An 11-Month-Old Girl Is Brought to the Emergency Department by Her

question 597

Multiple Choice

An 11-month-old girl is brought to the emergency department by her stepfather because she is "not acting like herself."  For the past 2 days, the girl has had intermittent episodes, lasting 10-15 minutes, during which she cries inconsolably and flexes her hips.  Since this morning, the patient has seemed more tired, napping more than usual.  Her appetite has been poor; she did not eat breakfast today.  The girl was born at term and has no chronic medical conditions.  Temperature is 36.7 C (98 F) , blood pressure is 100/62 mm Hg, pulse is 160/min, and respirations are 20/min.  On examination, the patient is alert but appears tired.  Anterior fontanelle is closed.  Oral mucous membranes are slightly dry, and the neck is supple.  Cardiopulmonary examination is unremarkable.  The abdomen is mildly tender but nondistended.  There is no rebound tenderness or guarding.  Neurologic examination shows equal and reactive pupils, and the face appears symmetric.  Strength is 5/5 bilaterally, and reflexes are equal.  Which of the following is the best next step in management of this patient?

• A)Abdominal ultrasound
• B)Blood and urine cultures
• C)CT scan of the head
• D)Lumbar puncture
• E)Urine drug screen
• F)Urine organic acid panel