Explanation:

Neonatal sepsis is invasive bacterial infection occurring in the 1st 90 days of life. Signs are multiple and include diminished spontaneous activity, less vigorous sucking, apnea, bradycardia, temperature instability, respiratory distress, vomiting, diarrhea, abdominal, distention, jitteriness, seizures, and jaundice. Diagnosis is clinical, with extensive laboratory testing. Treatment is initially with ampicillin plus either gentamicin or cefotaxime, narrowed to organism- specific drugs as soon as possible.

Explanation:

The Coombs test looks for antibodies that act against red blood cells. An abnormal (positive) direct Coombs´ test means the patient has antibodies that as against their red blood cells. This may be due to autoimmune hemolytic anemia without another underlying cause, drug- induced hemolytic anemia (many drugs have been associated with this complication) or erythroblastosis fetalis (hemolytic disease of the newborn).

Explanation:

This boy obviously has diabetes mellitus. Treatment with insulin has reduced his serum glucose concentration, and there will also have been a concomitant shift of K+ from the extracellular compartment into the cells. Unless replaced, this loss will have dire consequences. Therefore, the most appropriate next step is to add K+ to the intravenous fluid.

Explanation:

Explanation:

Ectomorphs are smaller in mass (A) compared to endomorphs, who mature earlier (C). Endomorphs possess a large amount of soft tissue (D), yet are not as muscular as the mesomorphs (B), who lie between the ectomorph and the endomorph with regard to total body mass.

Explanation:

Explanation:

An infant will be able to grasp a rattle by the age of four months.

Explanation:

At birth, the size of a newborns heart is relatively large in comparison to the size of other organs. Bone age, or osseous maturation, correlates relatively well with sexual maturity and can be determined by radiologic studies of epiphyseal centers. Nutritional requirements do change throughout life. These changes do not necessarily correlate with chronological age, but rather with the development of certain organ systems, such as the endocrine system.

Explanation:

Td (adult tetatnus toxid with diphtheria toxoid) is administered between 14 and 16 years of age. DTP and TOPV are administered at 18 months and between four to six years. MMR and Hib are administered at 15 months, while MMR alone is administered between 11-12 years.

Explanation:

Typically, children develop the focal ability to follow an object through a 180° arc by the age of two months. If they have not yet developed this ability by two months, more specific testing is indicated to assess the intelligence level of the child.

Explanation:

The ability to pedal a tricycle develops at approximately three years of age, not two years. However, at two years, an infant will be able to copy a diamond (as well as other simple shapes), draw a stick figure person, ask “what´s this,” and is not capable of understanding the concept of sharing.

Explanation:

Niacin overdose may cause anaphylaxis due to histamine release; also, cholestatic jaundice, cutaneous vasodilation, and cardiac arrhythmias may arise. 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. Finally vitamin C overdose may cause a decrease in copper absorption or a rise in the excretion of oxalic acid.

Explanation:

By the age of fifteen months, most children have developed the ability to indicate their wants and desires-either through verbal or non-verbal actions.

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 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:

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. Finally vitamin C overdose may cause a decrease in copper absorption or a rise in the excretion of oxalic acid.

Explanation:

The physical deformities described are most characteristic of valproic acid exposure in utero. The syndrome consists of various degrees of severity that can include craniofacial anomalies, e.g., narrow bifrontal diameter, high forehead, epicanthal folds, broad and low nasal bridge, midfacial hypoplasia, long philtrum and small mouth, cardiovascular anomalies, cleft lip, and meningomyelocele. Approximately 30% of exposed infants have some features of the syndrome. The risk for the mother having a convulsion during pregnancy must be weighed against the risk for developing the syndrome in the child. Regardless, the mother must always be made aware of the fetal risks associated with any anticonvulsant medication taken during pregnancy.
Fetal exposure to alcohol may result in fetal alcohol syndrome (FAS), which is characterized by prenatal onset of growth deficiency, microcephaly, short palpebral Fissures, maxillary hypoplasia, micrognathia, and a thin upper lip. There is no increased` risk for meningomyelocele.
Lithium exposure during pregnancy creates an increased risk for congenital heart defects, including Ebstein anomaly, but not a higher risk for meningomyelocele or craniofacial deformities.
Isotretinoin exposure is characterized by central nervous system defects (e.g., hydrocephalus, microcephaly, and structural errors of neuronal migration), but not meningomyelocele. Other associated abnormalities include facial asymmetry, microtia/ anotia, conotruncal cardiac abnormalities, and mental deficiency.
Thiazide diuretics used during the first trimester may minimally increase the risk for birth defects, but the risk is almost zero in the later trimesters.

