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

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.

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.

years

104

woman

32 /min

110 /min

SpO2

95 %

108/66 (80) 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