Share This Link

Sickle-cell anemia typically presents with normocytic anemia and may include signs such as dactylitis, splenomegaly, or pain crises. It is not characteristically microcytic or hypochromic, and the absence of hepatosplenomegaly makes this diagnosis less likely in a 12-month-old.

Hereditary spherocytosis is associated with normocytic anemia and spherocytes on peripheral smear. It often presents with splenomegaly and jaundice, which are absent in this case. Additionally, the anemia described is microcytic and hypochromic, which is not typical of hereditary spherocytosis.

Lead intoxication can cause microcytic anemia, but it is usually associated with other signs such as developmental delay, irritability, or basophilic stippling on smear. The absence of environmental exposure history and the clinical presentation make this less likely than iron deficiency.

Transfusions may be necessary in cases of severe anemia or hemodynamic instability, but they are not the first-line approach for reticulocytopenia unless the child is symptomatic with cardiovascular compromise. This option is premature without further evaluation.

Iron supplementation is appropriate for iron-deficiency anemia, but reticulocytopenia following a viral illness suggests transient red cell aplasia, such as in parvovirus B19 infection. Iron would not be effective in this context.

While observation may be considered in mild cases, the presence of reticulocytopenia and clinical symptoms warrants specialist input to rule out serious causes such as aplastic anemia or bone marrow failure syndromes. Passive observation alone is insufficient.

Waiting 6 months may delay diagnosis and treatment of a potentially correctable visual impairment. Early intervention is crucial in preventing long-term deficits in visual development.

Retesting in 1 month may still yield unreliable results if the child remains uncooperative. Without specialized tools or expertise, the primary care setting may not be sufficient for accurate assessment.

A 1-year delay is inappropriate for a child with subnormal vision and poor cooperation. This could risk missing a critical window for visual correction and neurodevelopmental optimization.

While intermittent strabismus may be normal in infants under 2 months, persistent esotropia at 4 months is concerning. Reassurance alone is not appropriate at this age.

Patching is a treatment for amblyopia and may be used after a diagnosis is confirmed. It is not initiated without specialist evaluation and may be inappropriate if the underlying cause is not yet identified.

Rechecking in 2 to 4 weeks may delay necessary intervention. Early referral ensures timely diagnosis and management, which is critical for preventing amblyopia and ensuring proper binocular vision development.

Transfusions are reserved for severe symptomatic anemia or hemodynamic instability. This child’s presentation suggests bone marrow suppression, which requires further evaluation before initiating transfusion therapy.

Iron supplementation is ineffective in cases of reticulocytopenia due to viral-induced marrow suppression. Iron is only indicated if iron-deficiency anemia is confirmed.

Observation alone is insufficient when reticulocytopenia is present. Delaying specialist input could risk progression of marrow failure or missed diagnosis of serious hematologic conditions.

Routine use of earplugs during bathing is no longer universally recommended unless the child is swimming in untreated water or has a history of otorrhea. Overprotection may be unnecessary and burdensome.

PETs typically remain in place for 6 to 12 months, not 3 to 4 years. They usually fall out spontaneously, and prolonged retention may require removal.

Improved hearing may occur, especially if effusion was present prior to tube placement. However, this is not guaranteed and should not be the sole expectation conveyed to parents.

Transfusions are typically reserved for cases of severe anemia with hemodynamic instability or symptomatic hypoxia. In this scenario, the anemia is accompanied by reticulocytopenia, which suggests bone marrow suppression, not necessarily requiring immediate transfusion.

Iron supplementation is appropriate for iron-deficiency anemia, which presents with microcytic, hypochromic indices and elevated reticulocyte count. Reticulocytopenia following a viral illness suggests transient aplastic crisis or marrow suppression, making iron therapy ineffective.

Observation alone may delay diagnosis and treatment. While monitoring is part of care, the presence of reticulocytopenia and clinical symptoms warrants expert input to guide further diagnostics and prevent complications.

Routine monitoring of hemoglobin and hematocrit is not sufficient to prevent iron deficiency. It is a reactive measure and does not address the need for proactive supplementation in exclusively breastfed infants.

A dose of 3 mg/kg/day is excessive for routine prophylaxis in healthy, term, breastfed infants. This dosage is typically reserved for treatment of confirmed iron-deficiency anemia.

Iron-fortified formula is an alternative for infants not exclusively breastfed. However, in this case, the mother plans to continue breastfeeding, so supplementation is preferred over formula substitution.

Middle ear effusion typically results in a flat tympanogram (Type B), indicating poor mobility of the tympanic membrane due to fluid accumulation. A sharp peak is not characteristic of effusion.

Tympanic membrane perforation is also associated with a flat tympanogram or large ear canal volume, not a sharp negative peak.

A normal tympanic membrane shows a peak near 0 mm H₂O (Type A tympanogram). A peak at -180 mm H₂O is outside the normal range and indicates pathology.

Irrigation may worsen inflammation and is contraindicated in cases of severe swelling or when the tympanic membrane status is unknown. It is not a standard next step in refractory otitis externa.

Oral antibiotics are generally reserved for cases with systemic involvement or extension beyond the ear canal. Topical therapy remains first-line unless complications arise.

Systemic corticosteroids are not routinely used for otitis externa and carry risks. They may be considered in severe allergic or inflammatory cases but are not first-line for persistent canal swelling.