Name: Nor Azlan Shuhaime bin Nor Azam

Nickname: Azlan
Age: 12 years 8 months
Gender: Boy
Race: Malay
Date of birth: 15 October 2003
Date of Admission: 10 July 2016
Date of clerking: 11 July 2016
Adress: No. 14, Jalan Kleebank Putra 7A, Taman 31200, Chemor, Perak.
Klinik One Malaysia (5 minutes away from home)
Informant: Mother and patient.
Chief complain: Prolonged fever for 3/12
Cough for 2 months
Chest pain for 2 months
Rapid breathing for one day
Azlan was apparently well until 2 months ago when he started experiencing episodes of
intermittent dry cough. The cough occur as frequent as 2-3 times in a week and usually last for a
whole day. It is associated with lethargy in which he will skip school and stay at home. The cough
remains constant and it is not worsening. The cough disappear upon sleeping? No history of
becoming blue or history of admission for the cough. In between episodes Azlan is active and
symptom free. He denied any aggravating factor that exacerbated the cough such as exertion, cold
weather, stress, pollen or pets. The cough is not exacerbated on lying flat and he denied
experiencing difficulty in swallowing food. No history of atopy, no history of eczema, food allergies,
frequent teary itchy eyes or runny nose and no history of frequent nebulisation. There are cats in
the house and his father his a cigarettes smoker who frequently smokes at home, but there is no
carpet
No history of ingesting foreign material and throat pain.
At the same time Azlan complains of a retrosternal chest pain for the past 2 months which
is well localised and aggravated mainly upon coughing and lifting heavy objects? The chest pain
was describe as sharp in nature which is not exacerbated on exertion. No ortopnoea, no
paroxysmal nocturnal dyspnoea and no exertion dyspnoea. No history of congenital heart disease.
It was associated with lost of appetite and loss of weight with evidence of loosening of his clothes
and mother claim that she notice her son was thinner compare to previously. He have lost around
3-4 kg for the past two months. Azlan also started to experience loss of appetite in which his
mother notice the significant reduction in food portion during meals. He denied any change in
eating habit such as eating in between meals or feeling hungry. However, he still remains active in
between episodes of cough. No history of contact with TB patient, no night sweats and no fever. He
has a strong family history of Asthma (DAD, ELDER SISTER AND POSSIBLY MUM) and atopy in
the family. But he denied any nocturnal cough, no wheezing, no breathlessness. He was not on any
long term medication such as acei. He was brought several times to see different doctor each
episode and was frequently send off with ..

There was no history of early morning sputum.(bronchiectasis). No history of chronic exposure to

dusty or air polluted with silica, environment. However, his father is a
smoker and he smokes frequently at home.

Any history of hemoptysis? History of vomitting in between cough? Does the cough disappear
when he sleeps?
On Saturday night (2 days prior to admission) after a long 5 hour journey back by car from Pahang,
Azlan complain of a sudden onset of cough. It initially started with a mild sore throat in the evening
and he started coughing later on at night. The cough was productive with greenish sputum and little
but he couldn't quantify the exact amount. No blood stained. Occasionally, the productive cough
precipitate vomiting of mainly digested food particle with no bile stained. It was said to be a chesty
cough and different from usual. The mother notice Azlan started to have difficulty in breathing with
rapid breathing observed and wheezing heard. However, it was mild and hence did not prompt his
parents to bring him to the see a doctor. Azlan denied experiencing any fever, chills or rigor. No
runny nose,
The following day Azlan cough worsens with difficulty in breathing and was brought to a clinic at
11am. He was seen by the doctor and was prescribed with cough syrup. Azlan cough was relieved
temporary with the cough syrup for one hour and soon develop back the cough as before. He had
difficulty in lying down flat without breathlessness. He claimed that he had a cousin who had mild
runny nose during rays other than that no history of sick contact.
During rays did he cough?? was he well?? is these symptom related or there are period of gaps
between one another??

The father decided to bring him to the HRPB as his breathlessness was worsening. At
casualty, Azlan was still alert and conscious, able to walk, and was not noticed to be blue. He had
difficulty speaking full sentences due to the breathlessness. He was nebuliser once at casualty and
subsequently his breathlessness improve. He was then admitted to the ward.
Azlan have a history of on and off fever for the past 3 months (March to May) prior to the chronic
cough. He usually complains of fever at least once in a week which lasted for 2-3 days with
medication given by the doctor. He was brought to see a doctor each time and was establish to
have high fever of 38-39 degrees. He usually will be prescribed with paracetamol and fever
subsides. He was prescribe with antibiotic in one or two occasions. Not associated with chills and
rigor. No cough, no runny nose, no sore throat, no difficulty in breathing, no abdominal pain, no
change in bowel habit, no increase in urinary frequency, no dysuria, no hematuria, no joint pain, no
rash and no swelling. No recent history of contact with TB patient, no history of jungle trekking.
Differential diagnosis of chronic cough in child:
Tuberculosis
Asthma
Chronic suppurative lung disease
Gastroeosophageal reflux

Post pertussis cough

Postnasal drip
No significant past surgical and medical history.
No known food or drug allergy
Family history
Father is 38 years old and mother is 37 years old. There is a strong family history of asthma with
the father, sister treated for asthma and on MDI. The sister was diagnose at 12 years old, not well
controlled with frequent use of inhaler. No family history of malignancy, heart disease, hypertension
or diabetic mellitus.

Antenatal history
Mother conceive Azlan at age 24 years old. It was not a planned pregnancy but and confirmed her
pregnancy with UPT. She did her booking as early as possible around 3 months of gestation.
Antenatal history was uneventful. Ho history of m

Birth history
Azlan was born termed at 38 weeks through spontaneous vaginal delivery at HRPB. Birth history
was uneventful, no prolonged labour, vacuum assisted delivery or He cried immediately after birth
and was breastfed, not cyanosed. Mother do not remember the colour of the liquor but ensure that
it was a normal uneventful delivery. No history of neonatal jaundice or seizure. No history of
frequent admission.

Mother do not have the baby book.

Immunisation
Immunisation history is up to date and never missed.

Denied any side effect on receiving immunisation such as allergy or ..that require
admission.
Developmental history
Azlan is developmentally normal with normal milestone throughout childhood as compare to his
elder sister. He started walking around 1 years old and talking aroundHe is currently in
form 1, studying at SMK Tasek, Chemor. He is in the .class and he is position in the class
is 8 out of the 38 students in the class. He is well active i sports joining running and foot ball. H e
represent the school?? He has no problem adapting to his surrounding and enjoys going to school.
He denied being bully at school and claim to has many friends. He claims that he still able to
handle his load of homework. However, some teachers are quite strict on him and sometimes in
addition to being frequently coughing, he skips class on certain days.

Feeding history???
Breast feed since birth to 2 months old and he started weaning at 4 months old. Currently, he only
eats half bowl of rice with vege? meet? Everyday like that?? He used to eat more than one bowl of
rice

Socioeconomic history
Father is a lorry driver and mother works as a sales lady at Pasar raya mydin. Parents are not well
educated and study till form 5. He lives with his parents and two other siblings. They live in a single
storey terries house with 3 rooms. Azlan has his own bedroom but frequently sleeps with his
parents as there is aircond. The house is well equipped with electricity, water and sewage system.
Claim to stay in a dengue prone area with last fogging being
but not nearby industries. They
have cats at home. But no carpets and changes bed linen once in a week.
His father is a chronic smoker who smokes at home
Mother claims no financial issue.