3.5 Kg.
He was not cyanosed at birth, cried immediately,& he was not dyspneac
after birth.
The child passed motion &urine in the 1st day of life.
The child had jaundice in the 2nd day of life,that resolved after4 days &
He can ride a tricycle,he dresses himself & buttons his clothes, he plays with
other children.
Feeding history:
The patient was breast fed,now he eats various food items.
The child received vaccination up to 9 months of age. BCG scar is present.
Family history:
The mother is 32years old ,graduate of primary school, healthy.
The father is 35 years old, graduate of secondary school.They are relatives.
The father is asthmatic.
There are no similar illnesses in family members.
Social history:
Crowding index =7/2.
They drink tap water ,they have no pets .
Examination:
Pulse rate:118
Weight: 7 kg
Height 103 cm
Head circumference: 51cm
The child is sitting comfortably in bed.He’s conscious,alert not in distress,
radiofemoral delay.
Head examination:
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
Palpation:
Percussion:
intercostal space.
Auscultation:
Good air entry, harsh vesicular breathing, there is bilateral expiratory
rhonchi all over the chest, vocal resonance is present & equal allover the
chest.
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:


Motor system:
symmetrical.
Bronchitis, pneumonia, whooping cough, asthma.
Investigations:
Chest X ray, complete blood count & differentials.
Case 5
‫منة ال سعد احمد‬
5days old female,resident of ‫حي العامل‬
Date of admission 11/8/2009 history was taken on 13/8/2009
Chief complaint: abnormal movements of the upper limbs 6 hours before
admission.
The baby is product of emergency cesarean section at term of G1P1A0
mother due to decreased fetal movements.
She weighed 2Kg at birth, she was not cyanosed & didn’t have shortness of
breath, she cried immediately.
She was kept in the nursery care unit for 1 day under observation, during
that day an attempt to feed her milk by teaspoon was done by her aunt but
the baby vomited the milk shortly after(non projectile).
She passed motion & urine on the first day of life.
On the second day she was discharged from hospital.
She was bottle fed , she received 1/2oz in the morning &1/2 oz at night,
there was no vomiting.
On the third day of life she was fed 1/2oz in the morning.
Then at about11 a.m. the baby started to have blinking of her eyes with
shaking of both upper limbs associated with abnormal sound that resembled
moaning & protrusion of the tongue with drooling of saliva from he whole
mouth & she became cyanosed during the fit. there was no passage of urine
or stool during it.
It lasted for about a minute followed by opening of the eye & the baby was
normal after that.
30 minutes later the fit recurred in the same manner . it occurred 4 times
before the baby was brought to hospital.
During that time no attempts were done for feeding her, her activity between
attacks decreased ,she didn’t pass motion, she had no fever.
In the hospital, serial blood tests & urine tests were done, they revealed low
blood glucose ,she was given IV fluid & IV injections.
Her activity improved on the second day of admission. she sleeps well , she
passed motion. Now she’s receiving ½ oz every 2hours, each feed lasting for
30 minutes (poor sterilization). The fit subsided.
During pregnancy, the mother had regular antenatal care ,she received
vaccination & was healthy in 1st & 2nd trimesters, no fever ,no rash, no
medications & no X ray.
In the 3rd trimester she developed hypertension & was put on methyl dopa.
She had fever & urinary tract infection on the 7th month of pregnancy & she
took oral medications for it.
She had rupture of the membrane & leaking liquor for 2 days before delivery
but it was not associated with fever.
System review:
blood with the stool, no jaundice.
Urinary system:no change in frequency or amount of urine, no change in
urine color,no blood with urine,no puffiness of the face.
Respiratory system:no shortness of breath, no cough, no audible sounds
with breathing.
Cardiovascular: no edema , no pallor.
Nervous system: good hearing&vision.
Family history:
The father is 35 years old, graduate of secondary school.They are not
relatives.
Both are healthy.
There are no similar illnesses in family members.
Social history:
Examination:
Heart rate:130
OFC=31 cm below 5th centile
Length= 48 cm at the 25th centile
Weight 2.750 Kg between the 10th &25th centile
The child is sleeping comfortably in bed. She’s conscious,alert not in
distress, not dyspneac, not tachypneac,no pallor, no jaundice no cyanosis, no
radiofemoral delay.
Head examination:
depressions. The anterior fontanel is 2.5*2.5 cm,the posterior fontanel is in
the size of fingertip.
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
Palpation:
Percussion:
intercostal space.
Auscultation:
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:


