Explanation:

If a child faces forward in a crash, the force is distributed via the harness system across the shoulders, torso, and hips, but the head and neck have no support. Without support, the infant´s head moves rapidly forward in flexion while the body stays restrained, causing potential injury to the neck, spinal cord, and brain. In a rear-facing position, the force of the crash is distributed evenly across the baby´s torso, and the back of the child seat supports and protects the head and neck. For these reasons the rear-facing position should be used until the child is 12 months old and weighs 20 lb (9 kg). For example, a 13- month-old child who weighs 19 lb should face rearward, and a 6-month-old child who weighs 21 lb should also face rearward.

Explanation:

The mother, whose age is unspecified, but is likely less than 60 years old, has no major risk factors for cardiac disease and her cholesterol levels are not elevated enough to trigger concern for a familial hypercholesterolemia. For these reasons, her child does not require any immediate attention but should wait until roughly two years old when his diet is free of breast milk and other sources of high fat content that infants often require.

Explanation:

The etiology of stuttering is controversial. The prevailing theories point to measurable neurophysical dysfunctions that disrupt the precise-timing required to produce speech. Stuttering is a common disorder that usually resolves by adulthood. Almost 80 percent of children who stutter recover fluency by the age of 16 years. As with many behavioral disorders of childhood, stuttering occurs three to four times more often in boys than in girls. Mild stuttering is self-limited, but more severe stuttering requires speech therapy, which is the mainstay of treatment. Delayed auditory feedback and computer-assisted training are currently used to help slow down speech and control other speech mechanisms. Pharmacologic therapy is seldom used, although haloperidol has been somewhat effective.

Explanation:

A helpful guideline for assessing normal growth in the very young infant is that birth weight should be regained by the 14th day.

Explanation:

Explanation:

Sudden infant death syndrome (SIDS) is the sudden and unexpected death of an infant or young child between 2 weeks and 1 year of age in which a thorough postmortem examination fails to show cause.
The prevention involves infants be placed supine (on back) for sleep. The incidence of SIDS increases with overheating (clothing, blankets, hot room) and in cold weather. Thus, every effort should be made to avoid an overheated or an overly cold environment, to avoid overwrapping the infant, and to remove soft bedding, such as sheepskin, pillows, stuffed toys/animals, and comforters, from the crib. Mothers should avoid smoking during pregnancy, and infants should not be exposed to smoke.
Note: “Prone” (face down) is often confused with “supine´ (face up).

Explanation:

Pica is the term used to describe craving for and eating nonnutritious things such as dirt and ice. This is a sign of lead poisoning. Most commonly, young children get lead poisoning from lead-based paint, which was used in many old homes. That´s why kids who live in older homes are at a greater risk for lead poisoning.
These children are found to have unsafe levels of lead in their blood, which can lead to a wide range of symptoms, from headaches and stomach pain to behavioral problems and anemia. Lead can also affect a child´s developing brain.

Explanation:

A lumbar puncture is not necessary in this child as she does not have a presentation that is suspicious for meningitis.

Explanation:

Antimicrobial prophylaxis is recommended for patients at high to moderate risk of infective endocarditis before procedures associated with bacteremias and subsequent infective endocarditis. For most patients and procedures, a single dose shortly before the procedure is effective. Procedures requiring antimicrobial endocarditis prophylaxis include oral-dental procedures, dental extraction, dental implant placement and reimplantation of avulsed teeth and periodontal procedures, including surgery, scaling, root planning, and probing.
Drug treatment in patients allergic to penicillin is with a macrolide such as erythromycin, clarithromycin or azithromycin.

Explanation:

Phenytoin has been associated with several forms of congenital heart disease, including pulmonary valve stenosis, aortic valve stenosis, coarctation, and patent ductusarteriosus. The other agents have not been described as causative factors for congenital heart disease.

Explanation:

Maternal diabetes often results in large-for-date babies. Prematurity, active tobacco smoking, maternal alcohol ingestion, and passive tobacco smoking all are associated with low birth weight.

Explanation:

At the age of five years, approximately the time most children enter kindergarten, children develop the ability to copy rectangles. Prior to this age, they generally cannot perform such an act.

Explanation:

The correct answer is C. All signs, including the child´s report, suggest child abuse; however, there can be mitigating circumstances that are present. All states have laws requiring everyone to protect children by reporting the suspicion of child abuse to Child Protective Services. It is the responsibility of this agency to prove or disprove the suspicion, and to establish supervision of the child if abuse is verified.
“I am going to call the police right now” (choice A), is only appropriate if the Child Protective Services is not available immediately. Choices B, D, and E do nothing to address the issue of the mandatory report of the suspicion of child abuse to the appropriate authorities.

Explanation:

An infant will be able to understand the concept of object permanence by nine to ten months. This is evident by the fact that infants of this age group will be able to uncover a hidden object, realizing that because an object is out of sight does not mean that it no longer exists.

Explanation:

An infant at six months is able to transfer an object, such as a toy from one hand to another. Prior to that, he cannot.

