Norah, a 7 year-old Saudi girl presents with her mother (mom) for c/o R ear pain x 2 days. Mom reports that the patient has had a runny nose and cough for the past 9 days. Mom reports that the nasal drainage started out clear and thick but now is thick and greenish. Mom reports the cough is worse in the morning and that her daughter does not cough up much phlegm. Mom denies patient has had headache, n/v/d/c, abdominal pain, or has complained with burning or pain with voiding, and states she doesn’t think her daughter had a fever as “she never felt warmer than usual” and did not complain of chills. She is concerned that her daughter caught something when they were at the waterpark in Dubai. Mom reports they flew home 3 days ago. Mom states neither of Norah’s two siblings, twin boys age 9 years-old, have had similar symptoms. Mom states Norah has not had these ear symptoms before. Norah reports her pain as an 8 on the Wong-Baker Faces scale but it gets better to a 4 when “mommy gives me pink medicine” (children’s paracetamol), the last dose was taken 8 hours ago. Norah is not on any ongoing prescriptions. She has no medical problems and was in the 90th percentiles for height and weight at her 7 year check-up 5 months ago. Norah is up to date on all childhood vaccines. She was a full-term vaginal delivery without complications APGR was 8 at one minute, 10 at 5 minutes. She is in grade 1 at primary school. Norah says she likes school and does well. She lives at home with her parents, 2 brothers, and paternal grandmother in a single family home with full utilities. Her mother does not work outside of the home. He father is employed as a regional manager for a restaurant chain. No known drug or food allergies. Religion: Sunni Islam. VS: T 37.2C, P 88, R 18, BP 102/78.
On physical exam:
No enlarged lymph nodes on neck, no mastoid redness, swelling, or tenderness. Conjunctiva without redness or drainage, no lid swelling. Scant light green, thick nasal drainage. Denies tenderness with palpation over frontal and maxillary sinuses.
Norah’s oropharynx: Movement is symmetrical and full (uvula is not actually enlarged, it the way I took the picture)