case of head trauma - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-10-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default case of head trauma

A 5-year-old boy is brought to his pediatrician's office after he falls from his bicycle and strikes his head against the sidewalk. There were no witnesses to this incident, which occurred 8 hours ago. The child is otherwise healthy, up-to-date on his immunizations, and not taking any medications. On physical examination, his vital signs are stable. He has a 5 × 4 cm abrasion on his forehead. He is alert and oriented to date, place and self. His motor and sensory examinations are normal and reflexes are normal. Which of the following constitutes reasonable management?

A. Admit overnight for observation
B. Instruct parents to observe neurological status for 24 hours
C. Obtain a head computerized tomography scan
D. Obtain a skull x-ray film and discharge if normal
E. Obtain a skull x-ray film, observe for 24 hours and discharge

answer with reason
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message



  #2  
Old 09-10-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

This question is bad because they dont mention that the patient lost conciousness or not (I know nobody saw the fall but still)
the management depends on that

IF the child didnt lose conciousness then he can be discharged only if parents will monitor him and dont allow him to fall asleep in order to see any change in mental status

IF the child lost conciousness after the fall then an immediate CT scan is in order not caring if right now he is asymptomatic.

So i dont know what to answer because I dont like to assume haha, because it can be either B or C depending on that
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (09-10-2012)
  #3  
Old 09-10-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,085 Times in 1,046 Posts
Reputation: 2105
Default

B. Instruct parents to observe neurological status for 24 hours

I think the clue here is that this happened "8 hours ago" and the kid is still asymptomatic with normal exam. If anything was to happen it would have happened by nowincluding the "lucid interval" since the most likely suspected diagnosis is epidural hematoma which is an arterial bleed. Hence, it is highly unlikely that he will remain symptom free for so long.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (09-10-2012)
  #4  
Old 09-10-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,316 Times in 706 Posts
Reputation: 1331
Default

Yup I agree with that, I picked that just in case but still..
Reply With Quote Quick reply to this message
  #5  
Old 09-10-2012
Anders's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 289
Threads: 7
Thanked 129 Times in 102 Posts
Reputation: 139
Default

Quote:
Originally Posted by K06100 View Post
A 5-year-old boy is brought to his pediatrician's office after he falls from his bicycle and strikes his head against the sidewalk. There were no witnesses to this incident, which occurred 8 hours ago. The child is otherwise healthy, up-to-date on his immunizations, and not taking any medications. On physical examination, his vital signs are stable. He has a 5 × 4 cm abrasion on his forehead. He is alert and oriented to date, place and self. His motor and sensory examinations are normal and reflexes are normal. Which of the following constitutes reasonable management?

A. Admit overnight for observation
B. Instruct parents to observe neurological status for 24 hours
C. Obtain a head computerized tomography scan
D. Obtain a skull x-ray film and discharge if normal
E. Obtain a skull x-ray film, observe for 24 hours and discharge

answer with reason
I would say B as the case has is asyptomatic, the best approach is observation with frequent wakening of the pt in case of prolonged sleep
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (09-10-2012)
  #6  
Old 09-10-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

The correct answer is
B. The patient has no findings on history or examination. An intracranial bleed or severe brain injury is not likely. If present, symptoms should have become manifest within several hours of the injury. Thus the parents should be advised to monitor for somnolence, vomiting, seizures and severe headaches, and to return if these occur.
Overnight admission (choice A) would be of little value since the patient has been symptom-free for 8 hours already.
A head CT (choice C) would be helpful in detecting an acute bleed due to injury to blood vessels, or to the brain tissue itself. Such trauma would likely be accompanied by somnolence and mental status changes. Were such signs present, an emergent head CT would be required. A head CT would be the preferred study in cases of symptomatic head injury instead of a skull x-ray film (choice D), since it is more likely to show the injury. A skull x-ray film would not necessarily rule out the pathology. Also, since the injury was 8 hours ago, admitting would not add much value. Observation at home is advisable (choice E).
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (09-10-2012)



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Ambulatory Managment of Head Trauma tyagee USMLE Step 2 CK Forum 4 07-10-2012 02:48 PM
Head pounding, head bobbing + murmur = good Qs cabreravelezmd USMLE Step 1 Forum 6 02-24-2012 11:19 PM
Concussion or Contusion? (head trauma) bebix USMLE Step 2 CK Mnemonics 0 12-17-2011 07:55 AM
Head Trauma and Hemiparesis docnok USMLE Step 1 Forum 4 11-11-2011 10:28 PM
Talking like a Robot after head trauma! saintdizzy USMLE Step 1 Forum 13 10-03-2011 10:36 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)