Explanation:

Vitamin D toxicity is associated with hypercalcemia, as well as constipation, and sometimes nephrocalcinosis. Vitamin E toxicity may cause a necrotizing enterocolitis and hepatitis in children. Vitamin K toxicity although uncommon, may cause vomiting and hemolysis, as well as albuminuria and hemoglobinuria. Pantothenic acid toxicity is associated with diarrhea. Pyridoxine toxicity, while very rare, is associated with peripheral sensory neuropathy.

Explanation:

A child will begin the routine use of sentences at three years of age. Prior to this time, the child can only use a few phrases up until the age of one, and only a few phrases up until the age of two. The child cannot participate in an active conversation until about four years, when he also becomes capable of eliciting a series of sentences. At the age of five years, a child becomes capable of using complex sentences that include the use of pronouns, adjectives, prepositions, and other complex language.

Explanation:

Children at the age of five have developed the ability to dress by themselves; however, many mothers still dress the child at this age even though the child can do it alone.

Explanation:

Preoperational intelligence develops at approximately two years.

Explanation:

The onset of maximum testicular volume approximately coincides with the end of the height spurt in adolescent boys, approximately 15.5 years of age.

Explanation:

Children who are elementary school age are more afraid of injuring themselves physically or losing a loved one, such as a parent. Children less than one year of age are most often scared of loud noises, heights, and lack of physical support. Children one year of age typically begin to experience stranger anxiety and separation anxiety. Children between the ages of two and six years are afraid of figments of their imagination (e.g., the bogeyman), as well as animals and the dark. Adolescents and teens are scared of failing or not being accepted socially.

Explanation:

By the age of five years, a child should have developed the ability to recite the alphabet without help. If this has not occurred; intelligence testing is indicated to determine whether there are any mental handicaps that are preventing the child from doing so.

Explanation:

According to the studies of Thomas and Chess, the “easy” child, or one that exhibits normal schedules of sleeping, eating, playing, etc., represents approximately 40% of all children. “Difficult” children, or those with irregular schedules of activities, represent 10% of children. “Slow to warm up” children, who are withdrawing as well as low in activity, represent 15% of children. Thomas and Chess did not designate categories for “indifferent” or “dependent” children.

Explanation:

By the age of two years, differences can be recognized in personality. Some parameters that can be measured in two-year-old children include passivity, timidity, and boldness. Other names for these characteristics include “harm avoidance” and “novelty seeking” behavior.

Explanation:

A child first develops the ability to draw a man with six separable parts-a stick figure-at approximately the age of five. None of the other ages correspond to the first development of this ability.

Explanation:

In older children, recumbent length is more accurate than standing height due to postural factors. Option A is correct, since single measurements that are taken at the beginning or end of a period of defective growth may reveal unusual features of a baby´s growth, but show nothing of the baby´s rate of growth. Since it is impossible to say what measurements represent normal growth, it is impossible to use average weight and height as a reference in determining whether a child´s growth is normal or abnormal. Malnutrition has more of an effect on weight than on height. Figures obtained from one country should not be used as a basis of comparison for children in another country, because the growth and development of children varies from one country to the other.

Explanation:

Children between the ages of two and six years are afraid of figments of their imagination (e.g., the bogeyman), as well as animals and the dark. Children less than one year of age are most often scared of loud noises, heights, and lack of physical support. Children one year of age typically begin to experience stranger anxiety and separation anxiety Children who are elementary school age are more afraid of injuring themselves physically or losing a loved one, such as a parent. Adolescents and teens are scared of failing or not being accepted socially.

Explanation:

The findings of dry mucous membranes, poor skin turgor, and tachycardia suggest that the infant is volume depleted. He has been taking the loop diuretic furosemide, which is used to treat bronchopulmonary dysplasia. Furosemide causes increased excretion of sodium (therefore water), potassium, and chloride in the urine. The body is therefore hypovolemic. Excessive loss of potassium causes the hydrogen-potassium pump across the cell membranes to transport hydrogen into the cells in exchange for potassium out of the cells. Transportation of hydrogen into the cells causes the number of hydrogen ions in the plasma to decrease and results in alkalosis. The chemoreceptors in the medullary respiratory center of the brain sense the metabolic alkalosis and respond by lowering the respiratory rate.
Therefore, more carbon dioxide is retained in the bloodstream and partially corrects the metabolic alkalosis.
Bartter syndrome is a rare autosomal-recessive disorder that manifests as hypokalemia, hypochloremia, and high renin and aldosterone levels. Primary aldosteronism is characterized by hypertension, hypernatremia, hypokalemia, and a suppressed renin-angiotensin system.
Primary respiratory acidosis with metabolic compensation represents a primary process of respiratory failure and increased retention of carbon dioxide. The kidneys compensate by retention of bicarbonate in an attempt to correct the acidosis. However compensatory mechanisms will never overcompensate for the primary process. Therefore, the pH should never be more than 7.40.
Pseudo hyperaldosteronism, also known as the Liddle syndrome, is a rare disorder of renal transport of sodium and potassium that resembles primary hypcraldosteronism. Affected people present in infancy or early childhood with hypertension, polyuria, polydipsia, and hypokalemic metabolic alkalosis. The serum concentration of aldosterone is low.

