WBR1134

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Psychiatry
Sub Category	SubCategory::Pediatrics, SubCategory::Psychiatry
Prompt	[[Prompt::A 6 year old girl with low IQ is complaining of pain in abdomen, constipation, vomiting was brought to an emergency room. She is well groomed, but highly irritable and uncooperative. On examination her vitals are stable, and has tender abdomen. A physician ordered X ray of the abdomen, which revealed multiple metallic particles spread across her gastrointestinal tract, and a couple of rounded foreign objects in stomach measuring about 3mm. Endoscopic removal was ordered as the foreign object would have not passed through the gastrointestinal tract. Blood lead level is 18 μg/dL. The family of girl lives in a very old house. In the past, she was diagnosed with chronic constipation and her pediatrician prescribed laxatives at bedtime. She is the 51th percentile for height and weight. What is the most likely diagnosis?]]
Answer A	AnswerA::Acute pancreatitis
Answer A Explanation	AnswerAExp::
Answer B	AnswerB::Pica
Answer B Explanation	[[AnswerBExp::Pica is characterized by an appetite for substances largely non-nutritive, such as ice, clay, chalk, dirt, or sand. According to DSM-IV criteria, for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate, not part of culturally sanctioned practice and sufficiently severe to warrant clinical attention. The most common, the consumption of ice can be considered very devastating to the maintenance to the body as there is a high risk of tooth cracking, enamel deterioration, and jaw joint strain. The consumption of ice also negatively affects the digestive tract, which causes the Peristalsis to move slower or even temporarily stop. This will make weight gain easier, and adversely weight loss harder, or even impossible. It can lead to intoxication in children, which can result in an impairment in both physical and mental development. In addition, it can also lead to surgical emergencies due to an intestinal obstruction as well as more subtle symptoms such as nutritional deficiencies and parasitosis]. Pica has been linked to mental disorders and they often have psychotic comorbidity. Stressors such as maternal deprivation, family issues, parental neglect, pregnancy, poverty, and a disorganized family structure are strongly linked to pica. Pica is more commonly seen in women and children, where it affects people of all ages in these subgroups. Particularly it is seen in pregnancypoverty, and a disorganized family structure are strongly linked to pica. Pica is more commonly seen in women and children, where it affects people of all ages in these subgroups. Particularly it is seen in pregnancy, small children, and those with developmental disabilities such as autism. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetraethyllead in petrol (in some countries) or prior to the cessation of the use of contaminated oil (either used or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of intestinal obstruction or tearing in the stomach. Another risk of dirt-eating is the ingestion of animal feces and accompanying parasites.]]
Answer C	AnswerC::Munchhausen syndrome
Answer C Explanation	AnswerCExp::
Answer D	AnswerD::Munchhausen syndrome by proxy
Answer D Explanation	AnswerDExp::
Answer E	AnswerE::Functional abdominal pain
Answer E Explanation	AnswerEExp::
Right Answer	RightAnswer::B
Explanation	[[Explanation:: Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Pica
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::