USMLE Forum Archives - USMLE Step 2 CK - Peds 17
Peds 17
TheOne - 06-25-07 15:14
A 5 years old girl falls from the jungle gym at preschool. She sustains minor abrasions and contusions, and is taken care of by the school nurse. Her parents take her that same afternoon to her regular pediatrician and demand "a thorough check-up" for possible internal injuries. The pediatrician complies, and a complete physical examination is normal. Her hemoglobin is 13 g/dL, and a urinalysis shows the presence of microhematuria. There are no additional signs of bleeding. 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 workup, starting with a sonogram
E. Retrograde ureterogram and cystogram
TheOne - 06-25-07 15:14
A 5 years old girl falls from the jungle gym at preschool. She sustains minor abrasions and contusions, and is taken care of by the school nurse. Her parents take her that same afternoon to her regular pediatrician and demand "a thorough check-up" for possible internal injuries. The pediatrician complies, and a complete physical examination is normal. Her hemoglobin is 13 g/dL, and a urinalysis shows the presence of microhematuria. There are no additional signs of bleeding. 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 workup, starting with a sonogram
E. Retrograde ureterogram and cystogram
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#2
Re: Peds 17 jwang - 06-26-07 02:20 I am going to pick B because honestly there is probably nothing wrong with the girl. If the way she fell on the jungle gym caused trauma to her genitalia then she would have a small amount of blood in her urine and that will go away on its own. However the parents sound like the type to sue so in real life if they are insistent and have insurance then perhaps I'd get a CT of her abdomen and pelvis. But I'm still sticking with my answer of B.
#3
Re: Peds 17 nrp - 06-29-07 12:19 The answer is D.Microscopic hematuria in children always need further work up to find out the cause.In adults on the otherside microscopic hematuria doesn't need further work up.
#5
Re: Peds 17
TheOne - 07-08-07 14:08 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.
#6
Re: Peds 17 bingousmle - 06-20-10 08:27 the child has had trauma and has evidence of microhematuria with the patients parents demand "a thorough check-up" for possible internal injuries start with USG
#7
Re: Peds 17 babbu5508 - 06-20-10 13:50 D. Urologic workup, starting with a sonogram...to evaluate the cause of microhaematuria...an ultrasound may give a clue to diagnosis of associated conditions
#9
Re: Peds 17 bingousmle - 06-30-10 17:53 such case scenarios which judge the high yields on ethics can be confusing at times so it is important to address the primary question though it might not be the standard of care
#10
Re: Peds 17 babbu5508 - 07-10-10 03:32 Microhematuria is in contrast to gross hematuria in which the blood is so plentiful that it is visible grossly with merely the naked eye.
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