296) A 6 month old Asian infant is brought by his concerned aunt for evaluation of dark blue areas on the child’s buttocks. She says she was called to baby-sit the infant since his mother found a new job 2 days ago. She noted the rash and became suspicious that the child may have been abused. The mother arrives in Emergency room an hour later and reports that the rash has been present since birth. The mother is divorced and lives alone with the child. On examination, there are bluish-green patches on bilateral buttocks and on the lower back. They are irregular in shape and margins are indistinct. There is no swelling or tenderness. An image of the skin findings is shown below:
Which of the following is the most appropriate next step ?
A) Order Skeletal Survey
B) Reassure that rash may fade away in few years
C) Contact Child Protection services
D) Obtain Coagulation parameters
E) Obtain Platelet count
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B, mongolian spots
B
B Mongolian spots
B, Mongolian spots
Mongolian spots are benign dark bluish marks present since birth in infants. They are often present on the buttocks and the back. They may fade after first decade of life. They are important because they are often confused with bruises raising the suspicion of Child abuse. Certain features can help differentiate Mongolian spots from bruises: Mongolian spots are present since birth. Unlike bruises, they are not associated with swelling or tenderness. Bruises are well defined consistent with the pattern of the object used to abuse however, Mongolian spots are irregular and have indistinct edges.
D and E are incorrect. Ecchymosis secondary to coagulation or platelet abnormalities may have similar appearance but this patient has had these spots since birth excluding the possibility of a coagulation disorder.
b
B
B
option B 🙂
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