Pediatric i-Human Case Study: Avery
Brook – 10-Year-Old Female Presenting
with Declining School Performance and
Slipping Grades | Full Clinical Encounter
Breakdown
,1. History of Presenting Illness (HPI)
Avery is a 10-year-old female brought in by her parents for a decline in school
performance, with slipping grades and difficulty completing homework over the
past 4-6 months. Parents report she used to be an "A/B" student who enjoyed
school; now she is receiving "C"s and "D"s. Specifically, parents note she
frequently "forgets" to turn in completed homework and requires constant
redirection to stay on task. Homework that used to take 30 minutes now takes up to
2 hours. Teachers have noted she "spaces out" in class, is easily distracted, and
loses personal items. Parents deny any recent illnesses, injuries, or medication
changes. They report no sleep or appetite disturbances; no headaches, vision
changes, or hearing concerns. Avery denies feeling "sad" but admits she feels
"frustrated" with school and "sometimes like I can't keep up."
2. Review of Systems (ROS)
• General: Denies fatigue, weight loss, fever, chills.
• HEENT: Denies headache, vision changes (no blurriness, double vision),
hearing loss, ear pain, sore throat.
• Cardiovascular: Denies chest pain, palpitations.
• Respiratory: Denies shortness of breath, cough.
• Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea,
constipation. Occasional "nervous stomach" on school mornings, but
resolves.
• Genitourinary: Denies dysuria, frequency. Toileting habits are age-
appropriate.
• Musculoskeletal: Denies joint pain, swelling, muscle weakness.
• Neurological: Denies tremors, seizures, coordination problems. No history
of head injury.
• Psychiatric: Denies persistent sadness, anhedonia, social withdrawal,
excessive worry, panic attacks, self-harm ideation. Admits to frustration and
occasional feelings of being "overwhelmed" with schoolwork.
, • Endocrinological: Denies excessive thirst or urination. No heat/cold
intolerance.
3. Physical Exam (PE)
• Vitals: BP 102/64 (50th percentile), HR 82 bpm, RR 18, Temp 98.4°F
(36.9°C), SpO2 99% on room air. BMI 18.2 (75th percentile - healthy
weight).
• General: Well-appearing, cooperative, well-nourished 10-year-old female in
no acute distress. Maintains eye contact but occasionally looks away when
asked direct questions.
• HEENT: Normocephalic, atraumatic. PERRLA, EOMI. Fundi benign
without papilledema. TMs pearly gray with good light reflex. Oropharynx
clear.
• Neck: Supple, no lymphadenopathy, no thyromegaly.
• Cardiovascular: RRR without murmurs, rubs, or gallops. Peripheral pulses
2+ and equal.
• Respiratory: Clear to auscultation bilaterally, no wheezes, rhonchi, or
crackles.
• Abdominal: Soft, non-tender, non-distended. Normoactive bowel sounds.
No hepatosplenomegaly.
• Neurological: CN II-XII intact. Motor strength 5/5 all extremities. Sensation
intact to light touch. Reflexes 2+ and symmetric. Finger-to-nose and heel-to-
shin intact. Gait normal.
• Skin: Warm, dry, intact. No rashes or lesions.
• Musculoskeletal: Full range of motion all joints. No tenderness or swelling.
4. Problem Assessment (PA)
Based on the history and physical exam, the patient's primary problem
is: Declining academic performance and inattention (onset 4-6 months ago)
without other medical or psychiatric symptoms.
Brook – 10-Year-Old Female Presenting
with Declining School Performance and
Slipping Grades | Full Clinical Encounter
Breakdown
,1. History of Presenting Illness (HPI)
Avery is a 10-year-old female brought in by her parents for a decline in school
performance, with slipping grades and difficulty completing homework over the
past 4-6 months. Parents report she used to be an "A/B" student who enjoyed
school; now she is receiving "C"s and "D"s. Specifically, parents note she
frequently "forgets" to turn in completed homework and requires constant
redirection to stay on task. Homework that used to take 30 minutes now takes up to
2 hours. Teachers have noted she "spaces out" in class, is easily distracted, and
loses personal items. Parents deny any recent illnesses, injuries, or medication
changes. They report no sleep or appetite disturbances; no headaches, vision
changes, or hearing concerns. Avery denies feeling "sad" but admits she feels
"frustrated" with school and "sometimes like I can't keep up."
2. Review of Systems (ROS)
• General: Denies fatigue, weight loss, fever, chills.
• HEENT: Denies headache, vision changes (no blurriness, double vision),
hearing loss, ear pain, sore throat.
• Cardiovascular: Denies chest pain, palpitations.
• Respiratory: Denies shortness of breath, cough.
• Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea,
constipation. Occasional "nervous stomach" on school mornings, but
resolves.
• Genitourinary: Denies dysuria, frequency. Toileting habits are age-
appropriate.
• Musculoskeletal: Denies joint pain, swelling, muscle weakness.
• Neurological: Denies tremors, seizures, coordination problems. No history
of head injury.
• Psychiatric: Denies persistent sadness, anhedonia, social withdrawal,
excessive worry, panic attacks, self-harm ideation. Admits to frustration and
occasional feelings of being "overwhelmed" with schoolwork.
, • Endocrinological: Denies excessive thirst or urination. No heat/cold
intolerance.
3. Physical Exam (PE)
• Vitals: BP 102/64 (50th percentile), HR 82 bpm, RR 18, Temp 98.4°F
(36.9°C), SpO2 99% on room air. BMI 18.2 (75th percentile - healthy
weight).
• General: Well-appearing, cooperative, well-nourished 10-year-old female in
no acute distress. Maintains eye contact but occasionally looks away when
asked direct questions.
• HEENT: Normocephalic, atraumatic. PERRLA, EOMI. Fundi benign
without papilledema. TMs pearly gray with good light reflex. Oropharynx
clear.
• Neck: Supple, no lymphadenopathy, no thyromegaly.
• Cardiovascular: RRR without murmurs, rubs, or gallops. Peripheral pulses
2+ and equal.
• Respiratory: Clear to auscultation bilaterally, no wheezes, rhonchi, or
crackles.
• Abdominal: Soft, non-tender, non-distended. Normoactive bowel sounds.
No hepatosplenomegaly.
• Neurological: CN II-XII intact. Motor strength 5/5 all extremities. Sensation
intact to light touch. Reflexes 2+ and symmetric. Finger-to-nose and heel-to-
shin intact. Gait normal.
• Skin: Warm, dry, intact. No rashes or lesions.
• Musculoskeletal: Full range of motion all joints. No tenderness or swelling.
4. Problem Assessment (PA)
Based on the history and physical exam, the patient's primary problem
is: Declining academic performance and inattention (onset 4-6 months ago)
without other medical or psychiatric symptoms.
