PNP Practice Test 2

In a 2 month old with visible rib fractures on radiograph, the NEXT most critical evaluation to obtain is a: A. long bone series B. coagulation profile C. CT scan of the head D. retinal ophthalmologic exam - Answer- The correct answer is C - CT scan of the head Posterior rib fractures associated with accidental trauma are rare. Posterior fractures can be seen in infants who have been shaken as the perpetrator hands are typically wrapped around the infant's thorax during the shaking, with the vertebrae acting as a fulcrum. These findings should alert the provider to consider abusive head trauma (AHT) (formerly known as shaken baby syndrome). Subdural and subarachnoid hemorrhages are the most common acute intracranial injuries seen in AHT and are associated with high rates of morbidity and mortality. Thus, the most important study to do next is a CT scan. Studies have shown that nearly one third of confirmed abusive head trauma cases were missed on initial presentation, and many infants then sustain additional brain injury along with poorer neurologic outcomes because of the delay in diagnosis. Long bone studies will be needed as part of a thorough work-up of non-accidental trauma, but the skull would be the most critical area to image first. Coagulation studies are done to rule out any coagulation problem associated with injury to the brain and are important for medico-legal reasons, but again, brain studies take precedence. A thorough ophthalmologic exam is needed in suspected cases of AHT—preferably done by a pediatric ophthalmologist Five weeks after joining the cross-country team, an adolescent complains of pain in the front of the left shin that intensifies 15 minutes into each practice run. Plain radiographs of the left leg are normal. Which subsequent test would be MOST appropriate? A. bone scan B. MRI of left leg C. repeat plai