| Author | 8 Posts |
dr_jojo
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previously healthy 2-year-old boy is brought
to the physician
20 minutes after an episode of cyanosis and loss of
consciousness that
lasted 3 minutes. The symptoms occurred after his
mother scolded him
for climbing onto the dining room table. The mother
says that the child
began to cry, let out a deep sigh, stopped breathing,
and jerked his
arms and legs back and forth. On arrival, he is alert
and active.
Neurologic examination shows no focal findings. Which
of the following is
the most appropriate next step in management?
A
) Reassurance
B
) >Electroencephalography
C
) CT scan of the head
D
) Anticonvulsant therapy
E
) Lumbar puncture
Edited by dr_jojo on 03/23/07 - 05:38 AM
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| robin082006
Forum Hero
Topics: 471
Posts: 5,125
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A Reassurance
1st time seizure in children--->reassurance
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| fongch
Forum Elite
Topics: 71
Posts: 316
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A looks most likely to me.
None of the other options make sense
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| coolmavs
Forum Elite
Topics: 21
Posts: 327
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reassurance, any more thoughts? esp since no neurologic signs are present and this is the 1st episode
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| dr_arc
Forum Senior
Topics: 5
Posts: 156
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reassurance.
the seizure ocured as a result of the child's breath holding which in turn was a response to the mother's scolding.usually seen in kids under 3. you scold them, they hold their breath , turn blue and sometimes faint . no neurological deficits.
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| liliaeliz
Forum Elite
Topics: 38
Posts: 351
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B
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| elitoki
Forum Guru
Topics: 54
Posts: 508
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Answer is A. Pt has Breath Holding Spells.
Breath-holding spells is a paroxysmal event in which a child stops breathing at end-expiration after crying, typically because of pain or anger. The crying may be brief or prolonged. Breath-holding spells are classified as simple, cyanotic, or pallid. A simple breath-holding spell results when the child becomes apneic (cyanotic or pale) but then takes a deep breath. Spells with loss of consciousness and muscle tone are classified by the child's color during the event. Cyanotic spells typically have an emotional precipitant (eg, anger, frustration), and with breath holding, the child progresses from cyanotic to apneic. The child may then become limp and lose consciousness.
The spell typically lasts less than 1 minute. An enhanced vagal response has been postulated to be a precursor to bradycardia or asystole. Seizures rarely result.
These are common in up to 4-5% of children younger than 8 years and peak at 2~3 yrs old with same incidence for girls and boys.
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| liliaeliz
Forum Elite
Topics: 38
Posts: 351
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yes elitoki ,first time reassurance if cpersist rule out seizure disorder thanks
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