MCQ Pediatrics Answer 36

The Correct Answer is A

The parents are describing classic breath-holding spells. These are a form of autonomic syncope frequently misdiagnosed as seizures. They occur in early childhood and infancy. They can be two forms: cyanotic, as described here, and pallid. The cyanotic form usually occurs after vigorous crying, while the pallid form commonly occurs after a sudden fright or minor injury. The history of a prodrome of injury, vigorous crying, or sudden fright is key to distinguishing a breath-holding spell from a seizure. Parents can be reassured that no brain damage occurs and, in the presence of a classic history, no further workup is necessary. An EKG and chest radiograph would be indicated if the history suggested orthostatic hypotension. A head CT scan would be indicated in the evaluation of new-onset seizures.


Ref: Tintinalli JE, Kelen GD, Stapczynski JS (eds): Emergency Medicine: A Comprehensive Study Guide, ed 5. McGraw-Hill, 2000. p 872. (ABFP 2002)

Category: Pediatrics MCQs