peraspera
Forum Elite
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A 5-week-old full-term female infant is presented to the emergency department (ED) by her parents. The mother states that the baby had been doing well until a few days ago, when she started to become fussy and irritable; since then, she has had episodes of vomiting, and swelling has developed around her right eye. She was feeding poorly the day before presentation, and the parents state that the infant has been “tired” for the last several hours.
On physical examination, the infant is irritable and listless. She has mild swelling with ecchymosis around the right eye, with an additional area of ecchymosis on the right knee. Her anterior fontanelle is bulging and her right pupil is dilated and unresponsive. A nonenhanced computed tomography (CT) scan of the infant’s head is ordered, but during preparation for scanning, the patient develops shallow breathing and hypoxia, with an oxygen saturation of 80% while breathing room air. This condition progresses to apnea and a decrease in her heart rate to 60 bpm. Atropine is administered, and the patient is intubated.
The CT scan of the infant’s head is performed (see Image).
Laboratory investigations are initiated, and they show the following values: on complete blood count, the white blood cell count (WBC) is 20.6 Ч 109/L (20,600/mm3); hemoglobin (Hgb), 89 g/L (8.9 g/dL); hematocrit (Hct), 0.273 (27.3%); and platelets (Plt), 516 Ч 109/L (516 Ч 103/mL). Additionally, blood urea nitrogen (BUN) is 5 mmol/L (14 mg/dL); creatinine, 17.7 mmol/L (0.2 mg/dL); aspartate aminotransferase (AST), 121 U/L; alanine aminotransferase (ALT), 149 U/L; total protein, 76 g/L (7.6 g/dL); and albumin, 46 g/L (4.6 g/dL). Prothrombin time (PT) is >50 s, and activated partial thromboplastin time (aPTT) is 90.6 s.
What is the diagnosis?
A. Subdural hematoma
B. Epidural hematoma
C. Embolic occlusion of posterial cerebral artery
D. Vitamin K deficiency
E. Subdarachnoid hemorrage
G. Orbital fractures
http://master.emedicine.com/email/radio/radio142/...
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| donjuan
Forum Junior
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Posts: 68
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i would go for D and this causes an intraventricular bleed correct me if i am wrong
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| Kamsi
Forum Guru
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A Subdural hematoma
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| hanialkhadher
Forum Elite
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Posts: 256
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A. Subdural hematoma
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| peraspera
Forum Elite
Topics: 38
Posts: 233
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The answer is :
http://master.emedicine.com/email/radio/radio142/...
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| me007
Forum Guru
Topics: 72
Posts: 803
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thank you, good qs , good explanation.
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