Explanation:

While it is commonly known that diabetes mellitus is associated with polyuria and polydipsia, many do not realize it also associated with weight loss despite increased eating. In our extremely weight and food conscious society, this phenomenon may be much more striking to the patient and his family than a change in the amount of fluid intake. The lesson learned is that a child who develops weight loss despite increased food intake requires a blood glucose test.

Explanation:

Explanation:

Explanation:

Recurrent abdominal pain (RAP) is common in children especially in pre- school children and adolescents. Recurrent abdominal pain is an expression of physiological maladjustments in response to family or school problems in predisposed children. Contrary to this belief, many studies have found organic causes of RAP to be more common. The occurrence of nocturnal pain is considered an important indicator of an organic (disease-lased). Night pain or pain on awakening suggests a peptic origin, while pain that occurs in the evening or during dinner is-a feature of constipation.
Organic causes include (but are not limited to) gastrointestinal disease, urinary tract infections, parasite infestation and esophagitis/gastritis.

Explanation:

Explanation:

The current measles-mumps-rubella vaccine (M R) does not contain a significant amount of egg proteins) In the past skin testing of all children with severe egg allergies before they received the M R was recommended; This is no longer necessary; Even those with dramatic egg allergies are extremely unlikely to have an anaphylactic reaction to the MMR. The benefits of the vaccine far outweigh the risks.
Although egg protein in the MMR is no longer a big problem, if your child has severe allergies with systemic sym toms, whatever the cause, it pays to become familiar with the hidden ingredients found in products of all kinds.

Explanation:

Hereditary angioedema is caused by deficiency (type 1; in 85%) or dysfunction (type 2; in 15%) of C1 inhibitor, a protein that regulates the classical complement activation pathway.
Inheritance is autosomal dominant. C1 inhibitor deficiency may also develop when complement is consumed in neoplastic disorders or when C1 inhibitor autoantibody is produced in monoclonal gammopathy (acquired deficiency). Attacks are precipitated by trauma or viral illness and aggravated by emotional stress. Symptoms and signs are similar to those of angioedema except that edema progresses until complement components have been consumed; the GI tract is often involved, causing nausea, vomiting, colic, and signs of intestinal obstruction.
Diagnosis is by detection of low levels C1 inhibitor. Treatment is attenuated androgens to stimulate hepatic C1 inhibitor synthesis.

Explanation:

In infants signs of 5% dehydration are slightly dry buccal mucous membranes, increased thirst and slightly decreased urine output.
In infants signs of 10% dehydration are dry buccal mucous membranes, tachycardia, little or no urine output, lethargy, sunken eyes and fontanelles, loss of skin turgor.
In infants signs of 15% dehydration are same as moderate plus a rapid. thready pulse, no tears, cyanosis, rapid breathing, delayed capillary refill, hypotension, mottled skin and coma.

Explanation:

Scabies is usually not seen on the head, neck, palms, and soles in adults, but these areas are often affected in infants. Lindane may be hazardous to young infants because of its percutaneous absorption and potential neurotoxicity. Permethrin is at least equally effective, and because it is poorly absorbed and rapidly metabolized, its toxicity is low. Crotamiton cream and sulphur in petrolatum are safe options, but must be applied continuously over 3.5 days. Laundering of clothing and bedclothes is sufficient to prevent reinfestation. In fact, clothes may simply be hung outside for 3-4 days, because the isolated mite dies within 2-3 days.

Explanation:

Rheumatoid arthritis (RA) is s chronic autoimmune disease, producing damage mediated by cytokines, chemokines, and metalloproteases. Peripheral joints (eg, wrists, metacarpophalangeal joints) are symmetrically inflamed, often resulting in progressive destruction of articular structures, usually accompanied by systemic symptoms. Diagnosis requires specific clinical, I laboratory, and radiologic criteria. If a patient takes aspirin daily (for RA, for example), it can cause or worsen tinnitus. For this reason, aspirin is no longer used for RA, as effective doses are often toxic.

Explanation:

Explanation:

During percutaneous placement of central venous lines, many complications are possible. Depending on the site f placement, the most serious complications vary. For all line placements however, injury to the accompanying artery poses a serious risk. In this case, the presence of a cola foot without pulses on the side ipsilateral to the line placement strongly suggests damage to the femoral artery.

Explanation:

In laryngotracheitis (croup) , intramuscular or oral dexamethasone (0.6 mg/kg) has been shown to; reduce the rate of subsequent admission after acute treatment. This disease is usually viral, and antibiotics are not helpful. Humidified air is of unproven benefit, and mist tents separate children from caregivers and hinder observation and evaluation.

Explanation:

The recommended fluid to be infused as maintenance for well children with normal hydration is:
0.45% NaCl with 5% Glucose + 20mmol KCl / Liter.
This is often written as D5 1/2 NS + 20KCl
The D5 refers to the glucose (dextrose); NS refers to Normal saline which is 0.9% NaCl. ¹/₂ NS would refer to 0.45% NaCl.
In this child the potassium is in the upper limit of normal, since normal/ range is 3.5-5.0. So do not add potassium at this time. The maintenance treatment would be with 0.45% NaCl. If giving a bolus, you would use 0.9% NaCl normal saline.