Motor system:
symmetrical.
Hypoglycemia, hypocalcemia, congenital infection, sepsis, hypoxic ischemic
encephalopathy, birth trauma, congenital anomalies.
Investigations:
Blood sugar, serum calcium, blood culture, general urine examination &
culture, brain ultrasound.
Case6
‫نرجس ايهاب مهدي‬
Resident of ‫السيدية‬, she’s 2days old.
She was admitted on 16/8/2009.history was taken on 17/8/2009.
Chief complaint: shortness of breath since birth.
Full term baby is a product of emergency cesarean section (at a private
hospital at 10 p.m.)of G2p2A0 mother due to breech presentation
She was short o breath since birth with rapid respiration & grunting & bluish
discoloration of the extremities & crying was delayed for about 30 minutes.
However there was no associated fever or abnormal movements.
She received resuscitation & Oxygen therapy & the cyanosis was relieved&
she was admitted to the nursery care unit.
In the morning she was brought to al-Kadhimya teaching hospital where
blood tests & culture & a chest X ray were done to her.
She received oxygen therapy, IV fluid & IV injections twice daily.
She passed motion & urine on the 2nd day of life.
She’s put only on IV fluid, oral feeding is not allowed by doctors.
Sleep is good & she cries wel.
Grunting & cyanosis improved but she still has rapid respiration.
During pregnancy the mother was healthy in the 1st& 2nd trimesters, she had
no fever, no rash,no medications,noX ray exposure, she had regular
antenatal care visits & took vaccinations.
She had urinary tract infection on the 7th month of pregnancy & she took IM
injections for it.
5days before delivery,she had diarrhea & colicky pain & she took tablet
form of medication for it.
System review:
Gastrointestinal system:the baby vomited twice of small amount of frothy
material with brown streaks, non-projectile,not associated with blood ,no
blood with the stool,no jaundice.
Urinary system:no change in frequency or amount of urine, no change in
urine color,no blood with urine,no puffiness of the face.
Nervous system: no abnormal movements, good hearing&vision.
Family history:
The father is 32 years old, graduate of secondary school.They are not
relatives.
Both are healthy.
1sister 2years old,she had o similar condition at birth.
There’s no family history of atopy or chronic illnesses.
Social history:
Examination:
Respiratory rate:70
Heart rate:140
OFC=31.5 cm below 5th centile
Length= 46 cm between 5th & 10th centiles
Weight:3 kg between the 10th &25th centile
The child looks in distress, dyspneac, tachypneac,no pallor, there is
peripheral cyanosis, no jaundice ,no edema, no lymphadenopathy.
radiofemoral delay.
Head examination:
depressions The anterior fontanel is 2.5*2 cm,the posterior fontanel is in the
size of fingertip.
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
The chest is symmetrical in shape,there’s central depression of the sternum,
no visible pulsations, no scars, moves regularly with respiration, there’s
intercostals &subcostal muscle recessions.
Palpation:
Percussion:
intercostal space.
Auscultation:
Poor air entry, harsh vesicular breathing, no added sounds, vocal resonance
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:


Motor system:
symmetrical.
Transient tachypnea of the newborn, amniotic fluid aspiration, meconium
aspiration, sepsis, respiratory distress syndrome, congenital anomalies,
hypoglycemia.
Investigations:
Chest X ray, blood sugar,complete blood count, blood culture, urine culture.
Case 7
‫حنين فلح حسن‬
10 days old,resident of ‫الغزالية‬, blood group of the baby & mother B+ve.
She was admitted on 17/8/2009. history was taken on 18/8/2009
Chief complaint:yellowish discoloration of skin & mucous membranes of
8days before admission.
Full term baby is product of uncomplicated normal vaginal delivery at home
of G4P4A0 mother.
She wasn’t weighed at birth.
She cried immediately after delivery,she was not cyanosed, not short of
breath after delivery, she was breast fed 1hour after delivery & breast
feeding continued by the mother on the need of the baby, each feed lasting
about 20minutes on both sides.
She passed motion & urine in the 1st day.
In the 2nd day the mother noticed yellowish discoloration of the face that
progressed gradually to cover all the body during the next 6days.
The baby’s feeding, activity, sleep were not disturbed but the mother noticed
that the stool became paler & the urine became darker than before. there was
no associated fever.
On the 7th day, the baby was taken to primary health care centre where
hospital admission was advised.
On admission to hospital, blood tests were done & the baby was put under
phototherapy. No exchange transfusion was done.
No improvement of discoloration was noticed till now.
No vaccinations were given till now.
During pregnancy, the mother had no antenatal care visits, no vaccinations
she had fever in the4th month of pregnancy & she took medication for it, she
had no rash.
She had no diabetes, no hypertension .
System review:
Gastrointestinal system:the baby has good sucking, she vomited twice on
the 3rd &4thdays of life of small amount of clotted milk, projectile,not
associated with blood ,no blood with the stool, the baby cries during
defecation.
Urinary system:no change in frequency or amount of urine, no crying
during urination, no blood with urine,no puffiness of the face.
Respiratory system:no shortness of breath, no cough, no audible sounds
with breathing.
Family history:
The father is 28 years old, graduate of primary school.They are not relatives.
Both are healthy.
2 brothers &1sister ,all healthy, none of them had a similar condition.
There’s no family history of hemolytic anemias,atopy or chronic illnesses.
Social history:
Examination:
Respiratory rate:50
Heart rate:140
OFC=33 cm on the 5th centile
Length= 50 cm on the 50th centile
Weight=2.750Kg between the 10th &25th centile
The child is lying comfortably in bed. She’s conscious,alert not in distress,
not dyspneac, not tachypneac,no pallor, no cyanosis, no clubbing, no edema,
no lymphadenopathy.
The body & sclera are yellowish in color.
radiofemoral delay.
Head examination:
depressions The anterior fontanel is 2*2 cm,the posterior fontanel is in the
size of fingertip.
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
Palpation:
Percussion:
intercostal space.
Auscultation:
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:


