Module 66, General Medical Level

A 2 year and 6 month old girl was recently adopted and brought for a medical evaluation. The available history was that the child was born to a mother who suffered from alcohol abuse. She was born prematurely (gestational age not available) at 2000 gms, 44 cm, with an apgar of 5/6. Furthermore, she had previously been diagnosed with encephalopathy, anemia, fetal alcohol syndrome and rickets. The adopted mother states that the child began walking recently at the age of 27 months.

Question 66A

Based of this information you strongly suspect that there is a previously undiagnosed inheritable syndrome present.

Question 66B

Children with static encephalopathy develop metabolic bone changes which are not well explained and it is likely that the girl's problems are all related to severe static encephalopathy and fetal alcohol syndrome.

Question 66C

A careful nutritional history should be obtained.

Question 66D

The only laboratory tests to order for this child are CBC, serum calcium and phosphorus.

Question 66E

The adopted mother wants to know what you think of this child's long term prognosis. You explain that making a prognosis with respect to her cognitive abilities is very difficult but you expect her to have severe physical limitation based on her bone problems and her encephalopathy.