Case #4 - A Child With Painless Wounds

Janaina Nogueira, MD, Janice Ford, MD, Mary Mancao, MD, Paul Maertens, MD


March 17, 2003

Physical Examination

Vital signs: oral temperature 97.9° F, pulse 68, respiratory rate 18/min, blood pressure 114/66 mm Hg.

The child was a thin female who appeared in no acute distress. There were no obvious signs of trauma. Pertinent findings included an old scab on the right second fingertip, edema and slight erythema of the right fourth distal phalanx with a 25-mm opening at the center of the fingertip, and a partially missing right fifth fingernail with erythema surrounding the nailbed. The left great toe had a 0.5-cm defect on the dorsum; the area had a purple discoloration due to the use of gentian violet by her mother. Mild clubbing of all digits was also present.

On neurologic examination, the patient was alert and oriented to person, place, and self and answered questions appropriately. All cranial nerves were intact, with no speech deficits. In all extremities, 5/5 motor strength was observed. There was decreased fine sensation and delayed response to vibratory stimulation on all extremities. The deep tendon reflexes were decreased throughout.


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