Q 1:
A 2-month-old infant is brought to the emergency department with irritability and lethargy. The parents state that he was well until he rolled off the couch on to the floor yesterday. On examination, he is inconsolable and afebrile. The fontanels are full and tense. He has a generalized tonic-clonic seizure. Which of the following is the most important initial diagnostic study to order?
(A) serum calcium, phosphorus, and magnesium levels
(B) analysis of cerebrospinal fluid (CSF)
(C) cranial computed tomography (CT) scan
(D) serum ammonia level
(E) serum acetaminophen level
Answer :
(C)
Though infection must be considered as an etiology, acute trauma is more likely in this scenario.
This case represents the classic picture of the shaken baby syndrome which produces intracranial trauma without obvious external findings. This infant is critically ill and lacks preceding illness or constitutional symptoms.
The tense fontanels reflect increased intracranial pressure. Acranial CT scan may show diffuse edema or a localized lesion, such as a subdural hemorrhage. Metabolic causes of seizures do not cause increased intracranial pressure. Acetaminophen toxicity does not cause CNS symptoms.
----
Q 2:
A5-year-old pedestrian is hit by a car in a mall parking lot and he is brought to the emergency department. There was loss of consciousness for less than 1 minute. On evaluation, the child has no neurologic deficits and a CT scan of the head reveals no intracranial abnormalities and no obvious skull fractures. The parents want to know what possible long-term problems there might be. You remember that problems after head trauma may include the development of seizures and that the risk of developing posttraumatic epilepsy is increased by which of the following?
(A) a brief loss of consciousness
(B) an acute intracranial hemorrhage
(C) retrograde amnesia
(D) posttraumatic vomiting
(E) a small linear skull fracture
Answer
(B)
Late posttraumatic epilepsy is diagnosed when a seizure occurs for the first time more than 1 week after a head injury. Factors that correlate with an increased risk of developing posttraumatic epilepsy include presence of a depressed skull fracture, acute intracranial hemorrhage, cerebral contusion, or unconsciousness lasting more than 24 hours. Because the risk of a subsequent seizure is approximately
75%, acute and chronic treatment with anticonvulsants is indicated. Loss of consciousness,
retrograde amnesia, and vomiting are relatively common immediate consequences of head trauma. They are usually transient and are not highly correlated with a risk of subsequent posttraumatic seizures.
Answer :
(C)
Though infection must be considered as an etiology, acute trauma is more likely in this scenario.
This case represents the classic picture of the shaken baby syndrome which produces intracranial trauma without obvious external findings. This infant is critically ill and lacks preceding illness or constitutional symptoms.
The tense fontanels reflect increased intracranial pressure. Acranial CT scan may show diffuse edema or a localized lesion, such as a subdural hemorrhage. Metabolic causes of seizures do not cause increased intracranial pressure. Acetaminophen toxicity does not cause CNS symptoms.
----
Q 2:
A5-year-old pedestrian is hit by a car in a mall parking lot and he is brought to the emergency department. There was loss of consciousness for less than 1 minute. On evaluation, the child has no neurologic deficits and a CT scan of the head reveals no intracranial abnormalities and no obvious skull fractures. The parents want to know what possible long-term problems there might be. You remember that problems after head trauma may include the development of seizures and that the risk of developing posttraumatic epilepsy is increased by which of the following?
(A) a brief loss of consciousness
(B) an acute intracranial hemorrhage
(C) retrograde amnesia
(D) posttraumatic vomiting
(E) a small linear skull fracture
Answer
(B)
Late posttraumatic epilepsy is diagnosed when a seizure occurs for the first time more than 1 week after a head injury. Factors that correlate with an increased risk of developing posttraumatic epilepsy include presence of a depressed skull fracture, acute intracranial hemorrhage, cerebral contusion, or unconsciousness lasting more than 24 hours. Because the risk of a subsequent seizure is approximately
75%, acute and chronic treatment with anticonvulsants is indicated. Loss of consciousness,
retrograde amnesia, and vomiting are relatively common immediate consequences of head trauma. They are usually transient and are not highly correlated with a risk of subsequent posttraumatic seizures.
ليست هناك تعليقات:
إرسال تعليق