Meckel’s diverticulitis. Hemorrhage is the most
common complication of Meckel’s diverticulitis in
children; therefore, this condition should be considered
in any child with abdominal pain of unclear
etiology associated with GI hemorrhage. Intestinal
obstruction is another possible diagnosis but is more
common in adults. The diagnosis of Meckel’s diverticulitis
can be confirmed by 99mTc-pertechnetate
scan, which detects heterotopic gastric mucosa or
pancreatic tissue within the diverticulum. Meckel’s
diverticula are usually completely asymptomatic, but
resection is necessary when complications develop.
Colonic arteriovenous malformations can cause GI
hemorrhage in children but are much less common
than Meckel’s diverticula. Appendicitis is common in
children but very rarely causes hemorrhage. Colonic
diverticulitis and gastric stress ulcers are exceedingly
rare in children and are unlikely in this case.
02.Answer B
Continued observation for 24 hours. The patient should be observed
for delayed passage of meconium, as this can be normal up to 48 hours
of life. If delayed beyond this period, meconium ileus, meconium plug,
imperforate anus, or Hirschsprung’s disease should be considered.
Evaluation of imperforate anus should include inspection for drainage
of meconium through a fistula to the perineum or the urinary tract
because this significantly alters treatment.1 Specifically, fistulae
occur with low termination of the colon/rectum, which can be managed
definitively with anorectoplasty. Absence of a fistula significantly
increases the likelihood of a “high defect” imperforate anus, which can
be managed with colostomy and subsequent contrast imaging of the
distal colon/rectum, followed by definitive repair at a few months of
age. Some surgeons obtain a cross-table lateral abdominal radiograph
(not MRI) to determine where the terminal colon/rectum
lies in relation to the perineum, but this approach is unnecessary and is
not widely practiced. Ultrasonography and radiography are required to
rule out VACTERL association, but there is no need for MRI.
Intubation and mechanical ventilation are not indicated in this case.
03.ANSWER D
Slipped Capital Femoral Epiphysis occurs as the result of
acute or repetitive microtrauma to a probable abnormal
femoral growth plate. It is unilateral in 40%-80% of
cases and occurs during or just prior to the adolescent
growth spurt (age 10 to 13 years). It is more commonly
seen in boys and in very obese and/or very tall
adolescents. Onset prior to age 10 years may indicate an
underlying endocrine problem such as hypothyroidism.
The clinical presentation is a limp with pain related to
the hip joint. There may be some shortening of the
involved limb, and internal rotation is limited. Biplanar
radiographs or computed tomographic scans will
establish the diagnosis. Mild demineralization of the
metaphysis on the involved side is often associated.
04.Answer D
Hand washing and cleaning toys that are shared by
children are the most effective means of preventing
the spread of colds and upper respiratory tract
infections during winter. If wearing a hat during cold
weather prevented the spread of colds, then children
in warm climates, would never get sick.
05.Answer E
Slipped capital femoral epiphysis typically presents
in girls aged 11 to 13 years and boys aged 13 to 15
years who are obese. It is most common in blacks.
Although a slipped capital femoral epiphysis can
produce pain localized to the groin area, it often
presents as knee pain, especially on the board
examination. Internal rotation is difficult. If you
were to suggest an x-ray, anteroposterior and frog
lateral x-rays of the pelvis would be the way to go.
06.Answer A
Failure to pass meconium of Newborn during the
first 24 hours of life may indicate Hirschsprung
disease or Congenital Aganglionic Megacolon, an
anomaly resulting in mechanical obstruction due to
inadequate motility in an intestinal segment. B, C,
and D are not associated in the failure to pass
meconium of the newborn.
07.Answer C
Ortolani’s sign is the abnormal clicking sound when
the hips are abducted. The sound is produced when
the femoral head enters the acetabulum. Letter A is
wrong because its should be “asymmetrical gluteal
fold”. Letter B and C are not applicable for newborns
because they are seen in older children.
08.Answer B
During feto-placental circulation, the pressure in
the heart is much higher in the right side, but
once breathing/crying is established, the
pressure will shift from the R to the L side, and
will facilitate the closure of Foramen Ovale.
