A 19/F with lack of growth CBBLE UDHC similar cases

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Chief complaints
Lack of gain of weight since childhood
Lack of gain of height since childhood

History of presenting illness
Informat - mother
Mother noticed child was not growing since young age 
Patient was taken to multiple hospitals for treatment and was given multivitamins
Patient failed to clear 10th class twice
Then she started working as a daily labourer


H/O burning mituration, polyuria since 1 month

No H/O pica
No H/O irritability
No H/O loss of weight, loss of appetite
No H/O diarrhoea, steatorrhoea
No H/O PND, ORTHOPNEA
No H/O reccurent infection
No H/O chough, duspnoea
No H/O cold intolerance to cold, constipation, hoarseness of voice, decreased activity

Birth history
Full term normal vaginal delivery
Birth weight 1kg
H/O fever in neonatal period, diagnosed with ? pneumonia

Past history
Not a known case of DM, HTN, THYROID DISORDER, EPILEPSY, TB

Developmental
Gross motor - started to walk without support at 2 years of age.
Fine motor - started feeding by herself by 2 years of age
Social - smiles and identified mother at 3 months of age
Language - used  bi-sylable words like "amama nanna" at 2 years of age

Menstrual history
Menarche 12yrs
3/30 irregular
LMP: 24/2/2022 

FAMILY HISTORY - 
Mother's height 150 cms
Father's height 180 cm
Mid-parental height 167.5

ON EXAMINATION -

PATIENT IS CONCIOUS , COHERENT COOPERATIVE
No Pallor, NO ICTRUS, CLUBBING , CYANOSIS , LYMPHADENOPATHY , EDEMA


Height 146 cm - less than 3rd percentile
Weight 35 kg
BMI 16.41 - 3rd percentile

VITALS - 

TEMPERATURE - 99.1
PULSE RATE - 94 BPM
BLOOD PRESSURE - 110/70 MM OF HG 
RESPIRATORY RATE - 16
SPO2 - 99 % AT ROOM AIR

SYSTEMIC EXAMINATION - 
PER ABDOMEN : NON DISTENDED, SOFT NON-TENDER, NO GAURDING/RIGIDITY

CARDIOVASCULAR SYSTEM : 
Apex beat - 5th intercostal space mid clavicular line right side
S1 AND S2 HEARD (prominent on right side), NO MURMURS
RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
CENTRAL NERVOUS SYSTEM : NAD


Sexual maturity ratings
Public hair -Stage 2 - Sparse, slightly pigmented, straight, at medial border of labia
Breasts - Stage 4 - Projection of areola and papilla to form secondary mound above the level of the breast



ECG
HEMOGRAM
HB 14.7
TC 9,400
PLT 3.99 lac
MCV 85.5
PCV 42.5
MCH 29.6
MCHC 34.6
SMEAR - NORMOCYTIC NORMOCHROMIC

RFT
Urea- 14
Creatinine- 0.7
Sodium- 140
Potassium- 4.1
Chloride- 99

LFT
TB- 0.74
DB- 0.20
AST- 25
ALT- 11
ALP- 189
TP- 7.3
ALB- 4.34

RBS
93
BGT 
O POSITIVE

Chest X-ray
Ultrasound abdomen
Liver on right side normal echotexture
Spleen on left side normal echotexture

Pelvis X-ray
2D echocardiogram
LA - 3 CM
LV
ESD 2.4
EDD 3.96
EF 62%
FS 32%
DPW 1
AORTA 2.6
RSVP 30MMHG
No RWMA
No Diastolic dysfunction
No PAH
 
 
Left mammary 

 Left mammary long axis



 
Subcostal

 



Thyroid function tests
T3 1.29
TR 12.33
TSH 3.67
MMSE
23/30 -  mild cognitive impairment
Diagnosis
Developmental delay with dextrocardia

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