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A 4 year old boy is brought to the emergency department after a 6 hour onset of lethargy, he is unable to walk without assistance. His eyes are swollen shut. Deep tendon reflexes are symmetric. There are several bruises over the thorax that the mother had not noticed until now. He moans during the examination. Which of the following are the most likely explanation of these findings?
A Acetaminophen poisoning
B Child abuse
C Hepatitis B
D Myositis
E Toxic hepatitis
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B seems like child abuse by mothers story!
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Guys B does seem like a good answer but I have a question regarding the child's eyes being swollen shut. Wouldn't they say that the patient has black or blue eyes? I also wanted to ask about the lethargy. I am trying to understand why B is the best answer.
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coz mothers story dont fit into it...how come she is not aware of his chest condition..like briuses...chid abuse moms act like that in usmle!
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its a bonus question
we got to know that mother can abuse the child too. previously healthy child and has bruises in the chest and mother does not know is a big point in favour of abuse and spportive evidence is eyes are swollen and he is a limp and lethargic , these are all not usual injury in a 4 yr child . one thing at a one place is one diagnosis but several thing at the several places is child abuse. pattern injury is child abuse most of the times. if you try to talk to him he will avoid eye contact though in this case it may not be an important point because it may be fthat he is lethargic.
racoon eyes can be with head injury and neuroblastoma too but histoty is not consistent.
we have to take the ct to r/o shaken baby syndrome and intracranial hemorrage and skeletal survey cxr and opthalmogic exam to see retinal hemorrage and hospitalize the pt and inform child protective services
but who abused the child and where did the child go previous before the event injury is a
different story. but now we must suspect child abuse.
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ans is D..........child abuse is never first diagnosis....it is a diagnosis of exclusion.......so first you need to think of other causes....
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I see the point you are making , norwalk.
