ࡱ> +-*\ N bjbj *jbjbN          , [88888$S    88" 8 88@ =b5Fz+0[{( ${ [B : Diagnosis of the Day 10 IC/CC: A 4 year-old black male presents with swelling of the hands and feet, fever, headache, and a feeling of heaviness in the abdomen. HPI: The child has recurrent abdominal pain and joint pain (due to ischemia). He has also been wetting his bed. The childs cousin has been recently diagnosed with a blood disorder. PE:VS: fever (38.3 C). Pallor of the conjunctiva, skin, and mucous membranes. Hypoxic spots on the retina. Heart has regular rate and rhythm with no murmurs. The lungs are clear. Splenomegaly is present. The skin over the metacarpals and metatarsals is warm to the touch, and the joints are tender. Labs: Peripheral blood smear (RBCs put under the microscope) demonstrate abnormally-shaped erythrocytes. Anemia is present. Questions Dactylitis is the most frequent initial manifestation of this disease. What is dactylitis? List 3 symptoms that the patient has complained of? What is meant by pallor of the conjunctiva? 4. Does this patient have a heart problem? (give your reasoning) Where are the metacarpals? The metatarsals? 6. Why is it important to know that this patients cousin has been recently diagnosed with a blood disorder? What are erythrocytes? Can you name a disease with abnormally-shaped erythrocytes, that is seen predominantly in African-Americans? _ a    N hr hrCJ hr5CJ hr5CJ$hr5>*CJ$ ^ _    w x   M N N  & F & F & F &d P $a$(/ =!"#$% s666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH66666666666666666666666666666666666666666666666666666666666666666p62&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH 8`8 Normal_HmH sH tH D@D  Heading 1$$@&a$ 5>*CJ DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 2B@2 Body TextCJ PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w<v NN N 8@0(  B S  ?%kuPad  P33333PjnfZ~)a 2l)^"4*A 2HʧدHI,a-=K hh^h`o(hh^h`o(.hh^h`o(hh^h`o(.hh^h`o(k^`ko(.hh^h`o(.HI2l)~)a2H-=Kjn4*A" QrNP@N@UnknownG.[x Times New Roman5Symbol3. .Cx ArialACambria Math"qh[G[G6  !24LL3HP(?"2!xx Diagnosis of the Day  2Dr. Michael Nirenstein Maury Rich(       Oh+'0 $ D P \ ht|Diagnosis of the Day 2Dr. Michael NirensteinNormal Maury Rich2Microsoft Office Word@F#@q@B3b@B3b ՜.+,0 hp|    L Diagnosis of the Day 2 Title  !#$%&'(),Root Entry FI=b.1Table WordDocument*SummaryInformation(DocumentSummaryInformation8"CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q