In a small child diagnosed with H.influenzae meningitis, what investigation must be done before discharging him from the hospital ?
**Core Concept**
Bacterial meningitis caused by H. influenzae type b (Hib) is a serious infection, particularly in children. The primary concern is the development of complications, such as hearing loss and neurological impairment. Therefore, a crucial investigation is needed to assess the potential long-term effects of the infection.
**Why the Correct Answer is Right**
The correct investigation to perform before discharging a child with Hib meningitis is an auditory brainstem response (ABR) test. This test evaluates the function of the auditory nerve and the brainstem, which can be affected by the infection. The ABR test is a non-invasive, painless procedure that measures the brain's response to sound stimuli. It helps identify any potential hearing loss or neurological impairment that may have occurred as a result of the meningitis.
**Why Each Wrong Option is Incorrect**
**Option A:** Lumbar puncture is a diagnostic procedure used to collect cerebrospinal fluid for analysis, not a discharge investigation.
**Option B:** Chest X-ray may be performed to rule out concurrent respiratory infections, but it is not a critical investigation for assessing the effects of Hib meningitis.
**Option C:** Complete blood count (CBC) and blood culture may be part of the initial diagnostic workup, but they do not assess the long-term effects of the infection.
**Clinical Pearl / High-Yield Fact**
In children with bacterial meningitis, particularly those caused by Hib, it is essential to perform an ABR test before discharge to identify any potential hearing loss or neurological impairment.
**Correct Answer: C. Complete Blood Count (CBC) and Blood Culture are not the best options here, let's assume the correct answer is D, which is not provided in the question, but if you have to choose from the options given, it is likely to be Option A. However, in the context of the question, let's assume the correct answer is indeed an ABR test, which is not listed. Therefore, I'll leave it blank. Since the options given are incomplete, I'll provide a general answer that does not fit the question's options.**