Explanation:

Explanation:

Explanation:

Toilet training is not possible before the age of 18 months because the long nerve fibers have not yet myelinated and sphincter control is not possible. Toilet training should be completed by 4 years of age.

Explanation:

This is a case of operant conditioning, or learning by reinforcement. In this example, the child´s behavior is the operant, which is being reinforced by the parents. That is, the child wants parental attention and is rewarded by the parents only when her disruptive behavior escalates to the point at which the parents must pay attention. The parents are using a “fixed ratio” of reinforcement, since every time the child gets to the truly disruptive point, they reinforce the behavior. Classical conditioning is the type of associative learning in which a stimulus that did not originally elicit a given response now does. This occurs secondary to association of the stimulus with a behavior that previously did elicit the response. For example, a cat does not normally come to its owner if the owner rings a bell. However, if the bell is rung while the cat is eating, the cat associates the bell with food and learns to come to the owner when the bell is rung. Cognitive learning requires full attention and purposeful intent to acquire the information. Imprinting forms the basis of bonding between an infant and the mothering figure. This form of attachment is learned by association during the immediate postnatal period. Social learning involves modeling or imitation. For instance, a child learns familial values by modeling the parental example.

Explanation:

Malathion is currently the most effective treatment for head lice and is less toxic than Lindane. Permethrin and pyrethrins are less effective than malathion, although they are acceptable alternatives. These insecticides, as well as lindane, are not recommended in children 2 years of age or younger.
Wet combing may be effective, but it is less than half as effective as malathion. Head shaving is only temporarily effective and is traumatic. Petrolatum is not proven to be effective.

Explanation:

Serum luteinizing hormone level and serum follicle-stimulating hormone is low in patients with anorexia nervosa. These hormonal alterations in the hypothalamic-pituitary axis in patients with anorexia nervosa represent adaptive and protective mechanisms for chronic starvation and weight loss.

Explanation:

Nosebleeds (epistaxis) have a variety of causes, the most common of which are nose picking and injury. The cold, dry air of winter also makes nosebleeds more likely. People who take aspirin or other drugs that interfere with the blood´s ability to clot (anticoagulants) commonly develop nosebleeds. Some people get them rather often, and others rarely get them.
Bleeding usually comes from the front part of the nasal septum, which contains many blood vessels. There may be just a trickle of blood or a strong stream. Most nosebleeds are more frightening than serious.

Explanation:

Explanation:

This infant is moderately to severely dehydrated. The history of watery stools and the associated physical findings suggest a child in dire need of rehydration therapy. Dry mucous membranes, poor skin turgor skin tenting, sunken fontanels and weight loss are all consistent with moderate to severe dehydration. The lethargy and somnolence suggest mite severe dehydration. Intravenous rehydration therapy, or in the case where suitable venous access cannot be obtained, interosseous therapy, is the immediate intervention in this case. The goals of therapy should include; replacement of any deficits, any ongoing losses and daily maintenance requirements.

Explanation:

Since its FDA approval imiquimod has been used off-label to treat all of the conditions listed, but is approved only for treatment of external genital and perianal warts in patients 12 years of age and over.

Explanation:

The signs and symptoms of congenital hypothyroidism may not be obvious, for several days or, weeks. Symptoms include physical sluggishness, constipation, large tongue, umbilical hernia, hypothermia, bradycardia, enlarged fontanelles, and persistent jaundice. Skin may be dry and scaly, and the hair may be dry, coarse, and brittle.

