MDcooper
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24. 5-year-old boy is brought to his pediatrician's office after he falls from his bicycle and strikes his head against the sidewalk. There were no witnesses to this incident, which occurred 8 hours ago. The child is otherwise healthy, up-to-date on his immunizations, and not taking any medications. On physical examination, his vital signs are stable. He has a 5 ¢² 4 cm abrasion on his forehead. He is alert and oriented to date, place and self. His motor and sensory examinations are normal and reflexes are normal. Which of the following constitutes reasonable management?
A. Admit overnight for observation
B. Instruct parents to observe neurological status for 24 hours
C. Obtain a head computerized tomography scan
D. Obtain a skull x-ray film and discharge if normal
E. Obtain a skull x-ray film, observe for 24 hours and discharge
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| prathapdoctor
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B. instruct parent to observe neurological status at home for 24 hrs.in this case there is no history of loss of conciousness so there is no need of CT and there is no indication for any investigation after examination.
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| Guptashutosh
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wel i think its C , no one witnessed him dureing the fall so u never know whether he lost conciousness , better to get the ct head done and rule out any bleeding
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| chemamr
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good point Gupta.
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| MDcooper
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i thought the same but explaination says send home and let the parents obesrve.
The correct answer is B. The patient has no findings on history or examination. An intracranial bleed or severe brain injury is not likely. If present, symptoms should have become manifest within several hours of the injury. Thus the parents should be advised to monitor for somnolence, vomiting, seizures and severe headaches, and to return if these occur. Overnight admission (choice A) would be of little value since the patient has been symptom-free for 8 hours already. A head CT (choice C) would be helpful in detecting an acute bleed due to injury to blood vessels, or to the brain tissue itself. Such trauma would likely be accompanied by somnolence and mental status changes. Were such signs present, an emergent head CT would be required. A head CT would be the preferred study in cases of symptomatic head injury instead of a skull x-ray film (choice D), since it is more likely to show the injury. A skull x-ray film would not necessarily rule out the pathology. Also, since the injury was 8 hours ago, admitting would not add much value. Observation at home is advisable (choice E).
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