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The Case of Nick Smith

Decent Essays

Mr. and Mrs. Smith bring their son Nick to the clinic a few weeks early for his 12 month follow up. The nurse, Joel, measures Nick’s height, weight and vital signs. Joel notices that his weight is only around the 25th percentile for his age. After a brief screening with Joel, Dr. Mike Leonard, the pediatrician, enters the room for the appointment. He greets the family cheerfully and asks how Nick is doing. Mr. and Mrs. Smith express concern. Nick has been finicky about eating since the last appointment and does not seem to have gained much weight. In addition to that, Nick is frequently cranky and no longer likes being picked up and held. He has also been displaying less activity lately. He just doesn’t seem to have the energy. He is not the sweet, sociable, enthusiastic child they are used to. The doctor comments that he had noticed that Nick did not seem as alert and cheerful as he had on previous visits. The parents are especially distressed that Nick has still not yet begun to crawl at an age when many children are already walking. The doctor examines Nick. The child’s skin appears pale. Dr. Leonard discovers a small lump on Nick’s abdomen. Nick does not appear distressed when the doctor examines the lump. He also tests Nick’s reflexes and motor coordination. They are not as good as they should be. What might be causing Nick’s pallor? What are some possible causes of Nick’s weight loss? What might Dr. Leonard suspect is wrong with Nick? What tests should Dr. Leonard

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