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Friday, August 17, 2018

Leukemia Scheme

Do GPE of 2 yr old child.


2 year old sehar is a sick looking , conscious and irritable throughout my examination having multiple bruise marks of different sizes and ages on her whole body.
She has radial pulse rate of 95 per minute which is regular and good in volume, BP of 90/50 mmHg, RR of 28/min and temp of 99degF.
her OFC is 48.5 cm ,  height is 83 cm, weight is 13 Kg all of which appear to be approproate for her age but i would like to plot them on percentile charts.
She has multiple bruises over her body in different ages, the largest measuring 8 by 8 cm on her back, with no gum , nose , ear ,conjunctival or joint bleed.She is pale , with anterior cervial lymphnodes palpable B/L, multiple lymph nodes measuring 3 by 5 cm,which are nontender, nonmatted, mobile, nonadherent to overlying skin, and the overlying skin is healthy. There are multiple medial and apical axillary lymph nodes palpanble on both sides with similar features having maximum size of 5 by 5 cm. There is no supraclavicular or inguinal lymphadenoapthy, no clubbing ,koilonychia,palmererythema, jaundice, examination of nose ear and oral cavity is no0rmal, BCG is present,  examination of neck for thryoid swelling is unremarkable, There is bine tenderness however i cld nt appreicate it fully since child is very irritable.
There is a circular scar mark over right iliac crest , hypopigmented and measuring 0.3 by 0.3 cm.

on further extending my examination , she has soft non tender abdomen , with hepatomegally 5 cm below rt s/c margin in midclaviluar line wih 9 cmc total span of liver, liver is nontender, having sharp border, firm in consistencey, smooth surface, left lobe is not pal[pable, spleen is enlarged 10 cm along its axix toward rt iliac fossa, splenic notch is palpable , it is not ballotable and hand could not be instituite between spleein and ribs. therer is no other visercomergaly and no eviden if free fluid in abdominal cavity. Her exmiantion of respiratory systemi is unremakbale.
Pt hasnt passed stools in pampers yet, which i would like to see for blood.


D/D
Acute Leukemia
Disseminated Tuberculosis
Gaucher disease

Ix for leukemia, and t/m

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so in this case there are bruises with lymphnodes. when we have either of these we look for the other of these.
and next we look for bleeding at other sites. and lymph nodes at other side. (not forgetting to measure both).
then we also dont foget to miss FEVER - bone TENDERNESS - BCG scar.
then we further FIND bone marrow biopsy scar !!!!!
and chk for viscera , and chest auscultwation.

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