An 18-month-old child presents to the clinic with unilateral eye swelling for 2 days. On examination, there is clear proptosis, painful and limited ocular movement with reduced vis... An 18-month-old child presents to the clinic with unilateral eye swelling for 2 days. On examination, there is clear proptosis, painful and limited ocular movement with reduced visual acuity. The mother said they missed 12 and 18 months vaccines. Which of the following is the most appropriate next step in management? A. Arrange for 18 month vaccines administration B. Brain MRI to roll out intraventricular hemorrhage C. Urgent CT scan to assess the spread of the infection D. Perform funduscopic exam to roll out inclusion body
Understand the Problem
The question describes a clinical scenario of an 18-month-old child presenting with symptoms suggestive of a serious eye infection (unilateral eye swelling, proptosis, painful and limited ocular movement, reduced visual acuity). The question requires you to identify the most appropriate next step in management, considering the child's symptoms and incomplete vaccination history. The key is to differentiate between possible diagnoses and prioritize interventions based on the severity and urgency of the condition. The symptoms point towards orbital cellulitis, a potentially sight-threatening and life-threatening condition, due to the proximity to the brain. We need to consider the best way to assess this and get the patient immediate help, whilst also not forgetting the missed vaccinations.
Answer
C. Urgent CT scan to assess the spread of the infection
The most appropriate next step is an urgent CT scan to assess the spread of the infection, which is option C.
Answer for screen readers
The most appropriate next step is an urgent CT scan to assess the spread of the infection, which is option C.
More Information
The child's symptoms (unilateral eye swelling, proptosis, painful and limited ocular movement, reduced visual acuity) suggest a possible orbital cellulitis. Given the severity and potential for rapid spread of infection in young children, imaging is needed.
Tips
The question describes a child with signs suggestive of orbital cellulitis, which requires prompt diagnosis and treatment to prevent serious complications such as vision loss or intracranial spread of infection. Missing vaccines may increase the suspicion of an infectious etiology.
Sources
- Week 22 Q&A | AccessMedicine Network - accessmedicinenetwork.com
- [PDF] Pediatric Ophthalmology in the Emergency Department - emergency.med.ufl.edu
- Orbital disease in neuro-ophthalmology - MedLink Neurology - medlink.com
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