First one with correct answer with justification win.

A two-year old child presents with a gunshot wound to the left flank. Work up on admission shows a moderate size lead bullet fragment in the left paraspinous muscle with a benign abdomen, no concern for penetration of the peritoneal cavity, no fractures of ribs or vertebrae and no damage to retroperitoneal structures. A screening serum lead level is 5 μg/dL. The parents ask if you need to remove the bullet to prevent lead poisoning from the retained lead fragment. You tell them

 

[size=20px]A serum lead level should be repeated in one month.

 

B paraspinous muscle location increases risk of cerebrospinal fluid contamination and infection and the fragment should be surgically removed.

 

C there is no risk of lead poisoning.

 

D lead level is too high and the lead fragment should be surgically removed.

 

E paraspinous muscle location increases risk of serum absorption and the fragment should be surgically removed.[/size]

Correct answer: A serum lead level should be repeated in one month.

 

Children are at potential risk of lead poisoning from retained lead bullet fragments due to faster absorption rates and smaller body size.

Repeated lead level assessment is according to the following table