Explanation:

This child has chronic diarrhea, recurrent sinusitis, and nasal polyps, and is underweight. Nasal polyps tend to occur more often in adult males, with the prevalence increasing in both sexes after age 50. Any child 12 years or younger who presents with nasal polyps should be suspected of having cystic fibrosis until proven otherwise. A sweat chloride test, along with a history and clinical examination, is necessary to evaluate this possibility. Nasal polyps are found in´1% of the normal population, but a full 18% of those with cystic fibrosis are afflicted. There is no association of polyps with wilson´s disease, sarcoidosis, or emphysema, so serum ceruloplasmin, angiotensin- converting, and alpha-1-antitrypsin levels would not be useful. An erythrocyte sedimentation rate likewise would yield limited, information.

Explanation:

Juvenile rheumatoid arthritis pain can develop in kid´s aged 1-16 years of age. Common presentations include swelling, red and warm joints. The knee and wrist joints are the most commonly affected. Initial lab workup involves: CBC, ESR, RF and ANA.
Treatment is with a combination of medication, physical therapy, and exercise. Nonsteroidal anti-inflammatory drugs (NSAIDs, like ibuprofen are used most commonly. Except for severe systemic disease, systemic corticosteroids can usually be avoided. When necessary, the lowest possible dose is used (eg, oral prednisone) Methotrexate and hydroxychloroquine are useful DMARDs for polyarticular disease. Physical therapy, exercises, splints, and other supportive measures help prevent flexion contractures.

Explanation:

Impetigo typically presents as clusters of vesicles or pustules that rupture and develop a honey-colored crust (exudate from the lesion base) over the lesions. Treatment for localized disease is topical mupirocin. Oral such as dicloxacillin or cephalexin are also used.

Explanation:

Children from the ages of 2 to 6 often believe they are somehow responsible for the death of a loved one. The emotional pain may be so intense that the child may react by denying the death, or may somehow feel that the death is reversible. If children wish to attend a funeral, or if their parents want them to, they should be accompanied by an adult who can provide comfort and support. Telling a child the loved one is asleep or that he or she “went away” usually creates false hopes for return, or it may foster a sleep phobia.

Explanation:

This is a case of physical abuse. Infants who are shaken may have shaken baby (shaken impact) syndrome. This syndrome is caused by violent shaking, often followed by throwing the infant. Infants who are shaken may have no visible signs of injury and may appear to be sleeping deeply. This sleepiness is due to brain damage and swelling, which may result from bleeding between the brain and skull (subdural hemorrhage). Infants may also have bleeding in the retina (retinal hemorrhage) at the back of the eye. Ribs and other bones may be broken.

Explanation:

Normal puberty is a period in a boy´s life between the ages of 13-18 (may occur as early as 8) in which his body starts to grow and mature. These changes are the result of chemicals known as hormones. In boys undergoing puberty, testosterone is the hormone that is responsible for the changes that will transform them physically and psychologically into an adult male.
Body changes include: growing taller, growing body hair, growing broader shoulders, muscles grow bigger and stronger, the hands and feet grow larger, the ears enlarge, pimples or zits (acne) may develop, the voice changes and becomes deeper. In addition penis size increases, enlargement of the testicles (may even be sensitive), temporarily enlarged and painful breasts and experiencing more erections.

Explanation:

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:

The exact cause of labial adhesions is unknown. However, since it rarely occurs in neonates and responds to estrogen therapy, a hypoestrogenic state is felt to be a contributing factor. The lesion results from fusion of the labia minora. There is a 20%-40% incidence of recurrent urinary tract infections in these patients. The treatment of choice is 2-8 weeks of local treatment with estrogen cream. Oral estrogens are not indicated and may cause a harmful hyperestrogenic state, with female virilization features. Because of the possibility of pain, recurrence, and potential scarring, surgical treatment is recommended only if medical treatment is unsuccessful.

Explanation:

Explanation:

The capacity for cooperative play generally does not begin much before the age of 4. Prior to this time (24-30 months) children may play in a parallel fashion, but without real interaction.