Motor system:
symmetrical.
Prolonged physiological jaundice, breast feeding jaundice, hereditary
hemolytic anemias, sepsis.
Investigations:
Total serum bilirubin, packed cell volume, blood group of the baby &
mother, blood film, retic count, blood culture.
Case8
‫مصطفى ناظم طالب‬
7days old male,resident of ‫التاجي‬
Blood group of the baby & the mother O+ve
He was admitted on 19/8/2009.history was taken on 24/8/2009.
Chief complaint: shortness of breath since birth.
The baby is product of normal vaginal delivery at home of G5P4A1(abortion
in 1st trimester with no obvious cause) mother. Gestational age at delivery
was32 weeks.
The delivery was smooth & no analgesics were taken by the mother.
The baby was not cyanosed at birth,& he cried immediately.
Few minutes later he developed shortness of breath,grunting & an hour later
bluish discoloration of face & extremities. He has no fever & no abnormal
movements.
He was brought immediately to the hospital where he was put on oxygen
therapy immediately & blood & urine tests & chestX ray were done to him.
He was also given IV fluid & injections & put in incubator.
Cyanosis was relieved on oxygen therapy & his shortness of breath
improved but didn’t disappear yet.
Oral feeding is not allowed yet.
No vaccinations were given yet.
The baby passed urine& motion on the 1st day of life.
He passed motion on the 2nd &3rd days of life.
He has good activity & sleep now.
During pregnancy,the mother had no antenatal care,no vaccinations.
She had no diabetes or hypertension.
She had fever in the 5th month of pregnancy but no rash, she had urinary
tract infection in the 7th month of pregnancy that was treated by oral
medications.
No X ray exposure.The husband is smoker.
System review:
Gastrointestinal system:the baby vomited twice on the 3rd &4thdays of life
of small amount of brownish material,non projectile,not associated with
blood ,no blood with the stool,no crying during defecation.
The baby had jaundice on the 2nd day of life,put under phototherapy on the
3rd day, no exchange transfusion needed. The baby improved &
phototherapy was removed on the 6th day.
Urinary system:no change in frequency or amount of urine, no crying
during urination, no blood with urine,no puffiness of the face.
Family history:
The mother is 25years old ,poor education.
The father is 27 years old, poor education.They are relatives.
Both are healthy.
3sisters ,all healthy, none of them had a similar condition.
There’s family history of atopy, diabetes,hypertension in 2nd degree
relatives.
Social history:
Examination:
Respiratory rate:67
Heart rate:140
OFC=30.5 cm below 5th centile
Length= 47 cm between 10th &25th centiles
Weight= 1.750kg below 5th centile
not dyspneac, not tachypneac,no pallor,no jaundice, no cyanosis, no
radiofemoral delay.
Head examination:
reactive to light.
in them.
Neck examination:
Chest examination:
Inspection:
Palpation:
Percussion:
intercostal space.
Auscultation:
Inspection:
Palpation:
No organomegally.
Percussion:
Auscultation:
the loin.
Genitalia & anus:


Motor system:
symmetrical.
Respiratory distress syndrome, sepsis, meconeum or amniotic fluid
aspiration, diaphragmatic hernia, cyanotic congenital heart disease,
hypoglycemia.
Investigations:
Chest X ray, blood glucose, blood culture, complete blood count.

Prepared By: Sarra'a Fawaz Abbas

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Prepared By: Sarra'a Fawaz Abbas

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Prepared by:

Sarra’a Fawaz Abbas

Past medical history:

The baby is a product of uncomplicated normal vaginal delivery in hospital .

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Past medical history:

The baby is a product of cesarean section due to 10 days postmaturity.

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Past medical history:

The child is a product of normal vaginal delivery at home.

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Past medical history:

The child is a product of normal vaginal delivery at home.His birth weight

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

Genitalia & anus:

Cranial nerve examination:all cranial nerves are normal bilaterally.

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