B27 Pediatric Case Study 8 month old female presents to the ER with a chief complaint of vomiting and lethargy; began
vomiting 24 hours ago,
was seen in clinic earlier today for evaluation and sent to the ER.
PMH: History of VP shunt placed at day 4 of life. Born via c-section at 37 weeks for
encephalocele which was diagnosed via ultrasound. Hospitalized at 4 months of age for VP shunt
revision; shunt revision prompted by periods of apnea requiring intubation.

What other information would you want to know from the mother of the baby?

HPI: Seen 1 day ago in neurosurgery clinic where a head CT was done and per mom was
“normal”. Shortly after clinic appointment had an episode of apnea, was taken to the ER where
per mom labwork was done and patient was sent home.

What are some differential diagnoses to consider?

What are some expected/initial diagnostic procedures?