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History of Present Illness:
Ann is a 6 yo girl who is brought to the pediatric clinic. For the last week, her mother says she has been very tired, lacks energy, sleeps more than usual, and has not had much appetite. Upon assessment, you discover bruises on the little girls’ arms and legs that Karen can't explain. She says, "I had no idea those were there!" and looks embarrassed and worried.
Past Medical History:
Ann was full-term from an uncomplicated pregnancy and delivery. All immunizations are current. Ann had measles at age 3 yo.
Ann has one brother, age 8 years, who is in apparent good health. The maternal grandmother died at age 55 from rectal cancer.
Developmental milestones on target.
Alert, interactive, pale, height and weight normal for 6-yr-old
HT 41 inches
WT 37 lbs
What are all the possible reasons for these signs and symptoms? Do you remember normal values for pediatrics vital signs? What information could you ask for that would give you the most information for a diagnosis? What labs do you want? What other diagnostic tests should we run?