LE1 Flashcards

Question

Baby Girl A was delivered full term at 40 weeks, weighing 1.5 kg, with chorioretinitis, hepatomegaly, thrombocytopenia, cerebral calcification, and hydrocephalus. What is the most likely diagnosis? A. Congenital toxoplasmosis B. Congenital hepatitis B C. Congenital herpes simplex D. Congenital rubella

Answer 1

. Congenital toxoplasmosis Rationale: Nelson's Pediatrics outlines that congenital toxoplasmosis can present with findings such as hydrocephalus, intracranial calcifications, and chorioretinitis, consistent with the clinical features described.

Answer 2

GI malrotation Rationale: Nelson's Pediatrics explains that malrotation involves abnormal positioning of the intestines due to incomplete rotation during fetal development, which is confirmed by upper GI series showing abnormal positioning of the ligament of Treitz and the cecum.

Answer 3

Erb’s palsy on the left arm Rationale: According to Nelson's Pediatrics, Erb's palsy, caused by injury to the brachial plexus during delivery, presents with the characteristic "waiter's tip" posture of the affected arm, consistent with the clinical picture described.

Answer 4

Administration of antenatal steroids Rationale: Nelson's Pediatrics emphasizes that antenatal steroids are the most effective intervention to prevent complications of prematurity, such as respiratory distress syndrome, by accelerating fetal lung maturity.

Answer 5

Increasing IgM titer Rationale: Nelson's Pediatrics states that an increasing IgM titer in the fetus or newborn is indicative of a congenital infection because IgM does not cross the placenta, and its presence suggests in utero infection.

Answer 6

physiologic jaundice Rationale: Nelson's Pediatrics describes physiologic jaundice as typically appearing on the second or third day of life and is characterized by a bilirubin level that rises less than 5 mg/dL per day and peaks at less than 12 mg/dL in term infants.

Answer 7

Exposure to phototherapy Rationale: According to Nelson's Pediatrics, phototherapy is the initial treatment for neonatal hyperbilirubinemia to lower bilirubin levels and prevent bilirubin-induced neurologic dysfunction.

Answer 8

Double volume exchange transfusion Rationale: Nelson's Pediatrics recommends double volume exchange transfusion when phototherapy fails, and bilirubin levels rise dangerously high, to rapidly reduce bilirubin levels and prevent kernicterus.

Answer 9

Neonatal drug withdrawal Rationale: Nelson's Pediatrics explains that maternal drug addiction, particularly to opioids, commonly results in neonatal drug withdrawal syndrome, characterized by a range of symptoms including irritability, poor feeding, and seizures.

Answer 10

Grave’s Disease Rationale: Nelson's Pediatrics identifies maternal Graves' disease as a common cause of neonatal thyrotoxicosis due to the transfer of thyroid-stimulating antibodies from the mother to the fetus.

Answer 11

Chronic Hypertension Rationale: Nelson's Pediatrics does not list chronic hypertension as a protective factor against hyaline membrane disease. Instead, conditions like diabetes mellitus, premature labor, and cesarean section delivery are associated with a higher risk.

Answer 12

Abdominal x-ray will show “double-bubble” sign Rationale: Nelson's Pediatrics describes the “double-bubble” sign on an abdominal x-ray as a classic indication of congenital duodenal obstruction, showing air in the stomach and the proximal duodenum.

Answer 13

Gastroscopy Rationale: Nelson's Pediatrics mentions that while gastroscopy can be used for various indications, it is not typically performed in the acute evaluation of neonatal bowel obstruction where plain abdominal x-ray, barium enema, or rectal biopsy are more commonly used.

Answer 14

Absence of ganglion cells in the bowel Rationale: Nelson's Pediatrics describes Hirschsprung disease as a congenital disorder characterized by the absence of ganglion cells in the submucosal and myenteric plexuses of the bowel. This results in a functional obstruction, leading to symptoms such as failure to pass meconium, abdominal distension, and constipation.

Answer 15

Maternal smoking Rationale: Nelson's Pediatrics notes that low birth weight, large for gestational age, and high preconceptual weight are all associated with an increased risk of childhood obesity. However, maternal smoking is typically associated with low birth weight and does not contribute to childhood obesity.

Answer 16

4 y/o Rationale: According to Nelson's Pediatrics, toilet training is usually completed by the age of 4 years. Most children achieve bladder and bowel control between 18 and 24 months, with some children taking longer.

Answer 17

5 y/o Rationale: Nelson's Pediatrics defines enuresis as repeated voiding of urine into bed or clothes at least twice a week for three consecutive months in a child who is at least 5 years old.

Answer 18

Psychosocial stressor Rationale: Nelson's Pediatrics states that secondary nocturnal enuresis, which is the reappearance of bedwetting after a period of dryness, can be associated with psychosocial stressors such as family disruptions, school problems, or other stress-inducing events.

Answer 19

4 yrs Rationale: Nelson's Pediatrics defines encopresis as the passage of feces into inappropriate places, such as clothing or the floor, after the age of 4 years. This is the age by which most children have typically achieved bowel control.

Answer 20

does not look or point at 5-10 objects Rationale: Nelson's Pediatrics indicates that by 15 months, a child should be able to look at or point to 5-10 objects when named. Failure to meet this milestone may warrant a speech and language evaluation.

Answer 21

Colic Rationale: Nelson's Pediatrics defines colic as episodes of crying for more than three hours a day, more than three days a week, for three weeks or longer in an otherwise healthy infant. This typically starts around 6-8 weeks of age and is characterized by paroxysms of fussiness and crying, often in the evening.

