How to Work-Up Failure to Thrive in a 6-Month Old

In Episode 49 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question:

A 6-month-old girl is brought to the pediatrician by her mother because of a 2-day history of vomiting and poor feeding. Her mother recently introduced solids into her diet. She has also been less interactive and playful in the past week. Over the past several days she has been more difficult to arouse from naps and is much more irritable and fussy when she is awake. Her mother denies any fevers, cough, cold symptoms, diarrhea, constipation, or changes in her urine output. There is no history of trauma or falls. She is fully vaccinated and spends most of the day with a nanny while her parents are at work. Her weight is in the 44th percentile, her height is in the 38th percentile, and her head circumference is in the 98th percentile. Vital signs are within normal limits. On examination, the abdomen is soft and non-distended. Cardiopulmonary examination is unremarkable. The anterior fontanelle is bulging, and funduscopic examination reveals bilateral retinal hemorrhages. Laboratory studies are pending. Abdominal x-ray reveals posterior 6th and 7th rib fractures bilaterally. Which of the following additional findings is most likely present?

• Intussusception
• Intracranial hamartoma
• Cutaneous neurofibromas
• Blue sclerae
• Bilateral subdural hematomas
• Enlargement of costochondral joints
• Obstructive hydrocephalus