1. San Gabriel Saniano Santos, J Santos, S Sison Sorreda Sotalbo
PEDIA SGD
San Gabriel
Saniano
Santos, J
Santos, S
Sison
Sorreda
Sotalbo

2. Patient Profile MP 13 years old Female Second year high school student
Nagcarlan, Laguna

3. History of Present Illness
13 yrs PTC
Pt was born term, SVD, in a hospital, assisted by MD, to then 23 year-old G6P1 (1051) female.
No fetomaternal complications.
Pt was noted to have hyperpigmented patch on Right anterior lower extremity.
No pruritus, no tenderness, no paresthesia.
Progression of the patch was slow to be even noticeable.

4. History of Present Illness
6 years PTC
While riding a bike, Pt fell from the bike and hit the ground with her Right femur.
Pain on Right hips and medial knee
Pt was seen at UERM and casting was done.
After the removal of the cast (2 weeks post-injury), Pt noted that the hyperpigmented patch has enveloped the entire Right lower extremity and has become darker.
No pruritus, no tenderness, no paresthesia.

5. History of Present Illness
3 yrs PTC
Pt noted that the Right lower extremity patch has become boggy and nodular.

6. History of Present Illness
2 weeks PTC
12 PM
Pt slipped on a rag containing floorwax.
Pt hit the cement floor with her Left calf and Right hips.
The left calf was not painful, but the Right hips has VAS of 8/10.
No open wound. No loss of consciousness.
Pt was still able to stand and ambulate with a limp.
Pt developed fever for 3 days, relieved by Paracetamol/Ibuprofen intake.
Pt sought a “hilot”, but no relief of pain.

7. History of Present Illness
8 days PTC
Due to the persistence of the pain on the Right hip, Pt sought consult at PGH-ER.

8. Past Medical History 2003: Fracture, Right femur
Primary Complex (PTB?), treated for < 6 months

9. Review of Systems
(paisa-isa na lang tong part na to. e/n naman ung pt except for difficulty on ambulation.)
Emphasize especially NF-related findings

10. Family History (+) Diabetes Mellitus (+) Hypertension
(+) Kidney disease
(+) Hemophilia – father’s side
(+) PTB
No history of similar presentation

11. Personal and Social History
Second year high school student
Average scholastic standing
Plays badminton
No menarche yet
Eldest of 3 siblings
Lives with parents and siblings

12. Birth and Developmental History
Pt was born to a G8P3 (3053)
Planned and anticipated pregnancy with regular prenatal check-up, after following 5 consecutive abortions
No fetomaternal complications
Speech, fine motor, gross motor, cognitive, and social skills : At par with age
Prior to the injury, Pt is a student and a badminton player

13. Physical Examination General
Awake, conscious, coherent, not in cardiorespiratory distress, ambulatory with unilateral axillary crutch
Vital Signs
BP 110/ HR RR Temp C
HEENT
Pale conjunctivae, anicteric sclerae, (-) tonsillopharyngeal congestion,
(+) multiple hyperpigmented macules/café au lait spots in circumoral distribution, midline trachea, (-) cervical lymphadenopathy
Pulmonary
Symmetrical chest expansion, normal tactile fremitus, normal breath sounds,
(-) wheeze/rhonchi/crackles
Cardio
Adynamic precordium, normal rate and regular rhythm, no murmurs
Abdomen
Soft and flabby abdomen, multiple café-au-lait spots, normoactive bowel sounds, no tenderness on palpation, liver edge not palpable

14. Physical Examination Extremities
Multiple hyperpigmented macules/café au lait spots at the back, Right forearm, Left palm, Left posterior leg
7 x 3 cm café au lait spot, Right elbow
Two 2x2 cm café au lait spots, lower back
Right lower extremity: hyperpigmented, boggy, hairy patch from ankle to inguinal area, with diffuse nodularity, (+) tenderness on nodule on medial knee
Right hip: (+) bony deformity, (+) pain
Full ROM for Upper extremities and Left lower extremity and Right foot. Right hip and knee ROM not assessed.

15. Physical Examination Neurologic Cranial nerves I-XII : Intact
MMT : 5/5 for all extremities except Right lower extremity which was not assessed
Sensory:
insensate/0% sensation in all café au lait spots
variable sensation in Right lower extremity (0-30%)
Reflex : +2 for all

16. Diagnosis
Pathologic fracture
Secondary to Neurofibromatosis 1 (?)

17. NF notes to follow in a while
Ikaw na lang bahala sa compilation *wink
Pasend na rin ng final compilation para makita ko rin, thanks!