A child is seen to have a retinal hemorrhage on ophthalmoscope exam and on physical exam he has anterior chest bruises and dilated sutures on the skull.
What is the most likely diagnosis?
Correct Answer D:
This is a case of physical abuse. Infants who are shaken may have shaken baby (shaken impact) syndrome. This syndrome is caused by violent shaking, often followed by throwing the infant. Infants who are shaken may have no visible signs of injury and may appear to be sleeping deeply. This sleepiness is due to brain damage and swelling, which may result from bleeding between the brain and skull (subdural hemorrhage). Infants may also have bleeding in the retina (retinal hemorrhage) at the back of the eye. Ribs and other bones may be broken.
The emergency department nurse pages you to come examine a 2-year-old girl. Her father states that his daughter fell down the stairs earlier in the evening, but he does not think that she hit her head during the fall. The only abnormality detected was on examination of her eyes. There are multiple scattered retinal hemorrhages visible in the retinal periphery of each eye.
The most likely diagnosis in this case is:
When a baby is vigorously shaken, the head moves back and forth. This sudden whiplash motion can cause bleeding inside the head and increased pressure on the brain, causing the brain to pull apart and resulting in injury to the baby. This is known as Shaken Baby Syndrome, and is one of the leading forms of fatal child abuse. A baby's head and neck are susceptible to head trauma because his or her muscles are not fully developed and the brain tissue is exceptionally fragile. Head trauma is the leading cause of disability among abused infants and children.
Shaken Baby Syndrome occurs most frequently in infants younger than six months old, yet can occur up to the age of three. Often there are no obvious outward signs if inside injury, particularly in the head or behind the eyes. In reality, shaking a baby, if only for a few seconds, can injure the baby for life. These injuries can include brain swelling and damage; cerebral palsy; mental retardation; developmental delays; blindness; hearing loss; paralysis and death. When a child is shaken in anger and frustration, the force is multiplied five or 10 times than it would be if the child had simply tripped and fallen.
A 4-month-old male is brought to your office for evaluation of “bloodshot eyes” of 2 days’ duration. He is otherwise well. He was born at 35 weeks gestation, weighed 2550 g (5 lb 10 oz), and was discharged the day after his birth. He has received well child care and immunizations at the local public health clinic. Examination confirms bilateral subconjunctival hemorrhages. Except for moderate irritability, the remainder of the examination is unremarkable. There is no known family history of bleeding disorders. An urgent evaluation by an ophthalmologist is requested, and it reveals bilateral retinal hemorrhaging.
Which one of the following is the most likely diagnosis?
Infants who are shaken may have shaken baby (shaken impact) syndrome. This syndrome is caused by violent shaking, often followed by throwing the infant. Infants who are shaken may have no visible signs of injury and may appear to be sleeping deeply. This sleepiness is due to brain damage and swelling, which may result from bleeding between the brain and skull (subdural hemorrhage). Infants may also have bleeding in the retina (retinal hemorrhage) at the back of the eye.
How would you approach the administration of the MMR vaccine in a child with an egg allergy?
Correct Answer C:
The current measles-mumps-rubella vaccine (MMR) does not contain a significant amount of egg proteins. In the past skin testing of all children with severe egg allergies before they received the MMR was recommended. This is no longer necessary. Even those with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction to the MMR. The benefits of the vaccine far outweigh the risks.
Although egg protein in the MMR is no longer a big problem, if your child has severe allergies with systemic symptoms, whatever the cause, it pays to become familiar with the hidden ingredients found in products of all kinds.
A 3-year-old girl has had a low-grade fever, "raspy" cough, and clear rhinorrhea for 3 days. She is brought to the emergency department when she begins to develop difficulty breathing. On physical examination her vital signs include a temperature of 39.7°C, a pulse of 160 beats per minute, and respirations of 36 breaths per minute. Auscultation reveals bilateral rhonchi, wheezing, and some mild stridor.
Croup (Laryngotracheobronchitis) is acute inflammation of the upper and lower respiratory tracts caused most commonly by parainfluenza virus type 1 infection.
It is characterized by a barking cough and inspiratory stridor. Diagnosis is usually obvious clinically but can be made by anteroposterior neck x-ray.
Treatment is antipyretics, hydration, nebulized racemic epinephrine, and corticosteroids. Prognosis is excellent.
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