So, just for giggles, I want all your medical geek opinions on a pt I saw recently.
You are conducting a MEDCAP in the Horn of Africa. A mother of three brings in her 20 month old African son. The mother states (through an interpreter) that about a month ago, the child "stopped wanting to eat. Even his favorite foods are left alone." As you talk to the mother, the child becomes agitated and scared, and crying. Produces tears and snot (cear) as he cries. In the course of the interview, child falls asleep. When asked if that is normal, the mother replies "He just does that. He gets exhausted from crying or playing, and just runs out of energy and goes to sleep." Mother reports he has some intermittent loose bowel/diarrhea, but is unable to say how many times a day he makes urine/fecal matter. She also states that he sleeps very well at night.
Upon inspection, the child seems to be undersized and slightly malnourished, but if you saw this child up and walking around, it would not "jump out" that he is malnourished. No signs of trauma, no significant med history because no doctors live where he does. Pt tracks personnel in the room prior to going to sleep, and interacted normally with the mother. HEENT intact and unremarkable. Intact brachial and pedal pulse, HR 110, cap refil -1, no turger, abdomen slightly distended, soft, and reveals no guarding, and the examination did not wake the patient. Lungs are equal and bilateral, with non labored breathing WNL. NSTR for the rest of the head to toe/interview. Reflexes normal. O2 sat normal (98 on ambient air). BGL is WNL. Temp is WNL.
You don't have access to a lab, so you're unable to draw/test labs. You don't have a CT scan or ultrasound because it's a field hospital.
Let's talk differential diagnosis and treatment.
Discuss!
You are conducting a MEDCAP in the Horn of Africa. A mother of three brings in her 20 month old African son. The mother states (through an interpreter) that about a month ago, the child "stopped wanting to eat. Even his favorite foods are left alone." As you talk to the mother, the child becomes agitated and scared, and crying. Produces tears and snot (cear) as he cries. In the course of the interview, child falls asleep. When asked if that is normal, the mother replies "He just does that. He gets exhausted from crying or playing, and just runs out of energy and goes to sleep." Mother reports he has some intermittent loose bowel/diarrhea, but is unable to say how many times a day he makes urine/fecal matter. She also states that he sleeps very well at night.
Upon inspection, the child seems to be undersized and slightly malnourished, but if you saw this child up and walking around, it would not "jump out" that he is malnourished. No signs of trauma, no significant med history because no doctors live where he does. Pt tracks personnel in the room prior to going to sleep, and interacted normally with the mother. HEENT intact and unremarkable. Intact brachial and pedal pulse, HR 110, cap refil -1, no turger, abdomen slightly distended, soft, and reveals no guarding, and the examination did not wake the patient. Lungs are equal and bilateral, with non labored breathing WNL. NSTR for the rest of the head to toe/interview. Reflexes normal. O2 sat normal (98 on ambient air). BGL is WNL. Temp is WNL.
You don't have access to a lab, so you're unable to draw/test labs. You don't have a CT scan or ultrasound because it's a field hospital.
Let's talk differential diagnosis and treatment.
Discuss!
). No period of fever, no joint pain, no swollen nodes or "Winterbottom's Sign" (characteristic swelling of the lymph nodes in the back of the neck). 
