Page 2 / April 07

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ANSWER:

• She had a "funny feeling" in her throat and chest pain before the onset of hemoptysis. It was an acute onset, occurred at rest, without any fainting or collapse. The bloody content was bright red in colour without sputum or food particles mixed in. She denied any history of bleeding from other sites such as melena, hematuria, or ecchymoses. She had lost 4 pounds in weight in 2 the last 2 months. There was no history of fever nor night sweats.
• She was born in Canada to parents of East Indian origin. There were complications neither of pregnancy nor neonatal illness. She denied a history of frequent sinopulmonary infection and her immunization was up-to-date.
• She was diagnosed as having asthma with a history of frequent coughing and wheezing heard by her pediatrician since the age of 5 years. Her current medications included inhaled fluticasone (125 microgram) 2 puffs twice daily and she "had to use" salbutamol 2 puffs almost twice a week due to coughing, which was aggravate by running and eating. Oral cortico-steroids were given once a year. She had one hospitalization 4 years ago due to pneumonia and an acute asthmatic attack.
• She was failing to thrive with her weight below the 3rd percentile and height between 3^rd and 10^th percentile.
• There was no family history of asthma, allergy or tuberculosis. The family was last back to India 4 year ago and remained there for 10 months. There was a 2- week close contact with grandmother and an uncle who came from India 2 months prior to her hemoptysis.

On physical examination she was conscious with neither pallor nor respiratory distress. Her temperature was 37OC, blood pressure 96/54 mmHg, pulse rate 79/min, respiratory rate 22/min and oxygen saturation 99% in room air. There weerw no nasal/oral ulcer or bleeding per gum. She had good air entry. Fine crepitation was heard at right lower lung field without any wheezing or rhonchi. Clubbing of fingers was noted. There were no ecchymosis, petechiae nor lymphadenopathy.

She had a complete blood count with a hemoglobin of 127 g/L, a hematocrit 0.37 and a reticulocyte count of 1%. Her platelet count was 374 x 109/L, white blood cell count was 9.5 (polymorphs 6.1, lymphocytes 2.6, monocytes 0.6) x 109/ L, erythrocyte sedimentation rate (ESR) 58 mm/hr and C-reactive protein(CRP) within normal limits at 1.7 mg/L. Serum electrolytes, urea and creatinine and routine urinanalysis were unremarkable.

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