Child/elder abuse: The Daily PANCE Blueprint

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Child/elder abuse: The Daily PANCE Blueprint

A 2-month-old, full-term boy is brought to the emergency department by his grandmother due to excessive sleepiness and poor feeding. The grandmother mentions that the infant had a fall from a sofa a few days ago. Since then, he has been less active and more irritable. Vital signs are within normal limits. Physical examination reveals a lethargic baby with a large, bulging anterior fontanelle. Bilateral retinal hemorrhages are observed on fundoscopy. Which of the following should be strongly suspected in this patient?

A. Abusive head trauma
B. Bacterial meningitis
C. Accidental head injury
D. Severe dehydration
E. Hypoxic-ischemic encephalopathy

Answer and topic summary

The answer is A. Abusive head trauma

Abusive head trauma (AHT), formerly known as shaken baby syndrome, is a significant cause of morbidity and mortality in infants. It is characterized by intracranial injuries such as subdural hematomas, cerebral edema, and retinal hemorrhages resulting from violent shaking or blunt impact. The key clinical findings in this case are lethargy, a bulging fontanelle, and bilateral retinal hemorrhages. These signs strongly suggest AHT, as accidental falls, particularly from low heights, are unlikely to produce such severe injuries. The presence of retinal hemorrhages is particularly concerning for non-accidental trauma.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Abuse and Neglect ⇒ Child/elder abuse

Also covered as part of the Pediatric EOR topic lists

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