Paediatric emergencies: abusive head trauma: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: abusive head trauma

Sample item

A 4-month-old is brought with irritability, vomiting and a seizure. The parents report no injury. The fontanelle bulges, CT shows an interhemispheric subdural haemorrhage, and fundoscopy shows multilayered retinal haemorrhages. What is the most appropriate next step along with stabilisation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Skeletal survey and child protection referral

Subdural haemorrhage and retinal haemorrhages in an infant with no history of trauma suggest abusive head trauma. After stabilisation, perform a skeletal survey for occult fractures, investigate for bleeding disorders and involve the child protection team. Lumbar puncture is unsafe with raised pressure.

Option by option

  • A. Vitamin K alone for presumed bleeding disorder

    Vitamin K alone ignores the inflicted injury as the likely cause.

  • B. Skeletal survey and child protection referral (correct)

    Correct. A skeletal survey and child protection referral are required to document injuries and protect the child.

  • C. Discharge after seizure control with follow-up

    Discharge would return a possibly abused infant to the same environment.

  • D. Immediate lumbar puncture for meningitis

    Lumbar puncture with raised intracranial pressure and a subdural bleed risks herniation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Skeletal survey and child protection referral. Subdural haemorrhage and retinal haemorrhages in an infant with no history of trauma suggest abusive head trauma.

Why is "Vitamin K alone for presumed bleeding disorder" not the answer?

Vitamin K alone ignores the inflicted injury as the likely cause.

Why is "Discharge after seizure control with follow-up" not the answer?

Discharge would return a possibly abused infant to the same environment.

Why is "Immediate lumbar puncture for meningitis" not the answer?

Lumbar puncture with raised intracranial pressure and a subdural bleed risks herniation.

What concept does this question test?

It tests Paediatric emergencies: abusive head trauma in Pediatrics. After stabilisation, perform a skeletal survey for occult fractures, investigate for bleeding disorders and involve the child protection team. Lumbar puncture is unsafe with raised pressure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: abusive head trauma?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.