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Boy with fatigue and facial paralysis
M
l R., age 12 years, comes to your office with a history of fatigue of several weeks’ duration and pain in the right side of the neck for the past 24 hours. He had been well until 3 weeks previously, when a fever developed that lasted 48 hours, followed by a fainting episode. M. was seen in your office by one of the pediatricians and determined to have a viral illness. The possibility of a seizure was explored and eliminated. The only positive findings were transient joint pain at the time of the fever and that the fainting episode occurred early in the morning before breakfast. Before this episode, M. had attended summer camp for a week on Cape Cod. The family was leaving shortly for a vacation to the Grand Canyon and brought him to the office for an examination before their trip. You are seeing M. after the family has returned from their western trip. M.‘s mother reports that for the first few days of their vacation, M. felt well and participated in hiking and other vigorous activities. On the third day he said
he felt tired and had no appetite. These symptoms continued for 7 days until he was again brought to your office. Your examination reveals a young male who appears tired and who has lost 3% pounds in the past 2 months. His vital signs were as follows: temperature, 99’ F; pulse, 86; respirations, 22; and blood pressure, 96/60. Results of his physical examination are unremarkable except for a small tender right anterior cervical node. No other adenopathy and no other physical findings are present. A throat culture for streptococcus is negative. A com-
CLINICAL I. 2. 3. 4.
What What What !Nhat
INSIGHTS QUIZ
diagnosis do you suspect? other questions would you ask? other physicalfindings might youfind? types of ilhzesses should you zview, based on this case?
Answers are on page 228.
J Pediatr Health Care. (1998). Copyright
72,218.
0 1998 by the National
0891.5245/98/$5.00+0
218
plete blood cell count, mononucleosis screening, and sedimentation rate are all within normal limits. You know that this young man is usually much more animated and are concerned about his lethargy. The pediatrician you consult recommends a chemistry profile, which also is normal. The decision is made to observe M. for several more days and have him return if further symptoms develop or he is not improving. Two days later, M.‘s mother calls to report that she notes drooping of the right side of his face.
Association
of Pediatric Nurse Associates
& Practitioners.
25/S/90726
July/August
1998
l R., age 12 years, comes to your office with a history of fatigue of several weeks’ duration and pain in the right side of the neck for the past 24 hours. He had been well until 3 weeks previously, when a fever developed that lasted 48 hours, followed by a fainting episode. M. was seen in your office by one of the pediatricians and determined to have a viral illness. The possibility of a seizure was explored and eliminated. The only positive findings were transient joint pain at the time of the fever and that the fainting episode occurred early in the morning before breakfast. Before this episode, M. had attended summer camp for a week on Cape Cod. The family was leaving shortly for a vacation to the Grand Canyon and brought him to the office for an examination before their trip. You are seeing M. after the family has returned from their western trip. M.‘s mother reports that for the first few days of their vacation, M. felt well and participated in hiking and other vigorous activities. On the third day he said
he felt tired and had no appetite. These symptoms continued for 7 days until he was again brought to your office. Your examination reveals a young male who appears tired and who has lost 3% pounds in the past 2 months. His vital signs were as follows: temperature, 99’ F; pulse, 86; respirations, 22; and blood pressure, 96/60. Results of his physical examination are unremarkable except for a small tender right anterior cervical node. No other adenopathy and no other physical findings are present. A throat culture for streptococcus is negative. A com-
CLINICAL I. 2. 3. 4.
What What What !Nhat
INSIGHTS QUIZ
diagnosis do you suspect? other questions would you ask? other physicalfindings might youfind? types of ilhzesses should you zview, based on this case?
Answers are on page 228.
J Pediatr Health Care. (1998). Copyright
72,218.
0 1998 by the National
0891.5245/98/$5.00+0
218
plete blood cell count, mononucleosis screening, and sedimentation rate are all within normal limits. You know that this young man is usually much more animated and are concerned about his lethargy. The pediatrician you consult recommends a chemistry profile, which also is normal. The decision is made to observe M. for several more days and have him return if further symptoms develop or he is not improving. Two days later, M.‘s mother calls to report that she notes drooping of the right side of his face.
Association
of Pediatric Nurse Associates
& Practitioners.
25/S/90726
July/August
1998