DrVirgo
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A 1-week old femald einfant is brought to the office by her 30 year old African-American mother because she has been "crying a lot". She was born at term. Her mother was diagnosed with gestational diabetes mellitus (GDM) at 24 weeks gestation adn has been on insulin injections since. During labor, there was a prolonged second stage due to difficulty in delivering teh shoulders. Her Apgar scores were 8 and 10 at 1 adn 5 minutes, respectively. Her birth weight is 3.8kg (8.5lbs). On examination, the infant is active. On sudden extension of the head, there is extension of all the extremities except for the left upper extremity. there is crepitus over the clavicular bone. Which of teh following statements is true for this baby?
A. This infant has a clavicular fracture and should be treated with a figure of 8 bandage
B. This is a clavicular fracture and the infant sould be evaluated for child abuse.
C. This is Erb Duchenne palsy due to difficult shoulder delivery.
D. This is a common outcome with large babies and related to gestational diabetes.
Please give a short explanation as to why your answer is right... thanks. 
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| Aashi
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D. This is a common outcome with large babies and related to gestational diabetes.
Clavicle is the MC fractured bone during diffcult delivery-->and it is associated with GDM moms with large babies,an absent unilateral moros reflex is the only notable sign on P/ex(which matches the hx given in the q)--->usually these fractures are self healing and no other treatment is required..
In erbs the arm is adducted,internally rotated and the palm is facing up( just like a waiter asking for a tip)-->here the P/EX doesnt support a erbs duchenne and hence r/o
GL
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| DrVirgo
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Thats right... My question is this... If this clavicle fracture occured during birth, why is it only being discovered NOW at 1 week? What about choice A?
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| robin082006
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What about choice A?
in children, this can spontaneously heal. Treatment when vessels are injured.
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| sprint123
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| Aashi
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Dear Dr virgo.why the fracture is discovered now,and not during the tme of delivery..i really dont have an answer to that.. probably a miss by the ob gyne/neonatologist or by the mom,but i strongly believe that this point in the q is a distractor,trying to point towards child abuse...but rest of the hx matches for a clavicular fracture due to difficult delivery.
and y not A--->i already explained it before,tht these are self healing,no t/t is required(u can go through kaplan PEDS for this info)
GL
Edited by Aashi on 03/18/07 - 02:32 PM
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| DrVirgo
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thanks... I just thought it was strange that they mentioned that the clavicle fracture was found a whole week AFTER delivery (makes it sound like its a NEW finding that just happened, instead of something which happened at birth) -thats why I was confused, but you are right...
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