Chapter 1216: 【1216】The inspection must be carried out thoroughly
The measles attenuated live vaccine is a mandatory free vaccination program in the country, and most citizens have completed the vaccination during childhood.
Widespread vaccination has significantly reduced the number of measles cases domestically. However, some individuals still develop the disease due to individual variability, even after receiving the vaccine. Fortunately, their symptoms tend to be milder compared to those who have not been vaccinated, mainly falling within the range of mild to moderate symptoms.
Even so, early detection and accurate diagnosis of the disease are certainly best for the patient. A cautious doctor will rule out all the major common diseases for the patient during examinations.
In the case of measles, there is a distinctive bodily sign called measles mucosal spots, which prompts doctors to examine the buccal mucosa inside the patient’s mouth.
Measles mucosal spots refer to small grayish-white dots approximately 0.5 to 1.0 mm in diameter that appear on the buccal mucosa 1 to 2 days before the rash breaks out, often surrounded by a faint reddish halo. These are considered specific signs of measles because this symptom is unique to measles, allowing for a significant differentiation from other diseases during diagnosis. If measles mucosal spots are found, the likelihood of measles is almost certain.
Xie Wanying carefully inspected the buccal mucosa and found no measles mucosal spots. She then cautiously pressed the child’s tongue using two cotton swabs to examine the throat. Cotton swabs, when used as substitutes for a tongue depressor, require the same level of attention. They should be placed at the anatomical location called the V-shaped groove at the junction of the front one-third and middle one-third of the tongue. If placed too far forward, they fail to press down on the tongue root and dorsum properly, obstructing the doctor’s view and hindering examination of the tonsils and pharyngeal mucosa. If placed too far back, they may easily trigger nausea and vomiting in the patient.
“Say ‘ah.'”
Following the doctor’s instruction, the boy obediently said “ah.”
The child opened his throat wide, and with the help of the tongue depressor, the doctor quickly noticed two small pinkish masses on either side of the throat—the palatine tonsils, commonly referred to as tonsils.
The flashlight illuminated the child’s tonsils, revealing signs of congestion and swelling. The surface appeared to have white purulent spots, confirming it as acute tonsillitis.
“My grandson just has a cold, doesn’t he, doctor? Please prescribe him some cold medicine to take,” the anxious grandmother urged the doctor to dispense medicine quickly, eager to return home to cook.
Xie Wanying remained calm, set down the cotton swabs, and proceeded to ask questions about the child’s diet, bowel movements, urination, and any physical pain. She also inspected the child’s skin for wounds or signs of a rash.
“He’s able to eat. He has bowel movements, but his urine is a bit yellow,” the grandmother reported.
Combining the information provided by the family members, the preliminary diagnosis leaned towards acute tonsillitis in children. Xie Wanying explained to the grandmother, “His condition requires a blood test and intravenous infusion—a drip.”
“Not just oral cold medicine?” The grandmother exclaimed in surprise.
“This isn’t a common cold. It’s acute tonsillitis in children with signs of pus formation. He must receive injections; oral medications alone won’t work,” Xie Wanying emphasized the severity of the child’s condition.
“Injections? Oh dear, I didn’t bring enough money. I’ll need to call his parents,” the grandmother said, slapping her thigh.
As a doctor, Xie Wanying refrained from suggesting hospitalization for the child, taking into account the family’s attire and estimating that their financial situation might not be ideal.
In clinical practice, most doctors try their best to consider the welfare of patients and their families, taking their economic circumstances into account. If financial constraints truly prevent hospitalization, treatment is often managed through outpatient or emergency care instead.