1. Step 6
1.1. Review session 1
1.2. Report new knowledge
1.2.1. Malaria
1.2.1.1. epidemiology
1.2.1.2. etiology
1.2.1.2.1. plasmodium life cycle
1.2.1.3. pathophysiology
1.2.1.4. symptoms and signs
1.2.1.5. diagnosis
1.2.2. Diarrhia
1.2.2.1. pathophysiolgy
1.2.3. Hemolytic aemias
1.2.3.1. thalassemia
1.2.3.1.1. is it discovered early?
1.2.3.1.2. Beta thalassemia
1.2.3.1.3. Alpha thalassemia
1.3. 30 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. Sever falciparm malria (5% of RBCs) + keep thalassemia in mind
2.2. Mechanism
2.2.1. endimec area
2.2.2. mosquito bite
2.2.3. affected RBCs adhered to endothelial cells
2.3. Presentation
2.3.1. intermettent fever
2.3.2. paleness
2.3.3. diarrhea
2.3.4. headach
2.3.5. drowsinees
2.3.6. dry couph
2.4. Supporting data
2.4.1. test
2.4.1.1. biochemistry
2.4.1.1.1. bilirubin high
2.4.1.2. blood
2.4.1.2.1. low lymphocytes
2.4.1.2.2. low platelets
2.4.1.2.3. MCV low
2.4.1.2.4. Hb low
2.4.1.2.5. malaria parasite found (falciparium)
2.4.1.3. mother
2.4.1.3.1. low MCH
2.4.1.3.2. hist mother not anemic but MCV 74, raised A2 (4.2%). Normal Hb F
2.4.1.3.3. iron is normal
2.4.2. examination
2.4.2.1. spleenomegaly
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complain
3.1.1.1. 6 years old
3.1.1.2. 2 days ago
3.1.1.3. headach, attack of shivering, sking was hot. Had some slight dry cough
3.1.1.4. they subsided after few hours (intermettent)
3.1.1.5. the folowing day they came back with abdominal pain and vomiting
3.1.1.6. went to a doctor: diagnosed with viral infection
3.1.1.6.1. sent him home and perscribed some paracitamole
3.1.1.7. 2 days later symptoms got worse and they went to children hospital (in Riyadh)
3.1.2. Previous medical / surgical history
3.1.2.1. fully immunized
3.1.3. Drug history / allergy
3.1.3.1. just the paracetamole
3.1.4. Family history
3.1.4.1. both parents are well. No history of anemia
3.1.4.2. the family moved to ryiadh 2 years ago. this the first visit to jazan since then
3.1.4.3. father and brother are normal
3.1.5. Social / occupational history
3.1.5.1. travel history
3.1.5.1.1. recently visited relatives in Jazan for 3 weeks, came back 1 week ago
3.1.5.2. mother from Jazan. works in a mining company with the fahter who is geologist working in Riyadh
3.1.5.3. one brother aged 8
3.1.5.4. Malaria is common where his mother lives (Jezan)
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. Vital signs
3.1.7.1.1. 40.4 c
3.1.7.1.2. pulse 156
3.1.7.1.3. pressure 100/60
3.1.7.1.4. reps rate 40
3.1.7.1.5. hight 113.5
3.1.7.1.6. wight 19.5
3.1.7.2. inspection
3.1.7.2.1. pale
3.1.7.2.2. extremly drowsy
3.1.7.2.3. dry mucus membranes
3.1.7.3. chest is clear
3.1.7.4. palpable spleen 3cm below costal cartilage, slightly tender
3.1.8. tests results
3.1.8.1. blood
3.1.8.1.1. low lymphocytes
3.1.8.1.2. low platelets
3.1.8.1.3. MCV low
3.1.8.1.4. Hb low
3.1.8.1.5. malaria parasite found (falciparium)
3.1.8.2. biochemistry
3.1.8.2.1. bilirubin high
3.1.8.3. mother
3.1.8.3.1. low MCH
3.1.8.3.2. hist mother not anemic but MCV 74, raised A2 (4.2%). Normal Hb F
3.1.8.3.3. iron is normal