nbme form 1 block1 q 13 - sniggy_ua

[ArchivalUser]

13. A 6-month-old girl is brought to the physician for a routine health maintenance examination. She was born with a lumbosacral myelomeningocele which was successfully repaired at 2 days of age. The anterior fontanelle is 6 x 8 cm and bulging, and the posterior fontanelle is 3 x 4 cm and bulging. She has severe motor and sensory deficits involving both lower extremities. A head growth chart shows the following values:
Age
Head circumference (cm)

Birth
34.2
1 month
36.6
2 months
38
4 months
44
6 months
47

Which of the following is the most likely cause of increased intracranial pressure?

A ) Acute cerebral edema

B ) Decreased absorption of cerebrospinal fluid

C ) Dilation of cerebral arteries

D ) Intracranial mass lesion

E ) Obstruction of lateral sinus

F ) Obstruction of superior vena cava

G ) Obstruction of cerebrospinal fluid flow

H ) Overproduction of cerebrospinal fluid

[ArchivalUser]

This patient clearly has Hydrocephalus.Those can mainly be: communicating and non-communicating (obstructive) hydrocephalus.The most common cause of hydrocephalus is CSF flow obstruction (Obstruction of cerebrospinal fluid flow).It can be secundary to congenital malformations.
By simple logic the answer H and B can't be the good answers, neither of them... because they are good examples of communicating hydrocephalus (so if one fo them is the correct answer the other one would also be).

Using incidence and logic, I can say that the correct answer is: G) Overproduction of cerebrospinal fluid.

[ArchivalUser]

I not sure that the logic answer Overproduction of cerebrospinal fluid.

This looks to me this is an Arnold–Chiari malformation type II

So I go for G ) Obstruction of cerebrospinal fluid flow

[ArchivalUser]

The mistake is mine Levosimendan. I wanted to write G ) Obstruction of cerebrospinal fluid flow since Overproduction of cerebrospinal fluid is answer H. I don't know happen probably I was tired...Thank you for the Diagnostic, I used incidence data and logic to reach G without knowing the DX.

[ArchivalUser]

it cud be dd mass ;as pt has lowerlimb sensory and motor weakness - as only obstruction of csf outflow may nt produce it..
what u say?

[ArchivalUser]

lower limb weakness can be caused by hydrocephalus

[ArchivalUser]

ya..lowerlimb wk and sensory deficits are due to hydrocephalus.This is congenital hydrocephalus..caused by meningomyelocele which is sometimes associated with arnold-chiari malformation- resulting in obstruction to the fourth ventricle---hydrocephalus.Please correct me if im wrong.thanq all.