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Developmental screening — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Developmental screeningUSMLE Step 3

A nonambulatory 7-month-old is brought in for irritability. Radiographs show a healing posterior rib fracture and a metaphyseal lesion; the caregiver reports no trauma. What is the most appropriate next step?

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Correct answer: C — Ensure immediate safety, report suspected abuse, and obtain a complete skeletal survey

The best answer is “Ensure immediate safety, report suspected abuse, and obtain a complete skeletal survey”. The fracture pattern and developmental incompatibility are highly concerning for inflicted injury. The clinician must protect the infant and report reasonable suspicion rather than prove abuse. A complete skeletal survey identifies occult fractures; further medical evaluation and follow-up imaging are coordinated with child-abuse specialists.

Reference: AAP Evaluating Young Children With Fractures for Child Abuse: https://publications.aap.org/pediatrics/article/155/2/e2024070074/200638/Evaluating-Young-Children-With-Fractures-for-Child