The Case of Donnie J
Fredric D. Burg MD1
1 Vice Dean for Education and Professor of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia
Mrs J has brought her 4-1/2-year-old son Donnie to your office for a first visit. She and her son have moved recently into your community, and she heard that you were the best pediatrician in town.
At present, Donnie has no complaints. He looks healthy and is comfortable with both his mother and you during the interview. You learn that Donnie has had no medical care since he was 2 years old, when he was hospitalized for a broken arm after he fell out of a tree. His mother has lost his immunization records, but thinks he has had all of his shots. Donnie was the product of a normal full-term pregnancy with no complications at the time of delivery.
His mother reports that she is unmarried and has been a "dead head" (a follower of the musical group "The Grateful Dead") for 14 years. She says that she has had many sexual partners and has used a variety of drugs before, during, and after pregnancy. She is presently living only with Donnie.
In reviewing the patient's history to this point, what points should alert you to potential problems with Donnie?
1. Immunization status.
2. Previous serious accident.
3. Potential prenatal exposure to human immunodeficiency virus.