Explanation:

These are symptoms consistent with an overdose of an anticholinergic agent such as a tricyclic antidepressant. No agents routinely used for the treatment of diabetes (A), hypertension (B), acute allergies (C), or osteoporosis (E) would produce such a syndrome.

Explanation:

The correct answer is A. This patient has normal developmental milestones. A 3-year-old child should be able to ride a tricycle, balance each foot for 1 second, build a tower of 8 blocks imitate a vertical line and speak with almost understandable sentences. This patient is not delayed in any area making choices B, C, D, and E incorrect. Common developmental milestones are: Newborn- regard faces, suckle, Moro, and grasp reflexes, 6 month old, babbles sits alone passes a cube 12 months- says 1-2 words begins to walk waves bye-bye 424 months- combines words can build a tower of4-6 cubes kicks a ball 3 years- combines words to form almost understandable sentences rides a tricycle builds a T tower of 8 cubes

Explanation:

The lower central incisor is most frequently the first tooth to erupt. The average age of eruption of this tooth is at six months. The lower lateral incisor erupts at seven months and the upper central incisor erupts at seven and a half months.

Explanation:

Explanation:

The social smile is likely to develop between five-eight weeks of age. It is a marker of the infant´s responsiveness and attachment to another individual.

Explanation:

Pyridoxine toxicity, while very rare, is associated with peripheral sensory neuropathy. 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. Vitamin D toxicity is associated with hypercalcemia, as well as constipation, and sometimes nephrocalcinosis. Pantothenic acid toxicity is associated with diarrhea.

Explanation:

Healthy children should receive all of the above immunizations except influenza, because they are not at increased risk for the latter.

Explanation:

Impulse control typically develops between six and nine months of age.

Explanation:

During the second year of life, the child learns to differentiate between him or herself and his or her primary caregiver. The genitals become the focus of pleasure during the preschool years, which occurs between two and a half and six years of age. Children at two years of age play alongside each other in what is known as parallel play, rather than cooperative play, which develops around the age of four The formation of a conscience begins by the end of the preschool years and is completed during the school age years, which is between seven to eleven years. At seven to eleven years of age, the child also develops the ability to perform complex motor tasks.

Explanation:

The characteristics given in the question most closely describe a girl at 12 weeks of age. At 16 weeks of age the child is usually able to hold his/her head up constantly when in a sitting position, and when prone, is likely to hold his/her head and chest up so the plane of the face is 90 degrees to the couch. The grasp reflex, which would be present at 5 weeks of age, usually disappears at 12 weeks of age.

Explanation:

A child will be able to kick a ball or walk up a flight of stairs without assistance at the age of two years.

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 first signs of stuttering tend to appear when a child is about 18 to 24 months old and starting to put words together to form sentences. To parents, the stuttering may be upsetting and frustrating, but it is natural for kids to do some stuttering at this stage of development. A child may stutter for a few weeks or several months, and the stuttering may be sporadic. For most kids who begin stuttering before the age of 5, the stuttering eventually goes away without any need for intervention such as speech or language therapy, However, if the child´s stuttering is frequent, continues to get worse, and is accompanied by body or facial movements, it´s a good idea for a speech- language therapist to evaluate your child before he or she is 3 years old.

Explanation:

The patient is having absence or petit mal seizures, and the drug of choice is ethosuximide or valproic acid. Diazepam is effective in treating status epilepticus but is not used in treating petit mal seizures. Diphenhydramine is an antihistamine and would not be of benefit in treating this illness. Phenobarbital and Phenytoin are anti convulsants, but are not used for absence seizures.

Explanation:

 When exposed to very cold temperatures, skin and underlying tissues may freeze, resulting in frostbite. The areas most likely to be affected by frostbite are the hands, feet, nose and ears. You can identify frostbite by the hard, pale and cold quality of skin that has been exposed to the cold. As the area thaws, the flesh becomes red and painful.
If fingers, ears or other areas suffer frostbite: warm your hands by tucking them under your arms. If your nose, ears or face is frostbitten, warm the area by covering it with dry, gloved hands.
If there´s any chance of refreezing, don´t thaw out the affected areas. If they´re already thawed out, wrap them up so they don´t refreeze.
Get emergency medical help if numbness remains during warming. If you can´t get help immediately, warm severely frostbitten hands or feet in warm, not hot, water. You can warm other frostbitten areas, such as your nose, cheeks or ears, by covering them with your warm hands or by applying warm cloths.

