John is 9 years old boy who is lying comfortably on the bed.
I can see on the table some enzyme tablet/ deferiprone tab....... etc.
He is from African/Asian/..... decent.
He looks well/unwell.
He looks thin/obese/short/tall but I would like to plot his weight and height on appropriate growth charts for his age and sex.
He has no clubbing/cyanosis/pallor/ koilonychia/.......
His pulse is 100/minutes and regular.
He has haemolytic facies including frontal bossing and malar prominence.
His conjunctiva is pale/yellow/ congested....
He has +/- ulcer in the mouth/pigmentation. Tongue and mucous membrane moist/dry/pallor/pink/cyanosis.
On chest there is +/- spider naevi/ gynaecomastia/ central line
On abdominal examination - abdomen is not distended/ scars/striea/distended veins/peristalsis/
umbilicus is flat/protuberant/discharge
His liver is palpable in the right hypochondrium below costal margin. The liver is soft/hard; tenderness+/-; measure ... cm below right costal margin. Liver span is ..... cm.
He has no splenomegaly/palpable kidney/ other masses
Fluid thrill and shifting dullness is absent/present.
The bowel sounds are normal/absent/increased. no bruits heard.
Examination of back - no kyphosis/scoliosis/ surgical scars/tenderness/renal bruit
To complete my examination - I would like to plot his weight and height on appropriate growth chart for age and sex/measure BP/palpate LN/hernial sac/ inspect genitalia and perianal area/ with relevant other system examination like CVS/Respi/CNS/joints
Also tell that you will examine patient in standing position.
Now tell that my differential diagnosis ................ I would like to do following investigations and the management is ............... I would like to ask the impact of this condition on the child and family.
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