Step 2

Pediatrics 4

A 6-month-old boy and his parents present to the pediatrician for routine evaluation. The boy’s father notes that the veins on his son’s head have become increasingly prominent over the last two months. The patient has also been more irritable than normal over the same time period. The patient was born at full term, has not had any health complications to date, and is up to date on his vaccines. Physical examination is significant for a bulging anterior fontanelle and paresis of upward gaze of both eyes, making the eyes appear to be driven downward. Review of the boy’s growth charts indicate a head circumference at the 85th percentile, up from 40th percentile two months ago.

Which of the following is the most appropriate next step in evaluation of this patient?

  • A) Computed tomography of the head
  • B) Lumbar puncture
  • C) Thyroid stimulating hormone level
  • D) Ultrasonography of the head
  • E) Vitamin D level

Authors

Alexandra Conway

Editor

Dr. Ted O'Connell

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