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Thread: Spot diagnosis!!!

  1. #1
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    Default Spot diagnosis!!!

    A 6 month old boy is brought for well-baby check-up. Mother denies any complaints. On physical exam following lesions r noted. What would b the most approriate next step to do?
    Most people are only alive because it is illegal to shoot them.

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    Hmm.. I am not a Pediatrician.. but i wil guess!

    1. Is it mongolian spot? If it is.. then it only needs reassuring the parents..

    2. If it is bruise then.. Battered baby syndrome.. do an Ophthalmosic examination..

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    Agree with you Kats..

    Seems like a mongolian spot to me!



    @ Kats, wy do we do opthal exam in Battered Baby Syndrome??

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    off course, there seem to b only two possibilities on DD

    1) Mongolian spots
    or
    2) battered babay syndrome
    however, as a clinician we ought to make a probable diagnosis based on history & exam
    and the most probable diagnosis is Mongolian spots

    Criteria:
    - bluish-green spots which r well-demarcated . bruises of battered baby syn mix into surrounding skin
    -no complaints from child or mother
    - the area of presentation i.e; sacral area & buttocks

    Mechanism:
    entrapment of melanocytes in dermis during fetal period

    Next step to do?
    do nothing. resolves with passage of time
    Most people are only alive because it is illegal to shoot them.

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    wy do we do opthal exam in Battered Baby Syndrome??
    Sometimes u can see retinal hemorrhage in Battered baby syndrome indicating a more serious Subarachnaoid or Intra cerebral bleed!

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    @ kats... cases of Battered Baby is rare here...

    we get battered wife rather!! its really bad!

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    @ Asrafee.. I think it is common in all societies.. many do not see the light of the day cos, babies cant talk!
    Another syndrome is: Shaken Baby Syndrome

    Shaken baby syndrome should be suspected in all children younger than one year of age who present with drowsiness, coma, seizures or apnea. A combination of subdural hematomas, retinal hemorrhages with minimal or no trauma and no coagulopatry is almost pathognomonic of this syndrome. The findings are caused by shaking with or without impact. Physical signs of violence are often absent and the syndrome may easily be mistaken for a serious infection or seizure disorder(1). The infant is held by the thorax and shaken. This causes a repetitive acceleration deceleration trauma which leads to the typical intracranial bleeding, eye injuries and paravertebral rib fractures. Many cases are fatal or lead to seizures and neurological disability including blindness. Cerebral palsy, mental retardation or epilepsy may occur in about 60% of the children.
    "It's psychosomatic. You need a lobotomy. I'll get a saw." - Calvin in Calvin and Hobbes


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