Answer 22

5% of infants Rationale: According to Nelson's Pediatrics, organic etiologies for excessive crying are found in less than 5% of infants after thorough evaluation. Most cases of colic are functional and not due to underlying organic disease.

Answer 23

2 years Rationale: Nelson's Pediatrics recommends developmental screening at 9, 18, and 24 or 30 months of age to identify any developmental delays early. The age of 2 years is a critical time for screening to catch developmental issues before they become more pronounced.

Answer 24

temper tantrums Rationale: Nelson's Pediatrics states that temper tantrums are common in toddlers and preschool-aged children. They are typically normal expressions of frustration or unmet needs and do not usually indicate a serious underlying condition when occurring in an otherwise well child.

Answer 25

It must be present in 2 or more settings and reported as such by independent observers Rationale: According to Nelson's Pediatrics, the DSM-5 criteria for ADHD require that symptoms be present in two or more settings (e.g., at home and school) and that they be observed and reported by others to ensure the behavior is consistent across different environments.

Answer 26

C. 6 of 9 inattentive symptoms or 6 of 9 hyperactive-impulsive symptoms for at least 6 months in two or more environmentsRationale: Nelson's Pediatrics specifies that a diagnosis of ADHD in children up to age 16 requires the presence of at least 6 out of 9 inattentive symptoms or 6 out of 9 hyperactive-impulsive symptoms for at least six months in two or more settings.

Answer 27

Absent babbling by 6 months Rationale: Nelson's Pediatrics states that concerns for ASD typically arise if there is absent babbling by 12 months, absent gestures by 12 months, no two-word spontaneous phrases by 24 months, or any loss of language or social skills at any age. Babbling by 6 months is not a diagnostic criterion.

Answer 28

Initiative vs Guilt Rationale: According to Nelson's Pediatrics and Erikson’s stages of psychosocial development, preschool-aged children (3-5 years) are in the "Initiative vs Guilt" stage, where they begin to assert power and control over their environment through directing play and other social interactions.

Answer 29

Autism Spectrum Disorder Rationale: Nelson's Pediatrics outlines that children with autism spectrum disorder (ASD) may exhibit behaviors such as lining up toys, a lack of interest in others, and speech delays. These behaviors are consistent with the description provided.

Answer 30

Dyspraxia Rationale: Nelson's Pediatrics describes dyspraxia as a disorder that affects motor planning and coordination, making it difficult for children to perform tasks requiring fine and gross motor skills, such as assembling a model.

Answer 31

Familial disorders Rationale: Nelson's Pediatrics states that speech delays between 3 to 4 months can often be related to familial factors or genetic predispositions, among other causes.

Answer 32

Dyslexia Rationale: Nelson's Pediatrics notes that dyslexia is the most common learning disability, affecting approximately 80% of children with learning disabilities. It primarily impacts reading and language skills.

Answer 33

It must be immediately attended to prevent hypoxia and onset of seizures Rationale: Nelson's Pediatrics explains that while breath-holding spells are usually benign and self-limited, immediate attention is required if the spell is prolonged to prevent hypoxia and the risk of seizures.

Answer 34

ignore thumb sucking and encouraging a substituted behavior Rationale: Nelson's Pediatrics suggests that thumb sucking is a normal behavior in infancy and early childhood. Encouraging parents to ignore the behavior and provide positive reinforcement for substitute behaviors is often effective.

Answer 35

Alcohol drinkers > smokers > drug users Rationale: According to Nelson's Pediatrics, the most common risk behaviors among adolescents include alcohol use, followed by tobacco use, and then drug use.

Answer 36

Malt liquor Rationale: Nelson's Pediatrics indicates that malt liquor typically contains a lower percentage of alcohol by volume compared to spirits like gin, vodka, and wine.

Answer 37

C. A 16-year-old girl who drank 1 glass of rum in 2 hours Rationale: According to Nelson's Pediatrics, binge drinking is defined as consuming a substantial amount of alcohol in a short period, typically within 2 hours. A standard drink of distilled spirits like rum contains a higher concentration of alcohol compared to beer or wine. Although the volume of a single drink may seem smaller, the alcohol content is much higher, making it more potent and risky. A single 12 oz glass of rum is far above the standard drink size for spirits (typically 1.5 oz per drink), significantly increasing the risk of alcohol overdose, especially in a young person with potentially lower tolerance. Thus, a 16-year-old girl consuming such a high alcohol content in a short period places her at a considerable risk of alcohol overdose

Answer 38

Alcohol Rationale: Nelson's Pediatrics highlights that alcohol is the most commonly abused substance among adolescents, surpassing the use of other substances like methamphetamine, marijuana, and inhalants.

Answer 39

There are more youth who admits to hurting someone than being hurt by someone in the past 12 months Rationale: Nelson's Pediatrics reports that a higher percentage of youth admit to aggressive behaviors such as hurting someone compared to those who report being victims of violence.

Answer 40

Fetal mortality, Low birth weight, Malnutrition Rationale: Nelson's Pediatrics identifies that early teen pregnancy impacts the fetus and newborn through increased risks of fetal mortality, low birth weight, and malnutrition, along with other complications.

Answer 41

Do a complete sexual history even if they only came in with a chief complaint of cough Rationale: Nelson's Pediatrics recommends taking a complete sexual history as part of the HEADSS assessment (Home, Education/Employment, Activities, Drugs, Sexuality, Suicide/Depression) to identify risk-taking behaviors in adolescents, regardless of their presenting complaint.