Explanation:

Selective Mutism (SM) is a complex childhood anxiety disorder characterized by a child´s inability to speak in select social settings, such as school. These children understand language and are able to talk normally in settings where they are comfortable, secure and relaxed. Over 90% of children with SM also have social phobia or social anxiety, and some experts view SM as a symptom of social anxiety. What is clear is that children and adolescents with SM have an actual fear of speaking and of social interactions where there is an expectation to talk.
A child meets the criteria for selective mutism if the following are true:
1. The child does not speak in ´select´ places such as school or other social events.
2. But, he or she can speak normally in at least one environment; usually this is in the home environment but a small percentage of children with SM are mute at home.
3. The child´s inability to speak interferes with his or her ability to function in educational and/or social settings.
4. The mutism has persisted for at least one month.
5. The mutism is not caused by a communication disorder (such as stuttering) and does not occur as part of other mental disorders (such as autism).

Explanation:

People with Tourette´s syndrome often have difficulty functioning and experience considerable anxiety in social situations. In the past, they were shunned, isolated, or even thought to be possessed by the devil. Impulsive, aggressive, and self-destructive behaviors develop-in many people, and obsessive-compulsive behavior develops in about half. Children with Tourette´s syndrome often have difficulty learning. Many also have attention-deficit/hyperactivity disorder. Whether Tourette´s syndrome itself or the extraordinary stresses of living with the disorder cause these problems is unclear.

Explanation:

Acute illness is not a contraindication to immunization. At 2 months of age this child should receive the following shots:
DTaP: Diphtheria, tetanus, and acellular pertussis vaccine
Hib: Haemophilus influenzae type b vaccine
IPV: Inactivated poliovirus vaccine
PCV: Pneumococcal conjugate vaccine
RV: Rotavirus vaccine, recommended for infants at 2, 4, and 6 months of age

Explanation:

Explanation:

Bleeding gums, petechiae, and other form of abnormal bleeding are associated with vitamin C deficiency as a result of abnormal collagen synthesis. The other conditions are not associated with such bleeding.

Explanation:

The other conditions have not been shown to be related to maternal smoking.

Explanation:

Motor vehicles cause approximately 8,000 deaths of children between the ages of 6 months and 19 years, rendering it the cause of the largest number of deaths in children of this age group.

Explanation:

Explanation:

Snakebites are more likely to be fatal in children because of the small size of the individual and the fact that essentially the same amount of poison is injected with each bite.

Explanation:

While school aged children typically develop fine motor skills, it is not until they are in their preteenage years (ten to fourteen years) that true enjoyment of hobbies and scientific activities becomes evident.

Explanation:

Adolescents should have developed a sense of self esteem by the age of fourteen. Prior to this time, a lack of a sense of self-esteem is generally normal.

Explanation:

Children are expected to reach fifty percent of their expected adult height by the time they are two years of age.

Explanation:

An infant typically begins teething between six and eight months of age, not earlier.

Explanation:

By three years of age, the child is expected to have a vocabulary of more than 50 words. Visual acuity test results equivalent to 20/40 at this age are not uncommon and do not correlate with visual acuity at five years of age and above. A, B, and E are all normal findings at this age.

Explanation:

Partial simple seizure is seen in association with focal muscle twitching, usually involving either the arm or the leg. It is often preceded by a lesion in the cranium, such as an infarct or tumor. Partial simple seizures are seen most often in adults. Partial complex seizures are seen in children, and often are associated with lip smacking and staring. Patients with partial complex seizures demonstrate semi purposeful actions, and their seizures are often preceded by sensory delusions, such as a deja vu experience or smelling abnormal odors. Generalized absence seizures are also known as petit mal seizures. They are also seen in children, and often are only recordable by a brief episode of staring. Generalized tonic clonic seizures are also known as grand mal seizures. They are characterized by jerking of the extremities and muscle contraction. Sometimes there can be loss of consciousness and biting of the tongue. Finally alcohol withdrawal seizures are manifested between one and four days after cessation of alcohol consumption. These are typically isolated seizures and are characterized as grand mal seizures.

Explanation:

This infant has developed hypernatremic dehydration from the diarrhea. Diarrhea in children results in a relatively greater loss of water than of sodium. In children, one of the most common fluid-electrolyte abnormalities is hypovolemia or dehydration, often related to vomiting and diarrhea from gastroenteritis. This infant has mild dehydration, as indicated by normal skin turgor, flat (not sunken) fontanelles, and slightly dry buccal mucosa. Infants with mild dehydration may have a normal or slightly decreased urine output. Labs show hypernatremia (serum sodium of 164mEq/L). The treatment for non-emergent (mild) dehydration with hypernatremia requires the administration of 5% dextrose in water (D5), which is a hypotonic solution. Amount of (D5W) to be administered is calculated as follows:
For every 3 mEq of sodium above 140 mEq, add 1 L of D5W In this patient, there is an additional 24 mEq of sodium above 140 mEq (164-140 = 24). Thus, 8 L of D5W (24 divided by3 = 8) has to be added. Correct this hypernatremic state with hypotonic solution (DSW) over 48 hours to avoid dropping the serum sodium too rapidly (15 mEq per 24 hours) to minimize the risk of cerebral edema leading to seizures or other neurologic sequelae.
Administering 4 L of DSW is incorrect because although the choice of fluid (D5) is correct, the amount is inadequate. It does not follow the recommended calculation given above.
Giving 4 L or 8 L of normal saline is incorrect because normal saline is an isotonic solution. We need to use hypotonic solution to correct hypernatremic dehydration. Rapid infusion of 20 mL/kg of normal saline or Ringer´s lactate is incorrect because the present patient is only mildly dehydrated.
This is the emergent management for rapid volume repletion in children with moderate to severe dehydration, regardless of the type of dehydration (hypernatremic/isonatremic / hyponatremic). Severe hypovolemia presents with hypotension, decreased peripheral perfusion with a capillary refill of greater than 3 seconds, cool and mottled extremities, lethargy, or frank shock. Initial therapy requires rapid bolus administration of normal saline or Ringer´s lactate (isotonic fluid) to restore an effective circulating plasma volume. Albumin, blood, or plasma can also be considered if there is no response after 2 coli of isotonic fluid.
ReSoMal is given in malnutrition.

