Differential Diagnosis for a Painful Examination in a 6-Year-Old

Given the limited information, we'll consider a range of possibilities that could cause pain during a physical examination in a child. The differential diagnoses are categorized as follows:

• Single Most Likely Diagnosis
  • Musculoskeletal injury (e.g., fracture, sprain): This is a common cause of pain in children, especially if they are active or have recently experienced a fall or other trauma.
• Other Likely Diagnoses
  • Infection (e.g., osteomyelitis, septic arthritis): Infections can cause significant pain, especially if they involve the bones or joints.
  • Appendicitis: Although more commonly associated with abdominal pain, appendicitis can sometimes cause pain that is exacerbated by movement or pressure during an examination.
  • Constipation: Severe constipation can cause abdominal pain that may be worsened by examination.
• Do Not Miss Diagnoses
  • Testicular torsion: A surgical emergency that can cause severe pain, often sudden in onset, and may be exacerbated by examination.
  • Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause severe abdominal pain and may be worsened by examination.
  • Ectopic testis or undescended testis with torsion: Similar to testicular torsion, this condition requires immediate attention.
• Rare Diagnoses
  • Leukemia or other bone marrow malignancies: These conditions can cause bone pain due to infiltration of malignant cells into the bone marrow.
  • Sickle cell crisis: In children with sickle cell disease, a crisis can cause severe pain due to vaso-occlusion in various parts of the body, including bones and joints.
  • Neuroblastoma: A type of cancer that can cause pain if it involves the spine or other areas that might be tender to examination.

Each of these diagnoses has a different level of urgency and requires a tailored approach to diagnosis and management. A thorough history and physical examination, along with appropriate diagnostic tests, are crucial for determining the cause of pain in a child.