Answer 42

Anovulation Rationale: Nelson's Pediatrics explains that irregular menstruation within the first two years after menarche is commonly due to anovulation. This is a normal part of the maturation process of the hypothalamic-pituitary-ovarian axis.

Answer 43

A. 13 years old in the absence of secondary sexual characteristics.

Answer 44

Chlamydia Rationale: Nelson's Pediatrics notes that chlamydia is a common cause of mucopurulent cervicitis and urethritis in adolescents. It often presents with mucopurulent discharge and can be asymptomatic in many cases.

Answer 45

b. Growth retardation in the donor twin Rationale: Twin-to-twin transfusion syndrome (TTTS) occurs in monochorionic twin pregnancies where there is an imbalance in blood flow between the twins through vascular anastomoses in the shared placenta. The donor twin transfers blood to the recipient twin, leading to growth retardation and anemia in the donor twin (option b). The recipient twin, on the other hand, may experience polycythemia, hypervolemia, and potentially heart failure, not growth retardation (option a) or anemia (option d). Polycythemia in the donor twin (option c) is incorrect, as it is typically seen in the recipient twin.

Answer 46

b. Group B Streptococcus Rationale: Group B Streptococcus (GBS) is a common cause of neonatal sepsis, particularly in early-onset disease (within the first week of life). Despite negative maternal laboratory tests, GBS can still be transmitted during vaginal delivery. Staphylococcus pneumonia (option a) and Haemophilus influenzae (option c) are less common causes in this age group, while Listeria monocytogenes (option d) can cause neonatal infection but is less common than GBS.

Answer 47

b. 3 Rationale: The Apgar score at 1 minute is calculated as follows: Appearance (Color): 0 (cyanotic and pale) Pulse (Heart rate): 1 (heart rate of 80) Grimace (Reflex irritability): 0 (no response to nasal catheter) Activity (Muscle tone): 1 (some flexion) Respiration: 1 (slow and irregular) Total: 0 + 1 + 0 + 1 + 1 = 3

Answer 48

a. Choanal atresia Rationale: Choanal atresia is a congenital condition where the nasal passages are blocked, leading to cyanosis that improves when the baby cries (as breathing occurs through the mouth). Esophageal atresia (option b), duodenal atresia (option c), and hypoplasia of the mandible (option d) do not typically present with this specific pattern of cyanosis and improvement upon crying.

Answer 49

a. Diaphragmatic hernia Rationale: A diaphragmatic hernia is characterized by herniation of abdominal contents into the chest cavity, leading to respiratory distress, a scaphoid abdomen, and absent breath sounds on the affected side. Pneumothorax (option b), pneumonia (option c), and transient tachypnea of the newborn (option d) do not typically present with these findings.

Answer 50

b. Endotracheal intubation to suction meconium Rationale: For infants born through meconium-stained amniotic fluid who are not vigorous (apneic, limp, pale), the initial step is to perform endotracheal intubation to suction meconium from the airway to prevent aspiration and further complications. Artificial ventilation with bag and mask (option a) and giving oxygen by mask (option c) are important but should follow initial suctioning. Catheterization of the umbilical vein (option d) is not the first step.

Answer 51

c. Tension pneumothorax Rationale: Tension pneumothorax is a common and potentially life-threatening cause of sudden cardio-respiratory deterioration in a newborn receiving positive pressure ventilation. It occurs due to air trapping in the pleural space, causing lung collapse and mediastinal shift. Bronchopulmonary dysplasia (option a) and reopening of the ductus arteriosus (option b) are less common and not typically sudden causes. Sepsis neonatorum (option d) can cause deterioration but not as acutely as a tension pneumothorax.

Answer 52

d. Perinatal asphyxia Rationale: Aspiration of meconium-stained amniotic fluid is associated with perinatal asphyxia, where the fetus experiences hypoxia and may pass meconium into the amniotic fluid. Congenital heart disease (option a), congenital megacolon (option b), and tracheoesophageal fistula (option c) are not typically associated with meconium aspiration.

Answer 53

d. Perform chest compressions Rationale: If the heart rate remains below 60 beats per minute after adequate ventilation (including intubation), the next step is to initiate chest compressions to improve cardiac output. Administering epinephrine (option a) may be considered if the heart rate does not improve with compressions. Sodium bicarbonate (option b) and atropine (option c) are not the immediate next steps.

Answer 54

a. Performing chest compressions Rationale: When a newborn's heart rate drops below 60 beats per minute despite adequate positive pressure ventilation, the appropriate response is to perform chest compressions to improve circulation and cardiac output. Administering epinephrine and sodium bicarbonate (option b) can be considered if compressions and ventilation are insufficient. Performing vigorous stimulation (option c) and providing continuous positive pressure ventilation (option d) are not as effective in this situation as chest compressions.

Answer 55

c. Congenital rubella syndrome Rationale: Congenital rubella syndrome is characterized by intrauterine growth restriction (SGA), cataracts or other eye abnormalities (opacities), and congenital heart defects, such as a patent ductus arteriosus (which produces a machinery-like murmur). Congenital toxoplasmosis (option a) usually presents with chorioretinitis and intracranial calcifications, not a machinery-like murmur. Congenital herpes infection (option b) and congenital syphilis (option d) do not typically present with these specific features.