Explanation:

A Mongolian spot is an area of hyperpigmentation found in 66% of all infants of Hispanic, Asian, and Native American ethnic background. It is sometimes mistaken for a bruise caused by trauma and-erroneously reported to the authorities as evidence of suspected child abuse. All physicians, and especially primary care providers, should be aware of this common normal feature in order to avoid such mistakes. An autopsy finding that may be mistakenly attributed to child abuse is postmortem livedo, which is due to blood settling to the dependent parts of the body once circulation stops.
CT/MRI studies would be useful to rule out the possibility of an underlying neural tube defect (dysraphism) in the presence of a hemangioma in a sacral location.

Explanation:

The baby is exhibiting stranger anxiety, which normally occurs between the ages of 5 and 9 months. Let´s review some other social milestones that are good to be aware of during clinical work in pediatrics:
Spontaneous smiling begins within several days after birth and disappears by 3 months. Smiling at any face occurs by 2 months, followed quickly by smiling only at familiar faces and when pleased. By 3 months, infants can imitate facial expressions. They laugh at 4 months. Crying occurs from birth. It peaks at 6 weeks and is most frequent from 4-6 PM. Colic is defined as crying more than 3 hours a day for more than 3 days a week. It often spontaneously resolves by 4 months. Treatment includes holding, avoiding overstimulation, and antispasmodics.
Separation anxiety occurs between the ages of 10 and 18 months, when the infant is separated from the mother. Between the ages of 2 months and 2 years, children might show preference for a comforting “transitional object” (e.g., a teddy bear), which is usually discarded by age 4, when the transition from dependence on the mother to independence is more complete.

Explanation:

The peak height velocity occurs at a mean of 13.5 years in boys and 11.5 years in girls. Since this boy is only in tanner stage II, he still has not reached the peak height yet.

Explanation:

The patient´s risk of infection with rabies virus must be addressed immediately. Because of the serious risk to the public of a rabid animal on the loose, it is important to document the conditions surrounding the attack. As a result of widespread vaccination of dogs against rabies, the most common source of the rabies virus is now wild animals, specifically raccoons, skunks and bats.
Nonetheless, there are still reported cases of rabies virus associated with a dog bite. Patients with a bite from a nonprovoked dog should be considered at higher risk for rabies infection than patients with a bite from a provoked dog. If the dog owner is reliable and can confirm that the animal´s vaccination against rabies virus is current, the dog may be observed at the owner´s home.
Observation by a veterinarian is appropriate when the vaccination status of the animal is unknown. If the animal cannot be quarantined for 10 days, the dog bite victim should receive rabies immunization.

Explanation:

There are published clinical guidelines for treating infants and young children (2-24 months) with a febrile urinary tract infection (UTI). They recommend ultrasonography in all these children following the first episode of febrile UTI, as well as either voiding cystourethrography or radionuclide cystography to rule out vesicourethral reflux (VUR). More than 50% of these children will have some VUR on these studies, and the degree of VUR correlates with renal parenchymal damage.
All children should have urine for culture collected by suprapubic aspiration or urethral, catheterization. The perineal bag has unacceptable rates of contamination, especially in girls and uncircumcised boys. A 7- to 14-day course of parenteral or oral antibiotics is recommended, with prophylactic oral antibiotics recommended until imaging studies are completed.

Explanation:

Tacrolimus is an immunomodulator indicated for the treatment of atopic dermatitis when corticosteroids and other conventional remedies are inadvisable, ineffective, or not tolerated. It is approved for use in patients over 2 years of age.

Explanation:

Explanation:

Nocturnal enuresis is urinary incontinence during sleep. The child is counseled about the etiology and prognosis of enuresis, the aim of which is to remove blame and guilt. The child assumes an active role, including talking to the physician, urinating before going to bed, recording wet and dry nights, and changing wet clothing and bedding himself. The child should not consume fluids during the 2 to 3 hours before bedtime, and caffeinated beverages should be strictly limited. Positive reinforcement is given for dry nights (eg, a star calendar, other age- appropriate rewards). In addition to counseling, enuresis alarms are effective and often recommended simultaneously. Drug therapy can be effective in patients unresponsive to counseling and alarms. Short-term treatment (4 to 6 weeks) with desmopressin acetate nasal spray (a synthetic analog of ADH) is typically used in patients > 6 years with persistent, frequent nocturnal enuresis.

