A 12-month-old boy with ICP - 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 12-13-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 612 Times in 234 Posts
Reputation: 622
Arrow A 12-month-old boy with ICP

A 12-month-old boy is brought to his pediatrician by his parents. He had had a normal, healthy childhood until 1 month ago. His parents complain that over the past month he has been vomiting frequently, and also appears to be increasingly irritable. He is now taking more naps during the day and is playing less than usual. His parents also think there is a problem with his sight, as he often does not appear to see toys and furniture that are directly in his line of vision. On physical examination, the patient has lost 3.6 kg (8 lb) since his last visit 6 weeks ago. He is afebrile, has a pulse of 140/min, a blood pressure of 90/56 mm Hg, and a respiratory rate of 24/min.Ophthalmologic examination show papilledema. Which of the following is the most appropriate next step in managing this patient?

(A) Administer mannitol
(B) Administer timolol
(C) CT scan of the head without contrast
(D) Lumbar puncture
(E) MRI scan of the brain
Reply With Quote Quick reply to this message



  #2  
Old 12-13-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 538 Times in 375 Posts
Reputation: 548
Default

ans C................
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (12-15-2012)
  #3  
Old 12-13-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 623
Threads: 111
Thanked 424 Times in 264 Posts
Reputation: 434
Default

(C) CT scan of the head without contrast
Reply With Quote Quick reply to this message
The above post was thanked by:
heartbeat (12-15-2012)
  #4  
Old 12-15-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 612 Times in 234 Posts
Reputation: 622
Default

The correct answer is C.
This patient exhibits symptoms of elevated intracranial pressure (ICP). Possible physical examination findings include papilledema; a dilated ipsilateral pupil; cranial nerve palsies of the third (most common), fourth, and sixth nerves; and nuchal rigidity. Hemiparesis, hypertonia, hyperreflexia, or Cushing’s triad (systemic hypertension, bradycardia, and respiratory depression) are late signs. In a case of suspected elevated ICP, the patient should be stabilized and a CT scan of the head without contrast should be performed. A midline shift or effacement of the sulci or basilar cisterns are possible findings on CT scan of the head that confirm the diagnosis of elevated ICP. The etiology of the elevated ICP, such as a mass or hemorrhage, may also be evident on CT scan. Other possible causes of elevated ICP are hydrocephalus, vasculitis, infarcts, and central nervous system infection.
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (12-16-2012), Future Radiolog (12-16-2012), hamzarayes (12-16-2012), ts1234 (12-17-2012)
  #5  
Old 12-15-2012
USMLE Forums Scout
 
Steps History: ---
Posts: 84
Threads: 2
Thanked 38 Times in 36 Posts
Default

Quote:
Originally Posted by heartbeat View Post
A 12-month-old boy is brought to his pediatrician by his parents. He had had a normal, healthy childhood until 1 month ago. His parents complain that over the past month he has been vomiting frequently, and also appears to be increasingly irritable. He is now taking more naps during the day and is playing less than usual. His parents also think there is a problem with his sight, as he often does not appear to see toys and furniture that are directly in his line of vision. On physical examination, the patient has lost 3.6 kg (8 lb) since his last visit 6 weeks ago. He is afebrile, has a pulse of 140/min, a blood pressure of 90/56 mm Hg, and a respiratory rate of 24/min.Ophthalmologic examination show papilledema. Which of the following is the most appropriate next step in managing this patient?

(A) Administer mannitol
(B) Administer timolol
(C) CT scan of the head without contrast
(D) Lumbar puncture
(E) MRI scan of the brain
C.. do a ct to exclude tumour/hydrocephalus
Reply With Quote Quick reply to this message
  #6  
Old 12-15-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,088 Times in 1,047 Posts
Reputation: 2108
Default

(E) MRI scan of the brain since CT is not good for tumors.
This patient has subacute presentation suggestive of IC Neoplasia.
__________________
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
  #7  
Old 12-15-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 387
Threads: 82
Thanked 612 Times in 234 Posts
Reputation: 622
Default

Quote:
Originally Posted by Novobiocin View Post
(E) MRI scan of the brain since CT is not good for tumors.
This patient has subacute presentation suggestive of IC Neoplasia.
A CT scan of the head without contrast is the initial imaging study of choice in children with suspected intracranial hypertension. If the initial CT scan is normal or if findings such as a neoplasm, hemorrhage, or unexplained hydrocephalus are noted, an MRI of the brain can be considered for further evaluation.
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (12-16-2012), hamzarayes (12-16-2012), Novobiocin (12-16-2012), slamdunk (12-16-2012), vaibhavmanu (12-24-2012)
  #8  
Old 12-16-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,088 Times in 1,047 Posts
Reputation: 2108
Default

Quote:
Originally Posted by heartbeat View Post
A CT scan of the head without contrast is the initial imaging study of choice in children with suspected intracranial hypertension. If the initial CT scan is normal or if findings such as a neoplasm, hemorrhage, or unexplained hydrocephalus are noted, an MRI of the brain can be considered for further evaluation.
You are right. Looks like I dropped the ball here. The question asks "next step in management" NOT the best step in management.

Next step >>>>>>>>>>CT scan of the head without contrast

Best step>>>>>>>>>>> MRI
__________________
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



Reply

Tags
Pediatrics-, Step-2-Questions

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
one month! Muzzy USMLE Step 1 Forum 0 04-10-2012 09:53 PM
i need just one more month-pls help MedicalDR14 USMLE Step 1 Forum 6 12-25-2011 12:55 AM
One Month to go... AndyG83 USMLE Step 1 Forum 7 05-14-2011 05:21 PM
One month to go mazrodin USMLE Step 1 Forum 1 03-07-2011 10:16 AM
Help Please Last Month Androide89 USMLE Step 1 Forum 7 11-08-2010 02:24 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)