sunny2
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A 9 month old boy is brought to the clinic by his 35 year old mother from Germany, for the past several months the boy has been bumping into objects, perinatal history is unremarkable. Ophthalmologist Dr.Schnider examined the boy at General hospital and reports that the physical examination of the eyes reveals white reflex, he cannot see the retina properly, he states that fundal reflex is absent and the pupil is white. What is the most likely diagnosis ?
1. Pterygium
2. Congenital Glaucoma
3. Conginital Cataract
4. Retinoblastoma
5. Eye injury
6. Pituitary tumor
7. Brain Lesion
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| frank100
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perhaps this is retinoblastoma, but cingenital cataract is a better guess...
my answer is (3), because there is saying that the pupil is white. so thatīs not consistent wth a retinal mass.
because the mom is german, the probability of TORCH is not likely (for me).
brain lesion would present as focal manifestation.
pituitary tumor, would not explain the eyeīs white reflex.
eye injury.
sometimes congenital cataracts develop shortly after birth, and this baby could have lost control appointments In germany, since mommy migrated to the US.
if mom was from a developing country, I would, for sure, choose (3). but physical exam always over history.
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| aml
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4 retinoblastoma
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| frank100
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the question is tempting you to choose retinoblastoma, but why do they insist saying that Dr. schnider, cannot see the retina at all? humm, Iīm a little bit paranoid, but...
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| frank100
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retinoblatoma is a retinal tumor, if you see the tumor, you see the retina itself...
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| GDS2008
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The answer is C. Congenital catarzct. Although one of the most serious causes of leukocoria (white reflex) is retinoblastoma (which needs to be ruled out in all cases), the most common cause is congenital cataract. On the basis of this, I will put my money on C. Congenital Cataract.
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| frank100
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Mr sunny2, would you please post the answer?, I just canīt handle it...
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| sunny2
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frank100, I will post the answer shortly but please have some more people think of it , it's a nice trap question and usmle loves to throw these traps !!
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| frank100
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letīs do it by elimination:
1. is superficial, any ophtalmogist in this world would have made the diagnosis just by doing a physical exam.
2. In germany, this disease should have been diagnosed from the beginning, and clinical history doesnīt follow the same path as thi one.
4.retinoblastoma: the buzz word "eye white reflex" makes you think immediately of retinoblastoma, but it is demonstrated that buzzwords are used by the USMLE people to lead you to the wrong answer...if ou read the whole presentation, this little boy is 9 months old. so you wouldnīt expect him to walk very well, so it is normal for him to be bumping on objects...and white reflex in retinoblastoma is seen in the photograph, not by just looking at the affected eye.
5. this one, would have been noticed even by mommy.
6. no focal stuff
7.brain lesion. not convinced at all about this one.
3. is my answer. thatīs my final answer
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| GDS2008
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Sunny -- I think we have reached a conclusion as to what the most likely answer would be. Can you please provide with your answer now...Thanks!
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| som
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C is the ans. retinoblastoma is the obvious trap here. but the point is congenital catract is the most common cause of white reflex (i'm not gud at the no's here) , BUT when a child presents with white reflex, RETINOBLASTOMA HAS TO BE RULED OUT. the que is asking what is the most likely cause, not what has to be ruled out.
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| frank100
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do you have the real explanation?
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| sunny2
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Answer is 3. Congenital Cataract and the explanation given by som is the right explanation for the answer.
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| frank100
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I developed almost 3 berry aneurysms since you posted this question. If you donīt want to provoke a SAH in a coleague, please post the answer SUNNY2...ohh, actually Iīm having chest pain...!!!!
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| frank100
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ok, sunny. Iīm posting from heaven (that means that you have just kill me), whatīs the answer...
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| sunny2
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hey , please.....answer is allready posted and you've done great in pointing out the correct answer so US people need you ...you would surely pass with great score frank100.
again the answer is 3 congenital cataract and the explanation is as written by som.
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