PEDIATRIC NEUROLOGY CLINIC CONSULT Essays

Abdomen: Obtuse with minimal bowel sounds, slightly distended. There is RLQ (right lower quadrant) tenderness with guarding and with pinpoint rebound. Positive McBurney and obturator signs with a negative psoas sign.

PHYSICAL EXAMINATION: Vital Signs. TEMPERATURE: 101.0, Blood Pressure- 127/179, Heart Rate-129, Respirations- 185, Weight-215. Situations 96% on room air. Pain Scale- 8/10. HEENT-Normal cephalic, atrumatic pupils equally round and reactive to light. Extra ocular motions intact. ORAL: Shows oral pharynx clear but slightly dry mucosal membranes. TMS: Clear. NECK: Supple, No thrangegally or JVD. No cervical, subclavicular, axilarry or lingual lymphinalpathy.

PHYSICAL EXAMINATION: Vital signs are WNL. Apparently he has had no chills, night sweats, or favors. Generalized malaise and a lack of energy have been the main concerns. HEART: Regular rate and rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS: Bilateral rhonchi. No significant amphoric sounds are noted. ABDOMON: Soft nontender. No hepatosplenomegaly or masses are detected. RECTAL EXAM: Prostate smooth and firm. No stool is present for hemoccult test.

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

Visual fields full to confrontation. Extraocular muscles intact. Pupils are slightly enlarged on the left compared to the right, which she states is old since her eye injury. They do respond directly and consensually. Normal facial symmetry, sensation, and movement. Tongue and uvula are midline. Normal shoulder shrug. Normal auditory acuity.

Breasts: no masses, no nipple retraction, no discharge. Heart: S1 and S2, no gallops, rubs, or murmurs appreciated. Abdomen is scaphoid, soft and non-tender with positive bubble sounds. Pelvic/ Rectal: deferred as patient has recently visited her GYN for a routine Pap smear. Neurologic exam reveals normal motor strength in all muscle

The earliest memories I have are of being pulled out of my classroom in the first grade, and then being hospitalized on multiple occasions. Memories of being treated differently as a kid are still fresh in my mind. The reason behind such treatment was kept from me and the only explanation my family and doctors could afford was that I was “different”. It wasn't before medical school I understood that, I had epilepsy. Had my parents received appropriate knowledge about my condition before and had I received regular pediatric care, my epilepsy would have been diagnosed and treated earlier and effectively. This, however, is a harsh and unfortunate reality a lot of families with limited resources face. Coming to terms with my reality motivates me to work hard every day and pursue a career in pediatric neurology.

Cardiovascular Assessment: No visible pulsations, no heaves or lifts. Apical pulse present in the fifth intercostal space at the left midclavicular line. Auscultation of apical rate 62 beats per minute, normal rhythm regular S1 - S2 heart sounds present. Pulsations present when supine and disappear at a 45 degree angle position. Extremities are brown color without redness, cyanosis, lesions or varicosities bilaterally. Temperature warm bilaterally, Allen test was negative. Homan’s sign negative. Carotids: +2 and present bilaterally. Right Radial +2, left radial +1 , Right Brachial: +2

Based on the medical report dated 03/25/16, the patient continues to have significant headaches and bilateral neck and shoulder pain. IW has numbness and tingling in both arms with neck pain.

What further tests should be conducted to confirm your diagnosis for this patient? (2 pts.)

I would like to pursue a career as a pediatric neurology at a large hospital that serves an urban population. When I shadowed a pediatric neurologist at Comer Children's Hospital, we saw many patients that came from a disadvantaged background. As a result, many parents lacked the proper education for to how to care for a child with a neurological disorder. Dr. Marcuccilli, the physician I shadowed, spent time to explain things like safety tips and how and when to administer medications. For that reason, my goal as a physician is not only to treat but to educate. I want to take time with my patients, to answer their questions, and to always ensure that they leave feeling reassured. At this time, my biggest goal for the future is to continue

Spinous processes should appear in straight line. Thorax should appear symmetric with an elliptical shape. The ribs should appear in a downward slope with about 45 degree relativity to the spine. The scapulae should be symmetrical in each hemithorax. The AP diameter should be less than the transverse diameter. The ratio should be 0.7 to 0.75 and increases with age in the average adult. The patient’s position should be noted while breathing and the person’s skin color and condition of the skin. There should be no presence of cyanosis or pallor. No lesions should be present. If any changes of a nevus occur the health care provider should inquire about these changes.

Head was inspected for size, shape, position and symmetry. Scalp noted clean and well maintain, no dryness, or lesions were noted. No sign of hair loss were observed. Facial structure were symmetrical, no skin discoloration, rashes, swollen or lesion were noted. No involuntary movement of the face were perceived. Neck was inspected, good symmetry were noticed, and no scar or lesions were perceived. No large lymph nodes or mass detected during palpation, patient denies pain or tenderness. Thyroid gland was not visible, during palpation no mass or nodule were identified. No bruit was perceived during auscultation of the thyroid lobes. Trachea was noted to be in the midline, no deviation was noted.

Cardiac: Regular rhythm without murmur, normal S1and S2. One plus edema to bilateral lower extremities. Capillary refills are presents and carotid bruits are absent.