Explanation:

Explanation:

Neuroblastoma is a cancer arising in the adrenal gland or less often from the extra-adrenal sympathetic chain, including the retroperitoneum, chest, and neck. Diagnosis is based on biopsy.
Routine prenatal ultrasound occasionally detects neuroblastoma. Patients presenting with abdominal symptoms or a mass should have ultrasound or CT. Diagnosis is then confirmed by biopsy of any identified mass.
Alternatively, diagnosis can be confirmed by the presence of characteristic cancer cells in a bone marrow aspirate or core biopsy, along with elevated urinary catecholamine intermediates. Urinary vanillylmandelic acid VMA), homovanillic acid (HVA), or both are elevated in ≥ 90 to 95% A 24-hour urine collection can be used, although a spot urine test is usually sufficient.

Explanation:

Starting transfusion with packed erythrocytes is the most appropriate management because this patient has severe iron deficiency anemia. Pallor is the most important clue to iron deficiency anemia. However, patients may also have other symptoms such as tachycardia, tachypnea, heart murmurs, and hepatomegaly. In patients with hemoglobin under 4 g/dL, a blood transfusion with packed erythrocytes should be given slowly. The quantity of packed erythrocytes administered should be sufficient to raise the level of hemoglobin to a safe level while awaiting the response to iron therapy.

Explanation:

Explanation:

Myopathies refer to a class of degenerative skeletal muscle disease that is not caused by nerve dysfunction. Myopathies cause progressive weakness and wasting away of skeletal muscles. The causes for Myopathies vary. They could be hereditary, an inflammatory response, or the result of an endocrine disorder. Creatinine phosphokinase (CPK) is an enzyme found in skeletal muscle, cardiac muscle, and the brain. An initial step is to measure the level of this CPK enzyme with a simple blood test.

Explanation:

The average weight gain in the first three months of life is 196 g per week. In the second three months of life, the average weight gain is 148 g per week.

Explanation:

The correct answer is E. This type of enuresis, the result of the defense mechanism of regression, is very common when new siblings enter the household. The boy feels neglected and returns to response patterns more typical of a younger child either out of anxiety, or as a direct attempt to gain more parental attention. Spending more, separate time with the boy will help to reassure him of the mother´s continued love and affection. With the motive removed, the symptom is likely to dissipate as well.
Having to discuss a problem about which he is already embarrassed with the authority figure of the physician (choice A) is likely to heighten, not reduce, the boy´s discomfort and embarrassment. The issue here is one between mother and child. The physician should encourage that direct relationship and not seek to form an indirect substitute.
The capacity of a 6 year old to articulate the abstract relationship issues which may be bothering him (choice B) will be limited. More likely the child will feel uncertain as to what to say, and may walk away with heightened embarrassment about his enuresis.
This is the correct pharmacology, but the treatment is premature. Imipramine (choice C) will reduce the bed-wetting, but this merely addresses the symptom, not the root cause. Remember that one of the key mechanisms by which imipramine reduces bed-wetting is through the reduction of delta sleep, which is not a long-term solution for the child.
Referring the mother to a breast-feeding seminar (choice D) misses the issue. The core problem presented is that of enuresis, not the mother´s difficulties with breast-feeding. Even if the mother is expert at this skill, the child is still likely to feel slighted by the attention given to the new sibling. The mother must be directed to affirm her relationship to her son on a daily basis, not advised how to bond better with the new baby.
Don´t “pass off” (choice F) the child. You can, and should, deal with this yourself. Enuresis after age 5 is diagnosable and, therefore, beyond the normal range (choice G). It is distressing to the mother and a cause of embarrassment to the child. The physician can, and should, provide guidance and help.

Explanation:

Cockayne´s syndrome is a DNA repair deficiency in nucleotide excision repair. The defect causes poor repair of genes that are being transcribed. It is manifested by photosensitivity, mental deficiencies, and dwarfism. While all of the other answer choices are also DNA repair disorders, none causes the same triad as seen in Cockayne´s syndrome.

Explanation:

At the age of 14, a child is able to feel as “depressed” as an adult feels. This should be differentiated from sulking, which many children do, which is not the same as true adult depression.

Explanation:

The factors that have been found to be most associated to a child´s height are sibling size (A), parents´ socioeconomic status (B), parents´ height (C), and the child´s birth weight (D). The mother´s diet during pregnancy most likely has an effect on a child´s height, but not to the extent of the other answer choices.

Explanation:

Children one year of age typically begin to experience stranger anxiety and separation anxiety. Children less than one year of age are most often scared of loud noises, heights, and lack of physical support. Children between the ages of two and six years (C) are afraid of figments of their imagination (e.g., the bogeyman), as well as animals and the dark. Children who are elementary-school age (D) are more afraid of injuring themselves physically or losing a loved one, such as a parent. Adolescents and teens (E) are scared of failing or not being accepted socially.

Explanation:

Studies have demonstrated that the increasing amount of violence that is visible on TV may be detrimental to a child´s development; it may predispose a child to becoming more aggressive and have fewer qualms about harming others.

