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A 12-yr-old white girl presents with arthralgias of the knees and elbow and swollen hands of 6 months’ duration. She has had intermittent fever and has lost 15 lb. Other than swollen joints, findings on physical examination are normal. Three years earlier, she was found to have thrombocytopenia and was diagnosed with idiopathic thrombocytopenic purpura (ITP). In addition,one summer she had severe sunburn, and 2 yr ago she had mouth sores.Today she has a hematocrit of 25% and a positive result on a Coombs test,and the urinalysis shows multiple red blood cells.
The most likely diagnosis is:
A newborn infant is noted to have dysmorphic features. The pregnancy was complicated by breech presentation, decreased fetal movements, and polyhydramnios. The child demonstrates hypotonia, a flat face, flattened occiput, epicanthal folds, and abdominal distention.
The most likely cause of this child’s dysmorphology is:
A 5 yr old is noted by the parents to snore at night. The child also has had problems staying awake in preschool and has had behavioral problems. The father also snores. Physical examination of the child reveals large, pink, nonexudative tonsils.
The most appropriate next step is: