On my second site visit I presented a 3 ½ year old female with no significant past medical history who presented to the pediatrician’s office with a fever. Her mother stated the fever started that morning with a maximum temperature of 101 degrees Fahrenheit taken orally, and that she had not given her any medications. The mother admitted the child has been irritable. She denied loss of appetite, cough, nasal discharge, shortness of breath, abdominal pain, diarrhea, constipation or recent sick contacts. Additionally, the mother stated the child goes to nursery school.

Fever and fussiness in a child can be due to many different diseases. In a 3 ½ year old it is hard to get a thorough history. During this site visit Professor Maida had me run through my differential diagnosis. For a case with a poor history, it can be hard to come up with a differential diagnosis, and often a broad differential diagnosis is made. During my site visit I also got to hear about my classmate’s cases. I found that those who presented cases with young children had a similar issue as me. This is one of the issues commonly faced in the pediatric population. I did a thorough exam on the patient and found she had a red tympanic membrane in the left ear, which was suggestive of acute otitis media. There were no other abnormal findings in her exam. I learned the importance of doing a thorough physical exam, especially on patients who are poor historians.