Explanation:

Children less than one year of age are most often scared of loud noises, heights, and lack of physical support. Children one year of age typically begin to experience stranger anxiety and separation anxiety. Children between the ages of two and six years are afraid of figments of their imagination (e.g., the bogeyman), as well as animals and the dark. Children who are elementary school age are more afraid of injuring themselves physically or losing a loved one, such as a parent. Adolescents and teens are scared of failing or not being accepted socially.

Explanation:

By the age of two, a child is expected to reach 85% of his or her expected adult head circumference.

Explanation:

Vitamin C overdose may cause a decrease in copper absorption or a rise in the excretion of oxalic acid. Although thiamin toxicity is very rare, the potential adverse effects include an anaphylactic response and/or respiratory depression. There are no significant toxicities associated with biotin overdose. Vitamin A toxicity may cause pseudotumor cerebri, or retching associated with a rise in intracranial pressure. Niacin overdose may cause anaphylaxis due to histamine release; also, cholestatic jaundice, cutaneous vasodilation, and cardiac arrhythmias may arise.

Explanation:

Maternal diabetes is associated with unusually large babies. The other conditions are all factors responsible for low birth weight infants.

Explanation:

During the “autonomy versus shame and doubt” stage, a child becomes aware that he is capable of doing things by himself. However; he simultaneously doubts himself and is uncertain of whether or not he is actually capable. While it could be argued that the child in the question is undergoing a battle between the “initiative versus guilt” stage (C), it is during this stage that the child actively seeks out productive means to expend energy i.e., taking initiative. None of the other choices are applicable to doubting and achieving independence from one´s mother or external sources, such as training wheels.

Explanation:

By the age of five, or approximately at the kindergarten-age level, a child should have garnered the ability to memorize his/her own name, address, and phone number.

Explanation:

It is important to give these children live attenuated vaccine that they have not yet received before chemotherapy is begun. Patients in the other groups are at increased risk for chronic viral shedding or severe infection with the immunizing agent if they receive live attenuated vaccines.

Explanation:

Partial simple seizure is seen in association with focal muscle twitching, usually involving either the arm or the leg. It is often preceded by a lesion in the cranium, such as an infarct or tumor. Partial simple seizures are seen most often in adults. Partial complex seizures are seen in children, and often are associated with lip smacking and staring. Patients with partial complex seizures demonstrate semi purposeful actions, and their seizures are often preceded by sensory delusions, such as a deja vu experience or smelling abnormal odors. Generalized absence seizures are also known as petit mal seizures. They are also seen in children, and often are only recordable by a brief episode of staring. Generalized tonic clonic seizures are also known as grand mal seizures. They are characterized by jerking of the extremities and muscle contraction. Sometimes there can be loss of consciousness and biting of the tongue. Finally, alcohol withdrawal seizures are manifested between one and four days after cessation of alcohol consumption. These are typically isolated seizures and are characterized as grand mal seizures.

Explanation:

This patient has the typical clinical presentation of Wiskott-Aldrich syndrome, an X-linked recessive disease of young boys characterized by recurrent infections, thrombocytopenia with hepatosplenomegaly, and eczema. Death usually occurs before the age of 6 due to infection or, less commonly, bleeding or malignancy. Only a few patients will survive to adulthood. They are highly inclined toward developing lymphoid malignancies. Clinically, a chronic eczematous dermatitis resembling atopic dermatitis is typical. Recurrent infections are the rule, such as suppurative otitis media, pneumonia, or purulent skin infections. Thrombocytopenic purpura presents with petechiae and easy bruising. Bleeding outside of the skin may also occur. Hepatosplenomegaly and cervical adienopathy are present. Serum levels of IgA and IgE are elevated, where as IgG is normal or low, and IgM levels are low. Female carriers are detected with genetic testing. Splenectomy may correct the bleeding diathesis and increase platelet counts but it makes the patient susceptible to infection and requires continuous antibiotic prophylaxis thereafter. Bone marrow transplant from an HLA identical sibling as early as possible provides complete reversal of the platelet and immune defect. It´s the treatment and cure for Wiskott-Aldrich syndrome. Elevated IgM levels are not present in Wiskott-Aldrich syndrome. On the contrary, they are usually decreased. Low IgA level and low IgE level are not characteristic of Wiskott -Aldrich syndrome. Synthesis of IgA, IgE, and IgM is accelerated but accelerated catabolism usually results in decreased IgM levels while IgA and IgE levels remain elevated. Lymphopenia is nova characteristic of Wiskott-Aldrich syndrome. The number lymphocytes are normal but they are dysfunctional. The defective gene codes for a protein called WASP that participates in the reorganization of the hematopoietic cell cytoskeleton in response to external stimuli. As a result, the hematopoietic cells of patients with Wiskott-Aldrich syndrome cannot polarize or migrate in response to normal stimuli, resulting in the clinical picture of the syndrome.

