Page 1 of 1: 3 mo vomiting

Kai1111 · Credits: 2036 My Scrapbook

Here is another one.....

3 mo M has Vx and crying. Take a focused hx from the mom.
- sxs since 1wk old; worse now
- Cries before vx. Non-projectile, 3-4X/d, assoc w feeds (1/2 post feed)
- Normal bm's, no diarrhea
- Term preg, vag deliver, no antenatal complication, normal course post birth; no congenital problems
- Developmental milestones ok, able to support head and roll body, alert and responsive to mom.
- Breast fed until 2 wks ago, switched to Enfalac w iron; no change in sxs.
- Child able to sleep, no vx at night
- One older sister (6 yo), no hx of such problem, no dietary problems
- Lives w husband who recently lost job; family is coping (no signs of child abuse)
PEP
- Interpret the growth curve (Ht 50th percentile, Wt 75th drop to <25%)
- Most likely diagnosis
- 2 management options besides drugs
- If child abuse suspected who to report to.

My thoughts:
Growth Chart Interpretation: Failure to thrive
Most Likely Dx: GER, child abuse/starvation?
Management Options:
Examine child and r/o dehydration
Abdominal series
If child abuse suspected, contact social services.

Would really like to others thoughts.....

hla · Credits: 2611 My Scrapbook

Did you get any Xrays, ECGs or any other kind of images for interpretation. I will appreciate it if you can answer me.
Thanks

Kai1111 · Credits: 2036 My Scrapbook

The goal for this senario is to just take a focused hx from the mom.

MONTY2008 · Credits: 154 My Scrapbook

I couldn't find anything about child abuse or failure to thrive bcz there was no weight loss.

hla · Credits: 2611 My Scrapbook

I'm sorry I wasn't refering to this specific case I meant in the exam in general did you have any images for interpretation?
For this particular case I think you were on the right track with the history and the differential because as you said there was a weight drop from the75th to the 25th that goes with failure to thrive. The child abuse though I wouldn't have thought about it if it wasn't suggested in the question below. Was there anything in the history suggestive of abuse?

vu · Credits: 1045 My Scrapbook

These were the pics I had:

1. ECG-Atrial flutter with A-V block
2. Vaginal saline prep with clue cells
3. Dermatology -pics erythemo-papular rash-syphyllis? ( in a sex-trade worker)
4. picture of a boy with dermatitis: dry exfoliated skin, excoriations etc on the face and head- atopic dermatitis?
5. picture of vulva in a patient from Africa- vulvar mutilation?

mdc · Credits: 310 My Scrapbook

1. CT of the head - HIV patient
2. Knee X-ray

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