A 5 years old boy presents with joint swelling after minor trauma, mother gives history of prolonged bleeding from circumcision site. His platelets count is 170000, PT is 10 seconds and APTT is 60 seconds. What is most likely the diagnosis?

Correct Answer: D

Rationale: In this scenario, the most likely diagnosis for the 5-year-old boy with joint swelling after minor trauma and a history of prolonged bleeding from a circumcision site is Hemophilia. Hemophilia is a genetic disorder that impairs the blood's ability to clot properly, leading to prolonged bleeding. The boy's normal platelet count of 170,000 rules out Idiopathic Thrombocytopenic Purpura (ITP), which is characterized by low platelet counts. Platelet function defects primarily affect platelet aggregation and function, not the clotting factors involved in Hemophilia. Von Willebrand disease is a common inherited bleeding disorder, but it typically presents with mucocutaneous bleeding rather than joint swelling and prolonged bleeding after minor trauma. Educationally, understanding the key clinical features and laboratory findings associated with different bleeding disorders is crucial for healthcare providers, especially in pediatric primary care settings. Recognizing the distinctive presentations of these conditions helps in making accurate diagnoses and providing appropriate management and referrals. This case highlights the importance of a thorough history, physical examination, and interpretation of laboratory tests in pediatric patients presenting with bleeding symptoms.

Correct Answer: B

Rationale: The correct answer to the question is option B: "We will not contact your parents regarding this visit." This response respects the 18-year-old patient's autonomy and confidentiality as a legal adult seeking healthcare services. In pediatric primary care, healthcare providers must uphold the principles of confidentiality and patient privacy, especially when dealing with sensitive issues like sexual health. Option A, "We will need to contact your parents," is incorrect as it violates the patient's right to privacy and confidentiality. Option C, "Who would you like us to contact about your visit today?" is not the best response in this situation because it puts the burden on the patient to make a potentially uncomfortable decision about who should be informed. Option D, "We cannot promise that the hospital will not contact your parents," is also incorrect as it does not affirm the patient's right to confidentiality and may deter the patient from seeking necessary care. In an educational context, it is crucial to teach healthcare providers, especially those working in pediatric care, about the legal and ethical considerations surrounding confidentiality and informed consent for adolescent patients. Understanding and respecting the rights of adolescent patients to confidential healthcare services is essential for building trust and ensuring that young individuals feel comfortable seeking medical care when needed. Healthcare providers must be knowledgeable about the laws and guidelines that protect adolescent confidentiality to provide appropriate care while respecting the autonomy of their patients.

Correct Answer: D

Rationale: In pediatric primary care, obtaining a urine sample in infants for evaluation of UTI requires a gentle and effective method. The best method for obtaining a urine sample in an 8-month-old being evaluated for a UTI is option D) Perform an in-and-out (straight) catheterization. This method is preferred because it provides a sterile sample directly from the bladder, minimizing the risk of contamination and ensuring accurate test results. It is also less invasive compared to an indwelling Foley catheter, which carries a higher risk of complications in infants. Option A) using a urine collection bag may lead to contamination from the perineum and is not recommended for accurate testing. Option C) placing a sterile cotton ball in the diaper is unreliable and may not yield a sufficient sample for testing. Educationally, it is important for healthcare providers to be aware of the most appropriate and accurate methods for obtaining urine samples in infants to ensure proper diagnosis and treatment of UTIs, highlighting the significance of evidence-based practices in pediatric care.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) weight. At 1.5 years of age, a child who was born prematurely at 32 weeks may exhibit suboptimal growth due to their early arrival. Weight is a crucial growth parameter to monitor in pediatric care, especially for premature infants, as it directly reflects nutritional status and overall health. By focusing on correcting the child's weight, healthcare providers can ensure that the child receives adequate nutrition for proper growth and development. Height (option B) and body mass index (option C) are also important growth parameters to monitor in pediatric care. However, in this specific case of a prematurely born child with suboptimal growth, weight takes precedence as it can be more directly impacted by nutritional intake and can be a more sensitive indicator of growth faltering. Head circumference (option D) is primarily used to assess brain growth and development, particularly in infants. While it is an important measurement, correcting head circumference is not the primary concern in this scenario where overall growth and nutritional status are the main focus. Educationally, understanding the significance of different growth parameters in pediatric care is crucial for healthcare providers to effectively monitor and address the growth and development of children, especially those with unique circumstances such as premature birth. By prioritizing weight correction in this case, healthcare professionals can ensure that the child receives appropriate interventions to support healthy growth and overall well-being.

Correct Answer: C

Rationale: In the context of pediatric primary care, enuresis, or bedwetting, is a common concern among children. The correct answer to the question is C) urinalysis. Urinalysis is the recommended test for most children with enuresis because it can help identify underlying issues such as urinary tract infections, diabetes, or other medical conditions affecting the urinary system. Choosing option A) blood sugar is incorrect because enuresis is primarily a urological issue rather than a metabolic one. Option B) serum electrolytes is also incorrect because electrolyte imbalances are not typically associated with enuresis in children. Option D) abdominal sonography is not the first-line test for enuresis unless there are specific indications such as suspected structural abnormalities in the urinary tract. Educationally, understanding the appropriate diagnostic tests for common pediatric conditions like enuresis is crucial for primary care providers. It helps in making accurate assessments, providing timely interventions, and ensuring optimal care for pediatric patients. By knowing when to order specific tests like urinalysis, healthcare professionals can address enuresis effectively and improve the quality of care for children experiencing this issue.