Visiting a GP

You are a primary care physician (GP), and you are treating a 4-year old female patient with recurrent respiratory infections in your office. She has been suffering from recurrent RTIs, fatigue, lack of appetite and has developed fever in the last 3 months, responding poorly to antipyretics (paracetamol). You examine the patient clinically and take CRP test.

What is your next step?

Help

I will recommend the parents to continue the established antipyretic therapy, or alternate paracetamol (Panadol) with ibuprofen (Nurofen) every 4 hours to avoid liver damage.

I´ll run CBC (complete blood count) test and determine the next course of action based on the results.

I will send a patient with a request and a finding of petechiae on the lower limbs for examination by a dermatovenerologist.

Based on the petechiae on the lower extremities and elevated CRP, I will recommend the parents to give the patient cold compresses on the lower extremities and acetylsalicylic acid (Aspirin), 150 mg every 4 hours, for possible temperature reduction.

years

104

woman

27 /min

99 /min

SpO2

95 %

89/54 (66) mmHg

temperature

36 °C

GCS

Examination

Medical history:
Personal history: healthy until recently, natural birth, birth weight 2900 g, birth length 49 cm, physiological postpartum adaptation, breastfed until 7 months, normal psychomotor development , vaccinated according to the prescribed immunization schedule
Family history: insignificant, father and mother healthy
Medications: none
Present status: height and weight appropriate to age, patient mildly apathetic, now afebrile, pale, increased respiratory and heart rate, liver and spleen non-palpable, petechiae on lower extremities and eyelids.

Inflammatory markers

Take a sample