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Prep4USMLE Forum » USMLE Step 2 CK Forum » Pediatrics Forum

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NE
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05/15/07 - 10:49 AM

A 3-month old infant is brought to a pediatrician's office because of increased lethargy and irritability. The parents state that the child rolled off the couch and fell on the floor one day prior to presentation. His parents report that the child has been previously healthy and is up to date on his vaccinations. He has been meeting his development milestones. His fontanelles are full. While in office the patient develops a tonic clonic seizure. Which of the following is the next appropriate step?

A. Obtain a head computerized tomography scan
B. Perform a retinoscopic examination
C. Check serum levels of ammonia
D. Administer intravenous benzodiazepines
E. Perform a lumbar puncture

virgola82
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05/16/07 - 06:13 AM

D? Try to stop the seizure first?

NE
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05/16/07 - 08:25 AM

This is why I posted the q. I answered D but the correct answer is B. If the patient has a seizure what is more important NOW?? Anyway how I can do retinoscopic exam in the middle of a seizure?

zhoufg
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05/16/07 - 09:34 AM

yes. It sounds like abuse. but she is seizuring, ?

sprint123
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05/16/07 - 10:14 AM

I think the rationale could be : We don't treat first time GTC in a neonate (though H/o child abuse is obvious-3 month infant can't roll).

perform fundoscopic examination and a skeletal survey to rule out rfactures and close observation is needed.

It is not 100% convincing but I think this might be possible!

Any suggestions?

smarty
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05/29/07 - 01:06 AM

i would say ruling out the cause and investigations would be more appropriate than administrating benzodiazepines immediately. what do u think docs?

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doc_clotaire
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05/31/07 - 04:20 PM

It 's a very tricky question and it ' s a jugment call .

In real life we might take care of the seizure first but for board purpose , they are stressing us to recognize child abuse because it 's so frequent and it 's a diagnosis that you cannot afford to miss . So since her story doesn ' t match with the reality (3 month shoudn ' t roll off the couch)

so the answer is :

B. Perform a retinoscopic examination

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cirus
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06/07/07 - 11:59 AM

I had almost the same quest in UW but for an adult, the answer is B and they explained that even though there are signs of neuro def, u should always make a retinal exam before u do a CT or administer an meds

Lenin
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06/12/07 - 05:07 PM

Seizures usually lasts 1-2 min. Retinoscopy to confirm baby shaking syndrome.

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