Answer 56

d. It is usually caused by an E. coli infection Rationale: Late-onset neonatal sepsis, occurring after the first week of life until 60 days, is commonly caused by coagulase-negative staphylococci, Staphylococcus aureus, and Gram-negative bacteria like Klebsiella and Pseudomonas. E. coli is more commonly associated with early-onset sepsis. The other statements are correct: late-onset sepsis can be community or hospital-acquired (option b), and complications like meningitis and necrotizing enterocolitis (NEC) are common (option c).

Answer 57

a. E. coli Rationale: Early-onset neonatal sepsis, occurring within the first week of life, is most commonly caused by Group B Streptococcus (GBS) and E. coli. While GBS is often considered the leading cause, E. coli is also a significant pathogen. Listeria monocytogenes (option b), Pseudomonas aeruginosa (option c), and Staphylococcus aureus (option d) are less common causes.

Answer 58

b. Herpes simplex Rationale: Herpes simplex virus (HSV) is typically transmitted during delivery through direct contact with infected genital secretions. In contrast, Toxoplasmosis (option a), Cytomegalovirus (option c), and Congenital syphilis (option d) are known to be transmitted transplacentally.

Answer 59

a. Congenital toxoplasmosis Rationale: Congenital toxoplasmosis is characterized by chorioretinitis, hepatomegaly, thrombocytopenia, cerebral calcifications, and hydrocephalus. These findings are specific to toxoplasmosis, while the other conditions (congenital hepatitis B, congenital herpes simplex, and congenital rubella) do not present with this specific combination of symptoms.

Answer 60

a. GI malrotation Rationale: Gastrointestinal malrotation is identified by the abnormal positioning of the ligament of Treitz and the cecum on an upper GI series. Gastroesophageal reflux (option b), pyloric stenosis (option c), and Hirschsprung disease (option d) present with different clinical and imaging findings.

Answer 61

b. Bacterial sepsis

Answer 62

c. Erb's palsy on the left arm Rationale: Erb's palsy, a type of brachial plexus injury, is characterized by weakness or paralysis of the arm, with the arm held in an internally rotated position and the forearm extended and pronated. The absence of the Moro reflex on the affected side is also indicative of this condition. Fractures of the left clavicle (option a) or humerus (option b) would present differently, and phrenic nerve paralysis (option d) would affect diaphragmatic function.

Answer 63

c. Group B Streptococcus (GBS) Rationale: Group B Streptococcus (GBS) is the most likely cause of early-onset neonatal sepsis in a baby presenting with fever and poor feeding within the first week of life, particularly in a preterm infant. Staphylococcus aureus (option a), Listeria monocytogenes (option b), and Streptococcus pneumoniae (option d) are less common causes.

Answer 64

a. Administration of antenatal steroids Rationale: Administration of antenatal steroids is the best way to prevent complications associated with prematurity, such as respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. Adequate nutrition (option b), maternal multivitamin supplements (option c), and aggressive neonatal resuscitation (option d) are important but do not specifically prevent complications of prematurity as effectively as antenatal steroids.

Answer 65

d. If clinical jaundice appears at 1 week or less in full-term infants or 2 weeks or less in preterm infants Rationale: Neonatal jaundice is considered pathologic if it presents within the first 24 hours of life (option a), if total serum bilirubin increases by more than 5 mg/dL per day (option b), or if direct serum bilirubin exceeds 1.5-2 mg/dL (option c). However, clinical jaundice appearing at 1 week or less in full-term infants or 2 weeks or less in preterm infants (option d) is not typically considered pathologic and can be part of the normal physiologic jaundice process.

Answer 66

a. Start phototherapy Rationale: For a 30-hour-old full-term infant with a bilirubin level of 15.5 mg/dL, phototherapy is indicated to reduce bilirubin levels and prevent the risk of kernicterus. Exchange transfusion (option b) is reserved for more severe cases with higher bilirubin levels or if phototherapy is ineffective. Recommending stopping breastfeeding (option c) is not necessary, and no action (option d) would not be appropriate given the elevated bilirubin level.

Answer 67

b. It is caused by shortened RBC survival Rationale: Anemia of prematurity is primarily due to shortened red blood cell (RBC) survival and a decreased production of erythropoietin. It typically occurs in premature infants in the early weeks of life, not the 5th month (option a). Packed RBC transfusion may be indicated if the baby is symptomatic (option c), and erythropoietin levels are usually inadequate in these infants (option d).

Answer 68

a. Severe deficiency of uridine diphosphate glucuronyltransferase Rationale: Crigler-Najjar syndrome type 1 is a rare genetic disorder characterized by a severe deficiency of the enzyme uridine diphosphate glucuronyltransferase (UGT), leading to an inability to conjugate bilirubin. This results in severe unconjugated hyperbilirubinemia. Increased production of bilirubin (option b), increased conjugation of bilirubin (option c), and deficient hepatic uptake of bilirubin (option d) are not the causes of hyperbilirubinemia in this condition.

Answer 69

a. Maternal ingestion of phenobarbital during pregnancy Rationale: Maternal ingestion of phenobarbital during pregnancy can induce hepatic enzymes in the fetus, leading to increased bilirubin conjugation and thereby decreasing the risk of neurologic damage due to hyperbilirubinemia. Hypoalbuminemia (option b), acidosis (option c), and sepsis (option d) all increase the risk of bilirubin crossing the blood-brain barrier and causing neurologic damage.

Answer 70

c. Bilirubin encephalopathy Rationale: Bilirubin encephalopathy (kernicterus) is a condition resulting from very high levels of unconjugated bilirubin, which can cross the blood-brain barrier and cause neurological damage. Symptoms include lethargy, opisthotonus, and spasticity. Sepsis neonatorum (option a), perinatal asphyxia (option b), and persistent pulmonary hypertension (option d) do not specifically present with the described symptoms and bilirubin levels.