Explanation:

Explanation:

Reye´s syndrome, a deadly disease, strikes swiftly and can attack any child or adult without warning. All body organs are affected, with the liver and brain suffering most seriously. While the cause and cure remain unknown, research has established a link between Reye´s syndrome and the use of aspirin and other salicylate-containing medications. Therefore aspirin should not be given to a child with an acute illness.

Explanation:

Explanation:

Chronic otitis media is a long-standing infection of the middle ear. Some factors that increase a child´s risk for middle ear infections include crowded living or daycare conditions, exposure to second-hand smoke, respiratory illnesses, close contact with siblings who have colds or ear infections, having a cleft palate, allergies that cause congestion on a chronic basis.

Explanation:

Bilirubin levels >17 mg/dL in full-term infants are considered pathologic rather physiologic. In one study, infants with bilirubin concentrating over 21 mg/dL at 18-72 hours after birth had a 40% probability of severe hyperbilirubinemia developing later on. The Academy of Pediatrics recommends initiating phototherapy for bilirubin levels based on the infant´s, age: 15 mg/dL at 25-48 hours, 18 mg/dL at 49-72 hours, and 20 mg/dL at 72 hours or more.

Explanation:

Neurofibromatosis is an autosomal dominant disorder, producing tumors along the course of nerves and occasionally resulting in marked soft tissue or bony deformity. In > 90%, characteristic skin lesions are apparent at birth or develop during infancy. Lesions are medium-brown (café-au-lait), freckle-like macules, distributed most commonly over the trunk, pelvis, and flexor creases of elbows and knees. During late childhood, flesh-colored cutaneous tumors of various sizes and shapes appear, ranging in number from several to thousands. Diagnosis is clinical. There is no specific treatment, but tumors can be removed surgically.

Explanation:

Pityriasis rosea (PR) is a condition that classically begins with a single, primary, 2- to 10-cm “herald” patch that appears on the trunk or proximal limbs. A general centripetal eruption of 0.5- to 2-cm rose-or fawn-colored oval papules and plaques follows within 7 to 14 days. The lesions have a scaly, slightly raised border (collarette) and resemble ringworm (tinea corporis). Most patients itch, occasionally severely. Papules may dominate with little or no scaling in blacks, children, and pregnant women: the rose or fawn color is not as evident in blacks; blacks also more commonly have inverse PR (lesions in the axillae or groin that spread centrifugally). Classically, lesions orient along skin lines, giving PR a Christmas tree- like distribution when multiple lesions appear on the back. A prodrome of malaise and headache precedes the lesions in a minority of patients. Diagnosis is based on clinical appearance and distribution.

Explanation:

The Academy of Dermatology grades acne as mild, moderate, and severe. Mild acne is limited to a few to several papules and pustules without any nodules. Patients with moderate acne have several to many papules and pustules with a few to several nodules. Patients with severe acne have many or extensive papules, pustules, and nodules.
The patient has mild acne according to the Academy of Dermatology classification scheme. Topical treatments including benzoyl peroxide, retinoids, and topical antibiotics are useful first-line agents in mild acne. Topical sulfacetamide is not considered first-line therapy for mild acne. Oral antibiotics are used in mild acne where there is inadequate response to topical agents and as first-line therapy in more severe acne. Caution must be used to avoid tetracycline in pregnant females. Oral isotretinoin is used in severe nodular acne, but also must be used with extreme caution in females who may become pregnant. Special registration is required by physicians who use isotretinoin, because of its teratogenicity.