Explanation:

Breast-feeding jaundice is common. Breasted infants have a higher incidence of increased bilirubin than formula-fed infants. It is related to decreased intake and increased enterohepatic circulation. The decreased intake is usually related to failure to establish an adequate milk supply.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a red cell enzyme defects resulting in hemolysis and the overproduction of bilirubin. It is X-linked and usually occurs in those of Mediterranean, African, or Asian descent. G6PD should be suspected in male infants with late onset of jaundice.
Hypothyroidism is a cause of prolonged jaundice in infants. However, the infant would be showing other signs of hypothyroidism (such as decreased muscle tone, macroglossia, and hypothermia) and would not look healthy.
Physiologic jaundice usually appears after 24 hours of age, slowly increasing to a peak between 3-5 days of age. In this case, the infant is 6 days old and just starting to get jaundiced; thus she is beyond the typical range for physiologic jaundice.
Rh incompatibility is not indicated in this case, since both the mother and infant are Rh positive.

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Explanation:

Explanation:

Growing pains are a common complaint of adolescents. Usually found in young men and women around the ages of 9 to 14, growing pains are the result of the rapid growth of these adolescents.
Several conditions such as Osgood-Schlatter Disease, and Sever´s Disease. are types of growing pains. These conditions are caused by inflammation around sites where large tendons insert. These tendons pull on the growing bone (at the growth plate) and cause inflammation.
Growing pains are almost always seen in active youths, often while participating in sports. Growing pains are best treated with rest, stretching, and ice packs. If activities are causing significant growing pains, they should be avoided until the symptoms resolve.
Growing pains are not usually associated with a limp.

Explanation:

Kindergarden is usually for children aged 4-6. So a 9 year old in kindergarden would not be considered normal. Also the fact that this child is unable to advance into a higher grade more appropriate for his age suggests that he has a global learning disability rather than a specific one for say math, reading or drawing/coloring. We now turn our attention to a) autism vs b) mental retardation.
a) Autism is a disorder in which a young child cannot develop normal social relationships, uses language abnormally or not at all, behaves in compulsive and ritualistic ways, and may fail to develop normal intelligence. Autistic children develop symptoms in at least 3 of the following areas: social relationships, language, behavior, and sometimes intelligence.
About 50% of autistic children never learn to speak. Those who learn do so much later than normal and use words in an unusual way. These children rarely have an interactive dialogue with others. Autistic children often speak with an unusual rhythm and pitch. About 70% of children with autism have some degree of mental retardation (an IQ less than 70). Their performance is uneven, they usually do better on tests of motor and spatial skills than on verbal tests.
b) Mental retardation is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of > 2 of the following: communication, self-direction, social skills, self-care, use of community resources, and maintenance of personal safety.
Delayed development is usually apparent by preschool age. Among older children, hallmark features are a low IQ combined with limitations in adaptive behavior skills. Although developmental patterns may vary, it is much more common for children with MR to experience slow progress than developmental arrest.
Behavioral disorders include lack of socially responsible behavior, impaired ability to communicate, and discomfort from coexisting physical problems and mental health disorders such as depression or anxiety.
In comparing autism and mental retardation, the question best fits the latter.

Explanation:

Aspirin has anti-platelet, anti-pyretic, anti-inflammatory and analgesic properties. Acetaminophen only has anti-pyretic and analgesic properties.
Aspirin use in children can cause Reye´s syndrome, which is a rare form of acute encephalopathy and fatty infiltration of the liver that tends to follow some acute viral infections.

Explanation:

Explanation:

There is no known vegetable source for vitamin B12. If the diet contains milk and eggs, however, the requirement will be satisfied. Vitamin C is present in high concentrations in fruits and vegetables. Vitamin A is found in green, leafy vegetables. Thiamine is present in grains, especially the outer coatings.

Explanation:

Cryptorchidism is defined as failure of the testis to descend from its intra-abdominal location into the scrotum. Incidence in premature male infants is 9.2-30%. In full-term infants, the incidence is 3.3-5.8%, and in infants aged l year, it is 0.8%.
The lifetime risk of death from testicular malignancy in men of any age with undescended testis is approximately 9.7 times the risk in men with normally descended testis.
Malignant degeneration: Testicular malignancies occur in 10% of men with cryptorchid testis. The incidence of malignant degeneration in an undescended testis is reportedly as high as 48 times greater than in a normal testis. Seminoma is the most commonly reported malignancy. Torsion is a rare condition, if present, usually is secondary to the presence of a mass.

Explanation:

Stimulant medications do not precipitate seizures and can be given safely to patients with a history of seizures. Substantial weight loss may occur in up to 15% of patients, but eventual adult height and weight are not affected. The number of side effects is similar for methylphenidate and dextroamphetamine. No significant changes in pulse or blood pressure occur either at rest or with exercise.

Explanation:

Testicular torsion is an emergency condition due to rotation of the testis and consequent strangulation of its blood supply. Symptoms are acute scrotal pain and swelling, nausea, and vomiting. Diagnosis is based on physical examination and confirmed by color Doppler. Treatment is immediate manual detorsion followed by surgical intervention.

Explanation:

Explanation:

The treatment of scoliosis is dependent on the age of the patient and curve progression. Premenarchal females have a greater chance of curve progression then females one to two years after menarche with similar curves. Curves of less than 25 degrees are observed and reevaluated every four to six months. The stage of pubertal development is important to note because a patient who has attained menarche will only have a small amount of additional growth; therefore, scoliosis will not progress.