Answer 71

a. Milder, hydrops is not common Rationale: ABO incompatibility typically presents as a milder form of hemolytic disease compared to Rh incompatibility, and hydrops fetalis is not common. Rh incompatibility (option b) involves an Rh-negative mother and an Rh-positive baby. ABO incompatibility can result in a weakly positive Coombs' test (option c), but this is not a key differentiator. It can occur during the first pregnancy, not just the second (option d).

Answer 72

b. Bronze baby Rationale: Phototherapy can occasionally cause a condition known as "bronze baby syndrome," characterized by a dark, grayish discoloration of the skin. Gangrene (option a), jaundice (option c), and kernicterus (option d) are not associated with this specific skin discoloration due to phototherapy.

Answer 73

b. Physiologic jaundice Rationale: Physiologic jaundice is common in newborns and typically appears after the first 24 hours of life, peaking around the third to fourth day. A bilirubin level of 8 mg/dL at 30 hours is within the expected range for physiologic jaundice. Pathologic jaundice (option a) would present within the first 24 hours or with much higher levels of bilirubin. Neonatal sepsis (option c) and G6PD deficiency (option d) would typically have other associated symptoms or risk factors.

Answer 74

b. Congenital hypothyroidism Rationale: Congenital hypothyroidism presents with symptoms such as hypotonia, constipation, umbilical hernia, and macroglossia (protrusion of the tongue). G6PD deficiency (option a) typically presents with jaundice or hemolytic anemia. Hypoglycemia (option c) would present with symptoms related to low blood sugar levels. Phenylketonuria (option d) presents with developmental delays and a musty odor but not the constellation of symptoms described.

Answer 75

c. Delayed clamping of the umbilical cord Rationale: Delayed clamping of the umbilical cord can lead to an increased red blood cell mass, resulting in polycythemia. Placenta previa (option a) and abruptio placenta (option b) are more likely to cause anemia due to bleeding. The donor twin in twin-to-twin transfusion syndrome (option d) typically has anemia rather than polycythemia.

Answer 76

b. Transient tachypnea of the newborn Rationale: Transient tachypnea of the newborn (TTN) is characterized by rapid breathing, usually within the first few hours of life, and is commonly seen in babies delivered via Cesarean section. Chest X-ray findings include fluid in the interlobar fissures and widened intercostal spaces. Neonatal pneumonia (option a), bronchopulmonary dysplasia (option c), and respiratory distress syndrome (option d) have different presentations and X-ray findings.

Answer 77

d. Tracheoesophageal fistula Rationale: Tracheoesophageal fistula is suggested by respiratory distress, drooling, and the inability to pass an orogastric tube, with the tube coiling in the upper esophagus on X-ray. Pyloric stenosis (option a) presents later with projectile vomiting. Intestinal obstruction (option b) and congenital diaphragmatic hernia (option c) would have different clinical and radiographic findings.

Answer 78

d. Necrotizing enterocolitis Rationale: Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition that typically affects premature infants, characterized by abdominal distension, feeding intolerance, and bloody stools. Hypertrophic pyloric stenosis (option a) presents later with projectile vomiting. Intestinal obstruction (option b) would present with vomiting and lack of stool passage, and tracheoesophageal fistula (option c) would present with respiratory issues and feeding difficulties soon after birth.

Answer 79

b. Pneumatosis intestinalis Rationale: Pneumatosis intestinalis, the presence of gas within the bowel wall, is pathognomonic for necrotizing enterocolitis (NEC). The double bubble sign (option a) is seen in duodenal atresia. Absence of presacral gas (option c) and thickened bowel loops (option d) are not specific to NEC.

Answer 80

a. Increasing IgM titer Rationale: An increasing IgM titer is suggestive of a congenital infection because IgM does not cross the placenta, so its presence in a newborn indicates that the infant has produced the antibody in response to an infection. Increasing IgG titer (option c) and decreasing IgG titer (option d) reflect maternal antibodies that cross the placenta and are not specific for congenital infection. Decreasing IgM titer (option b) is not indicative of active infection.

Answer 81

c. Hypertrophic pyloric stenosis Rationale: Hypertrophic pyloric stenosis typically presents in the first few weeks of life with non-bilious projectile vomiting, dehydration, and a palpable olive-like mass in the right upper quadrant. Tracheoesophageal fistula (option a) presents with feeding difficulties and respiratory symptoms. Congenital duodenal atresia (option b) typically presents with bilious vomiting. Congenital megacolon (option d), or Hirschsprung disease, presents with delayed passage of meconium and abdominal distension.

Answer 82

b. Physiologic jaundice Rationale: Physiologic jaundice is common and typically appears between the second and third day of life as the newborn's liver matures and begins to process bilirubin. Acute hemolytic jaundice (option a) and neonatal hepatitis (option d) usually present earlier with more severe symptoms. Biliary atresia (option c) presents later with persistent jaundice.

Answer 83

a. Exposure to phototherapy Rationale: For a newborn with a total bilirubin level of 21 mg/dL, phototherapy is the appropriate initial treatment to reduce bilirubin levels and prevent kernicterus. Exchange transfusion (option b) is considered if bilirubin levels are critically high or do not respond to phototherapy. Administration of IV immunoglobulin (option c) is used in specific cases like isoimmune hemolytic disease. Continuing monitoring without intervention (option d) is not appropriate given the high bilirubin level.

