determine
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A 7-year-old boy is brought to a physician's office after falling from his bicycle and striking his head on the sidewalk. No adult was present, and his friends are unable to give a reliable history. Neurological examination reveals no abnormalities; there is a 3-4 cm abrasion on the left forehead. Which one of the following is the most appropriate management?
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1) CT scan
2) overnight admission for observation
3) skull x-ray and discharging the patient if normal
4) instructions to the mother to observe the patient's neurological status during the next 24 hours
5) a skull x-ray, 24-hour observation, and discharge
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| babli
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4)
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| usmle_2
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4) instructions to the mother to observe the patient's neurological status during the next 24 hours
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| msyamp
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4
Edited by msyamp on 04/16/06 - 09:04 PM
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| Reddoc
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shouldn't it be 1? Since clear history ruling out loss of consciousness is not available here- we shud get a CT . If an adult was present stating clearly that there has been no loss of con. then 4 wud be appropriate.
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| msyamp
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http://www.nice.org.uk/page.aspx?o=CG004fullguide...
i think 4 is the answer. after doing research in pubmed and lot of other journals 
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| Reddoc
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alright.... thanx msyamp !!!
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| achilles
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i went for 5 but was not at all sure about the answer. thanks msyamp.
but i am not clear about this point, the question says that the child's friends could not give a clear history and the question does not say that the child is accompanied by an adult...would we discharge the child in such a situation when he is not accompanied by an adult or are we required to admit the child for Ix and observation ?
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| msyamp
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even if he had loss of consiousness unless he has Glsgow coma scale <13 and /or other neurological signs I dont think we need to do a CT. and yes!! it is preferable to observe at the hospital first. if they dont agree to stay then it is better for mthers observation. So actually
2 IS THE ANSWER
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| achilles
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gr8. thanks msyamp.
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| determine
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thanks doctors, you are all great!
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