Pneumonia is a common ailment for children in both resource-rich and resource-poor countries. Bacterial pneumonia was confirmed with chest x-ray.ĭiagnosis: Bacterial community-acquired pneumonia (CAP). Appendix was read as normal, but the CT scan also revealed the lower lobes of the patient’s lungs, where a left lower lobe consolidation was found. ![]() CT scan of abdomen/pelvis was then obtained. At the time the only change in his condition was a decrease in appetite, a rash on the left palm noticed the day before that had since resolved, and intermittent pain on the dorsum of both feet and low back.Īn ultrasound was ordered to visualize the appendix but was unable to visualize. Patient presented to the local ED 3 days later. Patient’s dad was told to follow up with pediatrician if symptoms did not resolve and to return to urgent care or go to the emergency room if symptoms worsened. He was discharged home with instructions for symptomatic management, strict return precautions, and instructions to monitor for worsening of symptoms/appearance of new symptoms. The patient’s diagnosis was presumed viral illness as no bacterial etiology had been found during the visit. Lungs are clear to auscultation bilaterally. Posterior pharynx is slightly erythematous, without exudates or petechiae. ![]() Minimal generalized abdominal pain is elicited on deep palpation, but the abdomen is soft, nondistended, without guarding and rigidity. The patient is pleasant, cooperative, and talking in complete sentences. Denied cough, shortness of breath, wheezing, ear pain, ear drainage. Patient is still eating, drinking, urinating, and defecating normally. ![]() ROS positive for increased irritability when febrile, minimal clear rhinorrhea, pharyngitis, two episodes of non-bloody emesis, and intermittent abdominal pain on deep inspiration. Awareness of associated signs and symptoms may assist the urgent care provider in proceeding more quickly to a correct diagnosis.Īlyssa Whited, PA-C and Christina Gardner, PA-C CASE PRESENTATIONĪ 5-year-old male with no significant past medical history presented to urgent care with his father, with a chief complaint of fever for the past 2 days (Tmax 104☏), controlled with acetaminophen. Urgent message: While pneumonia in general continues to be a common diagnosis in children in the United States, relatively few studies have sought to determine the signs and symptoms that help to predict occult bacterial pneumonia.
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