Answer 84

b. Double volume exchange transfusion Rationale: When bilirubin levels continue to rise despite phototherapy, reaching a critical level like 30 mg/dL, a double volume exchange transfusion is indicated to rapidly reduce bilirubin levels and prevent kernicterus. Continuing phototherapy (option a) alone is insufficient. Metalloporphyrin (option c) and phenobarbital (option d) are not immediate treatments for critically high bilirubin levels.

Answer 85

b. Neonatal drug withdrawal Rationale: Maternal drug addiction commonly leads to neonatal drug withdrawal, also known as neonatal abstinence syndrome (NAS), which can present with symptoms such as irritability, feeding difficulties, and tremors. Normal birth weight (option a) and large for gestational age (option c) are less common. There is a significant impact on the fetus (option d).

Answer 86

a. Graves' disease Rationale: Neonatal thyrotoxicosis is most commonly seen in infants of mothers with Graves' disease due to the transplacental transfer of thyroid-stimulating antibodies. Hypothyroidism (option b), Hashimoto's thyroiditis (option c), and postpartum thyroiditis (option d) are not typically associated with neonatal thyrotoxicosis.

Answer 87

c. Chronic hypertension

Answer 88

a. Abdominal X-ray will show "double-bubble" sign Rationale: The "double-bubble" sign on an abdominal X-ray is characteristic of congenital duodenal obstruction. Abdominal distension (option b) is more prominent in distal obstructions. Non-bilious vomiting (option c) is not typical for duodenal atresia, which usually causes bilious vomiting. Sawtooth contractions (option d) are not related to duodenal obstruction but are associated with Hirschsprung disease.

Answer 89

c. Gastroscopy Rationale: For a 3-day-old baby with bilious vomiting and abdominal distension, appropriate diagnostic tests include a plain abdominal X-ray (option a), barium enema (option b), and rectal biopsy (option d) to evaluate for potential causes like intestinal obstruction or Hirschsprung disease. Gastroscopy (option c) is not typically indicated in the initial evaluation of these symptoms.

Answer 90

a. Absence of ganglion cells in the bowel Rationale: Hirschsprung disease is characterized by the absence of ganglion cells in the bowel, leading to a lack of peristalsis and subsequent bowel obstruction. Extensive bowel necrosis (option b) is not specific to Hirschsprung disease. Hypertrophy of the muscles of the pylorus (option c) is seen in hypertrophic pyloric stenosis. Malrotation of the intestines (option d) is a different condition involving abnormal positioning of the intestines.

Answer 91

c. Autoimmune hemolytic anemia Rationale: A positive Coombs test, spherocytes, increased bilirubin, and increased reticulocytes are indicative of autoimmune hemolytic anemia. Anemia of prematurity (option a) typically involves low reticulocyte counts and is not associated with a positive Coombs test. G6PD deficiency (option b) can cause hemolysis but is not associated with a positive Coombs test or spherocytes. Intraventricular hemorrhage (option d) is not related to these hematological findings.

Answer 92

d. Cyanotic congenital heart disease Rationale: In the context of meconium staining and significant hypoxemia that does not improve substantially with 100% oxygen, cyanotic congenital heart disease is the most likely diagnosis. Pneumonia (option a), retained fetal lung fluid (option b), and meconium aspiration (option c) could cause respiratory distress but are more likely to show improvement in oxygen saturation with 100% oxygen.

Answer 93

d. Breastmilk jaundice Rationale: Breastmilk jaundice typically presents after the first week of life in an otherwise healthy, breastfed infant. Kernicterus (option a) is associated with severe hyperbilirubinemia and neurological symptoms. Pathologic jaundice (option b) would usually present earlier. Physiologic jaundice (option c) typically resolves by the second week.

Answer 94

d. Decreased production of pulmonary surfactant Rationale: Hyaline membrane disease (respiratory distress syndrome) is caused by decreased production of pulmonary surfactant, leading to alveolar collapse and respiratory distress. Increased metabolism of pulmonary surfactant (option a) and increased production of pulmonary surfactant (option c) are incorrect. Decreased metabolism of pulmonary surfactant (option b) is not a contributing factor.

Answer 95

a. Rubella Rationale: Congenital rubella syndrome includes clinical manifestations such as peripheral pulmonic stenosis, atrial septal defect, ventricular septal defect, chorioretinitis, hepatosplenomegaly, jaundice, and "blueberry muffin spots." Cytomegalovirus (option b), toxoplasmosis (option c), and syphilis (option d) present with different sets of symptoms.

Answer 96

b. Requires treatment with a sling Rationale: Clavicular fractures in newborns typically heal on their own without the need for a sling. It is commonly associated with Erb's palsy (option c) and can cause an asymmetric Moro reflex (option d). It occurs frequently in infants of diabetic mothers (option a).

Answer 97

b. Neonatal hepatitis Rationale: Direct-reacting hyperbilirubinemia on the 10th day of life suggests neonatal hepatitis. G6PD deficiency (option a), Gilbert syndrome (option c), and Crigler-Najjar syndrome (option d) are associated with unconjugated hyperbilirubinemia.

Answer 98

c. Intrauterine growth restriction Rationale: Infants of diabetic mothers are at risk for hypoglycemia (option a), transient tachypnea of the newborn (option b), and perinatal asphyxia (option d). However, they are more likely to be large for gestational age rather than experiencing intrauterine growth restriction.

