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PATIENT PRESENTATION

Chief Complaint

Restlessness at night

History of Present Illness

LT is a 5-year-old male who presents to your clinic today for a wellness check. His mother states that over the last week he has been restless while sleeping. Otherwise, LT is healthy. While giving him a bath, she has noted mild perianal irritation but no change in bowel frequency or diarrhea. LT has complained of being “itchy” at night on several occasions, but has no other complaint. He has no recent history of travel or walking barefoot, and the family currently does not own pets. There has been no change in laundry detergent or introduction of new fabrics or soaps. LT’s mother is not overly concerned but does want to ensure nothing is wrong.

Past Medical History

Seasonal allergic rhinitis

Surgical History

Tympanostomy tube placement

Family History

Mother has depression; father has type 1 DM; sister (age 3) is healthy

Social History

Mother reports he eats a balanced diet and is active throughout the day.

Allergies

NKDA

Home Medications

Loratadine 5 mg PO daily

Physical Examination

Vital Signs

Temp 98.1°F, P 95 bpm, RR 22 breaths per minute, BP 100/60 mm Hg, Ht 3′2″, Wt 19 kg

General

Energetic, talkative 5-year old in no obvious distress

HEENT

Normocephalic, atraumatic, PEERLA, good dentition

Pulmonary

Lungs clear, no abnormal breath sounds

Cardiovascular

NSR, no m/r/g

Abdomen

Soft, non-distended, non-tender, bowel sounds normal

Genitourinary

Normal male genitalia, scratch marks present near rectum

Neurology

Oriented to person, place, time

Extremities

Range of motion intact, no evidence of skin rashes

Laboratory Findings

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Na: 138 mEq/L

Hgb: 14.5 g/dL

K: 4.1 mEq/L

Hct: 37%

Cl: 105 mEq/L

Plt: 200 × 103/mm3

CO2: 25 mEq/L

WBC: 7.2 × 103/mm3

Glucose: 68 mg/dL

SCr: 0.6 mg/dL

BUN: 10 mg/dL

QUESTIONS

1. What is the likely cause of LT’s infection?

A. Ascariasis

B. Strongyloidiasis

C. Hookworm disease

D. Enterobiasis

...

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