Decline of the Medical History and Physical Examination

Abstract

Case 1. A 7-y-old girl with periorbital swelling initially diagnosed as allergy, presented one week later with fatal massive pulmonary edema secondary to undiagnosed acute poststreptococcal glomerulonephritis (APSGN). Case 2. A 9-y-old boy underwent cystoscopy by an outside urologist for gross hematuria. Apparently, a history of an antecent upper respiratory tract infection, and the presence of peripheral edema, were overlooked. A low serum complement confirmed the diagnosis of APSGN. Case 3. A four-y-old girl had abdominal distension and decreased urine output of two days duration. Her serum creatinine was normal. Catheterized urine was protein free. Upon further questioning of the parents, it became apparent that the child sustained abdominal trauma. A micturating cystourethrogram showed a ruptured bladder. Surgical repair was uneventful. Case 4. A four-mo-old boy with the congenital nephrotic syndrome, presented to the emergency department with gross hematuria. Since the patient was on warfarin, an international normalized ratio was ordered and found to be high. Following discontinuation of warfarin, the patient kept having recurrent hematuria. Upon questioning the parents, it became evident that the child was receiving anise (Pimpinella anisum), and plant Viagra (Radix ferula), both of which increase the action of warfarin. None of the house officers asked about herbal remedies, because they were not taught to do so at medical school.