(Note: that is why you should position the NB in
R side lying position to increase pressure in the L
side of the heart.)
09.Answer C
most CSF leaks resolve spontaneously. The child
should be maintained on bed rest until CSF leak
stops. NSAID's may be used. The child may assume
position of comfort. There are no dietary
restrictions.
10.Answer A
Because croup cause upper airway obstruction,
inspiratory stridor is predominant symptom
11.Answer C
excessive exercise, consumption of very small
amounts of food and food rituals, amenorrhea,
and excessive weight loss or weight is below
normal, lanugo, dry skin, bradycardia, are all
signs of anorexia nervosa.
12.Answer A
- the client experiences poor feeding (1 ounce = 30 ml)
which indicates specific problems. The infant normally
looses weight during the first week of life and he/she
usually gains weight on the second week.
13.Answer C.
Shortness of breath and perspiration during
feeding can also indicate left-sided heart failure.
14.Answer B.
The triad of cystic fibrosis is COPD, pancreatic
enzyme deficiency, and a high concentration of
sweat electrolytes.
15.Answer B
Because of the structural defect, children with cleft
palate may have ineffective functioning of their
Eustachian tubes creating frequent bouts of otitis
media. Most children with cleft palate remain wellnourished
and maintain adequate nutrition through
the use of proper feeding techniques. Food particles
do not pass through the cleft and into the
Eustachian tubes. There is no association between
cleft palate and congenial ear deformities.
16.Answer A.
Children with congenital heart disease are more prone
to respiratory infections. Bleeding tendencies,
frequent vomiting, and diarrhea and seizure disorders
are not associated with congenital heart disease.
17.Answer A.
For the child with Hirschsprung disease, fever and
explosive diarrhea indicate enterocolitis, a lifethreatening
situation. Therefore, the physician
should be notified immediately. Generally, because
of the intestinal obstruction and inadequate
propulsive intestinal movement, antidiarrheals are
not used to treat Hirschsprung disease. The child
is acutely ill and requires intervention, with
monitoring more frequently than every 30
minutes. Hirschsprung disease typically presents
with chronic constipation.
18.Answer C.
Projectile vomiting is a key symptom of pyloric
stenosis. Regurgitation is seen more commonly with
GER. Steatorrhea occurs in malabsorption
disorders such as celiac disease. “Currant jelly”
stools are characteristic of intussusception.
19.Answer C
Before surgery, the infant is kept in the prone
position to decrease tension on the sac. This allows
for optimal positioning of the hips, knees, and feet
because orthopedic problems are common. The
supine position is unacceptable because it causes
pressure on the defect
20.Answer D
For at least the first 24 hours after insertion
of a ventriculoperitoneal shunt, the child is
positioned supine with the head of the bed flat
to prevent too rapid decrease in CSF pressure. A
rapid reduction in the size of the ventricles can
cause subdural hematoma. Positioning on the
operative site is to be avoided because it places
pressure on the shunt valve, possibly blocking
desired drainage of CSF. With continued
increased ICP, the child would be positioned with
the head of bed elevated to allow gravity to aid
drainage.
21.Answer A
The goal in working with mentally challenged children
is to train them to be as independent as possible,
focusing on the developmental skills. The child may not
be capable of learning something new every day but
needs to repeat what has been taught previously.
Rather than encouraging more lenient behavior limits,
the parents need to be strict and consistent when
setting limits for the child. Most children with Down
syndrome are unable to achieve age-appropriate social
skills due to their mental retardation. Rather, they
taught socially appropriate behaviors.
22.Answer C
A toxic effect of valproic acid (Depakene) is liver
toxicity, which may manifest with jaundice and
abdominal pain. If jaundice occurs, the client needs
to notify the health care provider as soon as
possible.
23.Answer C
The child is angry and needs a positive outlet for
expression of feelings. An emotionally tense child
with pent-up hostilities needs a physical activity
that will release energy and frustration. Pounding on
a pegboard offers the opportunity.
Listening to a story does not allow child to express
emotions. It also places the child in a passive role
and does not allow the child to deal with feelings in
a healthy and positive way. Activities such as
paintings and stacking a tower of blocks require
concentration and fine movements, which could add
to frustration.
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