Answer 99

a. Methamphetamines Rationale: Methamphetamines are commonly produced in illegal laboratories and are popular among adolescents and young adults due to their potency and ease of absorption. Cocaine (option b) and Ecstasy (MDMA) (option c) are also abused but are not primarily produced in illegal laboratories. LSD (option d) is a hallucinogen and not produced for the same reasons as methamphetamines.

Answer 100

d. Intubate with an endotracheal tube Rationale: The presentation suggests a congenital diaphragmatic hernia, which requires immediate intubation to secure the airway and avoid bag-mask ventilation (option a), which could exacerbate the condition. Administering Naloxone (option b) and Sodium bicarbonate (option c) are not appropriate for this condition.

Answer 101

b. Vomiting Rationale: Vomiting is not a typical symptom of hypoglycemia. Symptoms of hypoglycemia include jitteriness (option a), cyanosis (option c), and hypothermia (option d).

Answer 102

c. Instruct the mother to breastfeed early and recheck the glucose after 30 minutes Rationale: Early breastfeeding and rechecking glucose levels after 30 minutes is appropriate to address mild hypoglycemia in a stable, asymptomatic infant. Administering a dose of Dextrose (option a) is reserved for more severe or symptomatic hypoglycemia. Total serum bilirubin and calcium (option b) are not immediately relevant. Rechecking the glucose in 1 hour (option d) is too long to wait.

Answer 103

b. Total serum bilirubin and hematocrit Rationale: Total serum bilirubin and hematocrit are appropriate to evaluate the extent of jaundice and to assess for polycythemia, which is common in infants of diabetic mothers. Total bilirubin and glucose (option a), total serum bilirubin, liver transaminases, and hepatitis panel (option c), and total serum bilirubin and calcium (option d) are not the most relevant initial tests.

Answer 104

b. Urine culture Rationale: A urine culture has the lowest diagnostic yield in a 12-hour-old infant with respiratory distress. Blood culture (option a), CBC (option c), and chest X-ray (option d) are more relevant for diagnosing conditions like sepsis or respiratory distress syndrome.

Answer 105

a. Gestational age Rationale: Being born at 36 weeks' gestation places the infant in the late preterm category, which is a significant risk factor for neonatal sepsis. Late preterm infants have an immature immune system and are more susceptible to infections compared to full-term infants. While prolonged rupture of membranes (more than 18 hours) is also a risk factor, in this case, the gestational age (prematurity) is the primary concern. Apgar scores, although indicative of the infant's initial condition, are less specific for sepsis risk. Maternal age is generally not a significant risk factor for neonatal sepsis.

Answer 106

a. Puberty begins in males approximately 12-18 months later than in females Rationale: Puberty typically begins in males about 12-18 months later than in females. Menarche (onset of menstruation) (option b) does not occur at the same time as thelarche (breast development). Pubic hair growth is not the first sign of puberty in males (option c) or females (option d).

Answer 107

d. Impulse control and planning Rationale: The pre-frontal cortex is responsible for impulse control and planning, which develops later in adolescence. Emotions and motivations (option a) are associated with the limbic system. Physical coordination and reward (option b) involve other brain areas. Judgment and present orientation (option c) are also functions of the pre-frontal cortex but are less specific than impulse control and planning.

Answer 108

d. Religious involvement Rationale: Religious involvement is generally considered a protective factor against risk-taking behaviors in adolescents. Violence at home (option a), low socio-economic status (option b), and living in a single-parent household (option c) are risk factors for such behaviors.

Answer 109

d. Altruistic Rationale: Adolescents are often prone to exaggeration and over-dramatization (option a), have a sense of invincibility (option b), and can be self-centered (option c). While some adolescents can certainly be altruistic, it is not a characteristic that typically defines adolescent thinking as much as the other listed traits.

Answer 110

c. Alcohol overdose Rationale: Common causes of morbidity and mortality in adolescents include injury (option a), leukemia (option b), and homicide (option d). While alcohol use is a significant health issue, alcohol overdose (option c) is not typically listed among the top 10 causes of morbidity and mortality in adolescents.

Answer 111

c. Alcohol drinkers > smokers > drug users Rationale: In many countries, including the Philippines, alcohol use is more common than smoking, and smoking is more common than drug use among adolescents.

Answer 112

c. There are more youth who admit to hurting someone than being hurt by someone in the past 12 months. Rationale: Among the youth, there is often a higher self-reported incidence of hurting others than being hurt themselves. Cyberbullying (option a) is common and often underreported, but not "never" reported. Media exposure (option b) can increase the risk of violence, not decrease it. Family and environment (option d) are important, but not the only factors to consider in screening for violence.

Answer 113

d. Admit patient and start IV cefoxitin and oral doxycycline Rationale: The patient's symptoms and physical findings suggest pelvic inflammatory disease (PID). Given the severity of her symptoms, including fever and significant abdominal pain, the appropriate next step is to admit her for inpatient treatment with IV antibiotics (IV cefoxitin) and oral doxycycline. Outpatient treatment (options b and c) might be appropriate for less severe cases. Wet mount saline microscopy (option a) is not the immediate next step and is more specific for diagnosing Trichomonas infection.

Answer 114

d. Admit patient and start IV cefoxitin and oral doxycycline Rationale: The patient’s symptoms suggest pelvic inflammatory disease (PID) with moderate severity (fever, significant abdominal pain, cervical and adnexal tenderness). Hospital admission for intravenous antibiotics (IV cefoxitin and oral doxycycline) is appropriate to ensure adequate treatment and monitoring. Outpatient treatment (options b and c) might be appropriate for less severe cases. Wet mount saline microscopy (option a) is used for diagnosing Trichomonas infection, not for immediate management of PID.