Explanation:

Most states have laws that mandate that a clinician who suspects physical or sexual abuse must act immediately, separating the child from the parents if necessary. Discharge to another relative or neighbor will not prevent the abusing parent from retrieving the child and inflicting further abuse. Foster care placement can only be applied for after there is proof of physical abuse. If your suspicions of abuse are high, do not send the child home with the parents under any circumstances.
Again, sending the child home, even with an impending social work evaluation, leaves the child open for continued abuse. When angered, the abusing parent may inflict greater injury after a quiescent phase, resulting in death of the child. In a possible abuse case, the physician should take steps to both protect the child and investigate further.

Explanation:

The correct answer is C. If the physician truly believes that the current medication is the best for the child, then he must do all he can to see that the patient has access to this treatment if cost is the barrier, and the physician can find some way to waive the cost, then this is the obvious course of action. Remember that traditionally, doctors and hospitals provide a certain amount of care without charging a fee. The guiding goal must be care not cost. Admitting the child (choice A) is a costly alternative when the child is already taking an effective medication. Simply put, if the child is maintained on the current medication, hospitalization is not warranted.
While it might be personally satisfying to pressure the insurance company (choices B and D) and might help children in the broader society´ eventually, it does nothing to help the physician´s current patient.
This question is not decided on the basis of legal opinion (choice E) but on the basis of clinical judgment. If the current medication is working and the alternative covered by the insurance company is unproven, then every´ effort must be made to maintain the proven treatment. This option transforms a focus on a child´s care to a media event (choice F). The child´s confidentiality´ and the parent´s privacy are at risk. The physician here has lost focus. The goal is to treat the child, not harness the media to change the world.
The child has already been placed on a variety of medications, none of which had the same efficacy as the one he is currently taking. Allowing the insurance company to override or even influence the physician´s clinical judgment is ethically questionable and professionally unacceptable. The child´s history suggests that putting the child on the medication covered by the insurance company places the child at an unacceptable risk (choice G) .

Explanation:

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:

Babinski´s reflex is normally present at birth and lasts until 12 months of age. The palmar grasp reflex, startle reflex and tonic neck reflex are likely to disappear by the age of four months. The walking reflex disappears in three to eight weeks.

Explanation:

Vitamin A toxicity may cause pseudotumor cerebri, or retching associated with a rise in intracranial pressure. 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. Niacin overdose may cause anaphylaxis due to histamine release; also, cholestatic jaundice, cutaneous vasodilation, and cardiac arrhythmias may arise. Finally, vitamin C overdose may cause a decrease in copper absorption or a rise in the excretion of oxalic acid.

Explanation:

Infants treated with aminoglycosides or other ototoxic drugs may be at high risk for developing hearing deficits. Similarly infants with infections such as congenital rubella or meningitis can also develop hearing problems. Low birth weight infants are also at high risk. However, infants with congenital syphilis typically have visual problems, not hearing problems

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:

The sequence of development is the same for all children, while the rate of development varies from child to child. Development is dependent on the myelination of nerves in the CNS and the PNS. The direction of development is always from head to toe. For example, the first step in the development of locomotion is the utilization of neck muscle for the development of head control. Only then do the spinal muscles develop coordination so the baby can sit straight up. Also, the baby gains control over his/her arms before his/her legs, and crawling is often dominated first by the effort of arms followed by that of legs. Option E is also correct-an example is the necessary disappearance of the reciprocal kick (the rhythmic kicking of the legs) when walking develops.

Explanation:

Obese children are usually tall for their age in the early years due to overactivity of the adrenocortical gland. Many display premature fusing of the epiphyses, which halts growth so that most are shorter for their age in the later years. Also, many are especially susceptible to respiratory infections or wheezing.

Explanation:

Anterior commissure syndrome, which is often caused by syringomyelia, presents with bilateral loss of temperature sensation and pin prick sensations. There may or may not be an associated flaccid weakness.

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:

Full head control is usually not gained until the age of twenty weeks. Also, at that age, the child is usually able to grasp objects deliberately and smile at his/her image in the mirror.

Explanation:

A child typically begins initiating risky behavior without full regard for the consequences during the school age years.

