Case Studies in Immunology PDF

Case Studies in Immunology 1 Case 1 2 Case 1: Information  A 2-year-old boy presents with a fever, cough and irritability for the past day http://www.raestern.com/stressduetoasickchild.php 3 Case 1: History of Present Illness What more would you like to know about the HPI?  What does the cough sou...

Case Studies in Immunology 1 Case 1 2 Case 1: Information  A 2-year-old boy presents with a fever, cough and irritability for the past day http://www.raestern.com/stressduetoasickchild.php 3 Case 1: History of Present Illness What more would you like to know about the HPI?  What does the cough sound like?  ◦ Dry, wet, hacking, wheezing…  How is his appetite?  Past medical history ◦ Infections, what kind, treatment/resolution Allergies (medications, environmental)  Environment (pets, daycare…)  Siblings & their medical history  4 Case 1: History of Present Illness  Max temperature was 103o F (auricular) ◦ What is the normal temp for a 2-yr-old? Temperature did reduce to 99 with ibuprofen  Cough sounds wet  Parents can hear “rattling” in the chest  Child is eating and drinking less than usual  Child is sleeping more than usual  Did not try any medications other than the ibuprofen  Has had “something like this” before  5 Case 1: Past Medical History First respiratory infection at 6-months-ofage  He has had several bacterial infections in the past  ◦ Sinusitis ◦ Otitis media https://thenativeantigencompany.com/wp-content/uploads/2019/08/shutterstock_754722076.jpg 6 Case 1: Allergies https://www.smartpractice.com/shop/wa/style?id=OELB0645&m=SPD&cid=406060 7 Case 1: Family History Both parents alive and well  One sister, age 4, alive and well  Maternal uncle with similar health problems  8 Case 1: Home Environment No smokers in the household  No pets in the house  Stays at home with nanny  9 Case 1: Physical Exam Findings Temp: 103o F by ear [98.6-100.3]  Pulse: 160 [90-150] bpm  Respirations: 34 [22-30] rpm  Absent tonsils  ◦ What might this indicate?  No lymphadenopathy 10 Case 1: Physical Exam Findings General: appears lethargic, clinging to the mother, appears ill  Abdomen: flat, (+) bowel sounds, soft, non-tender, nondistended, no organomegaly appreciated  Lungs: grunting respirations; intercostal retractions, crackles at right lung base  Journal of Education and Teaching Emergency Medicine: https://jetem.org/peds_retractions/ 11 Case 1: Physical Exam Findings  HEENT: dry mucous membranes, oral pharynx without erythema, absent tonsils, no cervical or submandibular lymphadenopathy; nasal mucosa pink and moist, flaring of nostrils medicalimages.allrefer.com/.../nasal-flaring.jpg 12 Case 1: Physical Exam Findings Musculoskeletal: patient is moving all extremities well, but only with prompting  Skin: warm, dry skin with decreased turgor; no rashes or lesions appreciated  What might decreased turgor indicate? https://ufhealth.org/skin-turgor 13 Case 1: Lab Results Chest x-ray with focal right lower lobe infiltrate  Elevated WBC count at 15,000 [5k-10k]  Normal T lymphocytes – both CD4+ and CD8+ 