Answer 115

b. Fetal mortality, Low birth weight, Malnutrition Rationale: Early teen pregnancy can negatively impact the fetus and newborn, leading to increased risks of fetal mortality, low birth weight, and malnutrition. Pre-eclampsia (option a) affects the mother more directly. Neonatal pneumonia (option c) and LGA (option d) are not primary impacts of teen pregnancy.

Answer 116

b. Do a complete sexual history even if they only came in with a chief complaint of cough Rationale: It is important to take a complete sexual history as part of a thorough assessment for adolescents, even if they present with a seemingly unrelated complaint like a cough. Asking together with parents (option a) may inhibit the adolescent's openness. Disclosing minor risk behaviors to parents without the adolescent's consent (option c) can breach trust. Skipping the physical examination (option d) is not appropriate; a thorough assessment is necessary.

Answer 117

c. Ectopic pregnancy

Answer 118

a. Functional cysts Rationale: Functional cysts are the most common type of pelvic mass found in adolescent girls. Tuboovarian complexes (option b), chocolate cysts (endometriomas) (option c), and dermoid cysts (option d) are less common.

Answer 119

c. Polycystic ovarian syndrome Rationale: Polycystic ovarian syndrome (PCOS) is characterized by irregular menstruation and the presence of a pelvic mass (enlarged ovaries with multiple cysts). Given the patient's history and the physical finding of a pelvic mass, PCOS is the most likely diagnosis. Anovulation (option a) is a common feature of PCOS. Pregnancy (option b) is unlikely given the mother's statement and the absence of other symptoms. Malignancy (option d) is less likely given the normal physical examination apart from the pelvic mass.

Answer 120

a. Anovulation Rationale: Irregular menstruation in a 12-year-old who had menarche 10 months ago is likely due to anovulation, which is common in the first few years after menarche as the hypothalamic-pituitary-ovarian axis matures. Pregnancy (option b) and PCOS (option c) are less likely given the patient's age and the normal physical examination. Mass/malignancy (option d) is unlikely without other symptoms or abnormal physical findings.

Answer 121

a. 13 Rationale: Primary amenorrhea is defined as the absence of menses by age 13 in the absence of secondary sexual characteristics.

Answer 122

c. 15 Rationale: Primary amenorrhea is defined as the absence of menses by age 15 in the presence of normal secondary sexual characteristics.

Answer 123

d. Seminoma Rationale: Seminoma is the most common type of testicular neoplasia in adolescents and needs to be ruled out when a testicular mass is present. Hydrocele (option a), varicocele (option b), and spermatocele (option c) are less likely to be neoplastic.

Answer 124

b. Varicocele Rationale: A varicocele is described as a "bag of worms" on palpation and does not typically transilluminate. A hydrocele (option a) transilluminates but does not feel like a "bag of worms." Spermatocele (option c) and seminoma (option d) have different presentations and characteristics.

Answer 125

d. No test to be done and provide reassurance Rationale: Bilateral breast enlargement during puberty is common and usually benign (pubertal gynecomastia). Reassurance is often the appropriate management. Chromosomal analysis (option a), checking serum estrogen level (option b), and ordering liver function tests (option c) are not necessary unless there are other concerning findings or persistent symptoms.

Answer 126

d. Significant loss such as death of grandmother Rationale: While significant loss, such as the death of a grandmother, can be a contributing factor, it is less directly associated with adolescent suicide compared to substance abuse (option a), peer/family conflict (option b), and divorce or separation of parents (option c).

Answer 127

d. None of the above Rationale: Adolescents may indeed be reluctant to report rape due to self-blame (option a), fear (option b), and embarrassment (option c). Therefore, there is no exception among these reasons.

Answer 128

a. Ecstasy (MDMA) Rationale: Ecstasy (MDMA) is known to cause agitation, hyperactivity, and hypersexual behavior. LSD (option b), PCP (option c), and methamphetamine (option d) can cause agitation and hyperactivity but are less associated with hypersexual behavior.

Answer 129

d. Refer for psychosocial evaluation and counseling Rationale: Given the context of chronic headaches, dislike for school, lack of participation in activities, and difficulty concentrating, a psychosocial evaluation and counseling is the best next step. A CT scan (option a) is not indicated without focal neurological findings. Prescribing Sumatriptan (option b) may not address the underlying issue. Keeping a headache diary (option c) can be useful but is not the most immediate step.

Answer 130

b. Problems with law enforcement Rationale: Problems with law enforcement (option b) can be a result of substance abuse but do not directly indicate the pattern or severity of substance use itself. The other options, driving while using marijuana (option a), craving marijuana use while at school (option c), and no longer attending soccer practice to smoke with friends (option d), directly involve the use of the substance and can be used as criteria to assess substance abuse disorder. Thus, only option b does not directly assess the use of the substance.

Answer 131

c. Experimentation Rationale: The second stage of drug abuse in adolescents is experimentation, where adolescents begin to try drugs and the focus should be on reviewing risks and emphasizing safety. The other options do not correctly represent the second stage.

Answer 132

b. Cocaine Rationale: Cocaine is a CNS stimulant that increases dopamine levels by preventing reuptake, leading to effects such as euphoria, increased motor activity, decreased fatiguability, and mental alertness. Amphetamines (option a) have similar effects but work through a different mechanism. Ecstasy (MDMA) (option c) is both a stimulant and hallucinogen. LSD (option d) is a hallucinogen.