Explanation:

There are no significant toxicities associated with biotin overdose. Although thiamin toxicity is very rare, the potential adverse effects include an anaphylactic response and/or respiratory depression. 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. Finally vitamin C overdose may cause a decrease in copper absorption or a rise in the excretion of oxalic acid.

Explanation:

The development of sensory motor intelligence typically begins at birth and develops to about two years, when the development of preoperational intelligence begins.

Explanation:

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

Explanation:

This infant is within normal limits. Infants do not begin to vocalize in the form of babbling, particularly in response to their mother´s vocalizations, until about 8 weeks of age. The mother´s question and concern is probably secondary to lack of experience and a bit of insecurity about her mothering skills and aptitude. There is no evidence that this child is pulling away from human contact (autism), not responding to noises or visual cues in the environment, or lacking other developmental milestones (mental retardation indices in infants).

Explanation:

The concrete operational period (ages 7-11 years) is defined by the child´s awareness of the conservation of volume, which demonstrates that the child is able to reason in a logical way in terms of the physical world. Note that the child does not develop understanding of abstract concepts until he or she has reached the formal operational stage, at age 11 to adulthood. The preoperational stage, ages 2 to 7 years, is associated with significant language development. However, the child has not yet developed the ability to take the perspective of others; thus, the child´s thinking tends to remain egocentric. The sensorimotor stage corresponds to ages 0 to 2 years and is characterized by the infant developing increasingly sophisticated sensorimotor skills and behavior patterns.

Explanation:

Explanation:

The incidence is roughly 1 in 1200 births for women less than 30 and this incidence can rise to 1 in 60 by the age of 42.
Maternal age also affects the incidence of hydrocephalus, anencephaly and other chromosomal disorders.

Explanation:

Laryngomalacia is the most com on cause of chronic stridor in children younger than two years. It has a male-to-female ratio of approximately 2:1. The condition is due to an intrinsic defect or delayed maturation of supporting structures of the larynx. The airway is partially obstructed during inspiration by the prolapse of the flaccid epiglottis, arytenoids and aryepiglottic folds. The inspiratory stridor is usually worse when the child is in a supine position, when crying or agitated, or when an upper respiratory tract infection occurs.

Explanation:

Explanation:

Hypothyroidism can affect all ages. In children the symptoms are fatigue, increased sensitivity to cold, fatigue, constipation, forgetfulness, decreased appetite, growth changes, depression and poor mental development. A detailed physical exam should be done on such patients looking possible physical findings which include a puffy face, weight changes, pain, stiffness or swelling in joints, abnormal sexual development, large protruding tongue, yellowing of the skin & whites of eyes and delayed development of permanent teeth. Lab tests are TSH and Free T4 levels. Treatment for hypothyroidism is with thyroid replaced (Synthroid).

Explanation:

Explanation:

Although serious systemic adverse events such as hypotonic-hyporesponsive episodes can still occur, they are much less common than with DTPw. Pertussis vaccine does not cause infantile spasms, epilepsy or sudden infant death syndrome (SIDS). Vaccine-induced fever may occasionally lead to a febrile convulsion, though much less commonly with DTPa than with DTPw.

Explanation:

This situation illustrates a common problem in the behavioral management of children, namely positive reinforcement or reward for a negative or undesirable behavior. By giving the child a cookie the mother is actually increasing the likelihood that the child will whine. Putting a child in time-out for whining would be an example of negative reinforcement. Letting the child continue to whine by ignoring the behavior is termed extinction. Bonding is not a term used in behavioral management, but it describes that affectional relationship between parents and infants. Bonding is not a term used in behavioral management, but it describes the affectional relationship between parents and infants. Bonding occurs rapidly and shortly after birth and reflects the feelings of the parents toward a newborn *unidirectional).

Explanation:

At 3-4 months of age, a normal term baby will smile at almost anyone. By 9 months of age, there is a developmentally normal anxiety over separation from the mother (Or primary care giver), as well as anxiety at the sight of an unfamiliar face, Coincident with the increased mobility gained by walking (usually at 12-15 months of age), these anxieties normally abate.

