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  #1  
Old 09-07-2012
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Arrow Gyrus Daily Questions; Pediatrics #19

A 1-year-old child is brought to the emergency room because of a swollen left thigh. The parents, who appear very concerned, state they left the child in the care of a newly hired housekeeper early that morning, and when they returned home in the evening they noted the swelling. Other than tender swelling of the thigh, physical examination is entirely normal. X-ray examination discloses a displaced fracture of the shaft of the femur; skeletal survey reveals no other fractures or abnormalities. The grandparents, who live with the parents and who had accompanied them on their trip, corroborate the parents’ story. After first admitting the child for treatment of the fracture, what is the most appropriate next step?


(A) order a computerized tomography (CT) scan of the head
(B) order a complete coagulation profile
(C) order magnetic resonance imaging (MRI) of the leg
(D) order calcium, phosphate, and uric acid laboratory tests
(E) report the incident to a child protection agency
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Old 09-07-2012
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I would still say E, it is their version vs reality,and also how irresponsible from them leaving the kid with complete strangera
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Old 09-07-2012
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ans A .........

i guess just one single injury + normal skeletal survey is a hint to support the parents that its not child abuse but to completely rule out child abuse one may need to do a Ct brain to check for contusions or haemorrhages due to head trauma .

no MRI of leg needed as child is usually treated conservatively as they have excellent remodelling capacity

Last edited by Hitman; 09-07-2012 at 10:08 PM.
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Old 09-07-2012
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Yeah you are right, damn i hate this kind of questions haha
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Old 09-07-2012
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Very Nice Question

The patient has a fracture shown on Xray, may be the parents did it and they r telling a lie

I will go with Answer E
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Old 09-07-2012
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(A) order a computerized tomography (CT) scan of the head
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Old 09-08-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
A 1-year-old child is brought to the emergency room because of a swollen left thigh. The parents, who appear very concerned, state they left the child in the care of a newly hired housekeeper early that morning, and when they returned home in the evening they noted the swelling. Other than tender swelling of the thigh, physical examination is entirely normal. X-ray examination discloses a displaced fracture of the shaft of the femur; skeletal survey reveals no other fractures or abnormalities. The grandparents, who live with the parents and who had accompanied them on their trip, corroborate the parents’ story. After first admitting the child for treatment of the fracture, what is the most appropriate next step?


(A) order a computerized tomography (CT) scan of the head
(B) order a complete coagulation profile
(C) order magnetic resonance imaging (MRI) of the leg
(D) order calcium, phosphate, and uric acid laboratory tests
(E) report the incident to a child protection agency
A.) order head CT scan of the head.
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Old 09-08-2012
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E. CPS

I would call them and then start treating the patient. A fracture of the femur is very rare at this age and is usually due to abuse or trauma.
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answer E

All states have laws requiring any person having reason to suspect child abuse or neglect to report the case to the proper child protective authority. Proof is not a prerequisite for reporting. In a case of suspected abuse, physicians must identify and treat physical injuries and must ensure the child’s immediate safety. Detailed recording of exact history given, including history in the child’s own words if he/she is old enough to speak, and physical findings (photographs or videos) can be extremely useful to the child protective team. In this case, further evaluation by scanning, or blood tests are not necessary since the fracture is clearly seen on plain films
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