Heres a TWO part Challenger for you today! Hope you have a great week! A nine-month old female is brought to the nurse practitioner for a well visit. Mother states she has no concerns or questions; however, the child has had a clear runny nose and dry cough with a small swollen gland in her right neck for about 3 weeks. Other than that, the mother is happy with her daughter’s growth and development. When questioned about the infant’s appetite, the mother states that over the past few weeks, it has decreased but she thinks it may be related to her increased activity with crawling, attempting to walk, and transition from baby food to table foods. Mother denies crankiness, fever, or unusual behavior in the infant. Diaper changes for urine and stool were normal according to history. The last visit was at the 6-month-well-visit and her weight was 16 pounds 2 ounces (50%ile; 7.25kg) and height was 25.5 inches (50%ile; 64.77 cm). Vital signs were WNL. She is up to date on immunizations. Growth and development is age appropriate. She is an only child and lives with both parents and the family pet, a house cat. Mom stays at home with the infant and dad is a lawyer who works outside the home. Father smokes occasionally, mother non-smoker. Examination reveals a slightly pale appearance, slight tachypneic but otherwise friendly 9-month-old. Weight is 17 pounds (25%ile; 7.71kg); height 33 inches (50%ile; 83.82 cm); heart rate 165 beats per minute; Respiratory rate 30 breaths per minute; temperature 99.6°F (axillary); pulse O2 98.5%; gingival swelling; Chest: CTA bilaterally; Heart: II/VI systolic murmur; lymph nodes: cervical: 3 cm right and 2 cm left firm but mobile, femoral: pea size, firm, moveable lymph node noted on left, 2 cm on right; abdomen: liver palpable 3.5 cm below right costochondral margin, spleen palpable 2.5 cm below left costochondral margin; skin: several small petechiae noted on upper chest, upper arms and legs. Full range of motion all extremities; neurologic: intact. Remainder of exam WNL. Based on the history and findings listed below: 1. What are the most likely differential diagnoses? a. Chronic myelogenous leukemia b. Infectious lymphadenopathy c. Congenital heart disease d. Acute lymphoblastic leukemia e. Non-Hodgkin’s lymphoma f. Idiopathic thrombocytopenia purpura 2. Which labs and tests should be ordered initially? (Select all that apply) a. CBC with differential and peripheral smear b. Chemistry profile c. Reticulocyte count and Erythrocyte sedimentation rate (ESR) d. Echocardiogram e. Chest X-Ray f. Bone marrow biopsy
Posted on: Mon, 28 Jul 2014 17:29:52 +0000