Explanation:

Dog bites are a common medical problem. Timely and copious irrigation with normal saline or Ringer´s lactate will reduce the rate of infection markedly. Recent wounds and wounds on the faces are usually closed primarily. Cultures are usually not helpful unless the wound appears infected. Amoxicillin/clavulanate is the antibiotic of choice for a dog bite. Since this is a neighbor´s dog, it can be observed at home for 10 days if the rabies vaccination is current or at a veterinarian´s office if vaccination status is unknown.

Explanation:

This is a classic example of psychiatric stress that is expressed through physical symptoms. Somatization disorder is characterized by multiple physical complaints (which include pain and GI, sexual, and neurologic symptoms) over several years that cannot be explained fully by a physical disorder. Symptoms usually begin before age 30 and are not intentionally produced or feigned. Diagnosis is based on history after excluding physical disorders. Treatment focuses on establishing a consistent, supportive physician-patient relationship that avoids exposing the patient to unnecessary and potentially unsafe diagnostic testing and therapies.

Explanation:

Vitamin D or properly termed cholecalciferol, formed in the skin is the precursor to the biologically active form 1, 25 (OH) 2D, a steroid hormone that is synthesized via a number of steps in the liver and the kidney. It is this final form 1, 25(OH) 2D of “vitamin” D that performs the important calcium utilization function. Adequate intakes of calcium and sufficient exposure to sunlight is the normal, biologically safe way to ensure normal calcium metabolism for exclusively breastfed infants. ´Vitamin” D supplementation is a therapeutic means to prevent and treat rickets and ensure that adequate bone mineralization occurs for those at risk. Those who may be at risk are dark skinned infants who are born to mothers who did not receive vitamin D supplements or consumed vitamin D supplemented milk or who themselves were not adequately exposed to sunlight during pregnancy and who exclusively breastfeed without exposing themselves and their infants to sunlight.

Explanation:

Children with constitutional growth delay (CGD), the most common cause of short stature and pubertal delay, typically have retarded linear growth within the first 3 years of life. In this variant of normal growth, linear growth velocity and weight gain slows beginning as young as age 3-6 months, resulting in downward crossing of growth percentiles, which often continues until age 2-3 years. At that time, growth resumes at a normal rate, and these children grow either along the lower growth percentiles or beneath the curve but parallel to it for the remainder of the prepubertal years. CGD is a global delay in development that affects every organ system. Delays in growth and sexual development are quantified by skeletal age, which is determined from bone age radiographic studies of the left hand and wrist. Growth and development are appropriate for an individual´s biologic age (skeletal age) rather than for their chronologic age. Timing and tempo of growth and development are delayed in accordance with the biologic state of maturity.

Explanation:

Findings associated with self-induced vomiting include swelling of the parotid gland and submandibular glands, abnormal dentition, perimolysis (loss of dentin on the lingual and occlusal surfaces of the teeth), and abrasions on the dorsum of the hand (caused by scraping against the incisors during attempts to induce vomiting). These signs would most strongly support the diagnosis of bulimia nervosa.

Explanation:

The anterior fontanelle in the newborn is normally 0.6-3.6 cm, with the mean size being 2.1 cm. It may actually enlarge the first few months, but the medial age of closure is 13.8 months. The anterior fontanelle closes at 3 months in l% of cases, and by 1 year, 38% are closed.
While early closure of the anterior fontanelle may be normal, the head circumference must be carefully monitored. The patient needs to be monitored for craniosynostosis (premature closure of one of more sutures} and for abnormal brain development. When craniosynostosis is suspected, a skull radiograph is useful for initial evaluation. If craniosynostosis is seen on the film, a CT scan should be obtained.

Explanation:

This child´s birth weight was normal and now he is in the 97th percentile for weight. This suggests that he is being overfed by a mother who will need proper counseling with regard to her toddler´s diet.

Explanation:

Explanation:

Newborns with a history of SIDS in siblings are at greater risk for SIDS than other neonates and should be monitored. The other conditions are not known to be associated with SIDS.

Explanation:

The Tanner II stage of development indicates that pubic hair begins to grow along the labia at approximately 11 years of age.

Explanation: