drk1980
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A 4-year-old boy falls from the jungle gym at preschool. He sustains minor abrasions and contusions, and is taken care of by the school nurse. His parents take him that same afternoon to his regular pediatrician and demand "a thorough check-up" for possible internal injuries. The pediatrician complies, and a complete physical examination is normal. His hemoglobin is 14 g/dL, and a urinalysis shows the presence of microhematuria. Which of the following is the most appropriate next step in management?
A. CT scan of the abdomen and pelvis
B. Reassure the parents that microhematuria from minor trauma will resolve spontaneously
C. Serial hemoglobin and hematocrit determinations
D. Urologic work up starting with sonogram
E. Retrograde ureterogram and cystogram
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| drk1980
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Forgot to mention, i think this may be from kaplan qbank
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| SilatK
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b
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| drk1980
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try again SilatK.
Clue: it's a pediatric patient not adult
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| wyvern
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D
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| msyamp
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D
Edited by msyamp on 07/22/06 - 05:19 PM
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| shumaila
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d
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| drk1980
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good job!!
The correct answer is D. No one thinks this kid is going to bleed to death, or fears a major urologic injury. However, microhematuria after trivial trauma in children may be a sign of a congenital anomaly that makes the urinary tract unusually vulnerable. The warning should be heeded, and an anomaly sought. The first, noninvasive test should be the sonogram.
CT of the abdomen and pelvis (choice A) would be overreacting. No major intraabdominal or pelvic injuries are suspected.
Reassurance, on the other hand (choice B), would miss the significance of this laboratory finding.
Serial hemoglobins (choice C) misses the significance of the situation. We are not concerned with the magnitude of the bleeding (it is microhematuria, not gross hematuria).
Retrograde studies (choice E) would be too invasive to be used as the first test. Sonogram will probably give the diagnosis if there is a problem, and intravenous pyelogram could be added if needed.
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