This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Musculo Skeletal Disorders, Subject name: Pediatrics
A baby was vigorously shaken by parents. What do you expect in the baby? 
Select and explain. 
A. Rib fractures, B. Pelvic fracture, C. Ruptured spleen, D. Sub-dural hematoma
D: Sub-dural hematoma
Answer: D: Sub-dural hematoma 
Explanation: d. Sub-dural hematoma(Ref: Nelson's 20/e p 239-243, 3067)Child abuse/Shaken baby syndrome/lnflicted childhood neurotraumaIt occurs secondary to violent, non-accidental, repetitive, unrestrained acceleration-deceleration head & neck movements, with or without blunt head trauma in children typically <3 year of age.Inflicted childhood neurotrauma accounts for 10% of all cases of child abuse and carries a mortality rate of up to 25%.Retinal hemorrhage (multiple, involving >1 layer) is the most common ophthalmic finding.Fractures that strongly suggest abuse include classic metaphyseal corner lesions, posterior/1st rib fracture, scapular/sternal fracture, spinous process fracture. These fractures require more force than would be expected from a minor fall or routine handling and activities of a child.Abusive head trauma (AHT) results in the most significant morbidity and mortality & may be caused by direct impact, asphyxia, or shaking.Subdural hematomas, retinal hemorrhages & diffuse axonal injury strongly suggest AHT, especially when they co-occur.