A 3-month-old precious baby of a keen and highly educated family presented with history of URTI followed by deterioration of level of consciousness and seizure. CT brain shows intracranial bleeding with no evidence of skull fracture. Fundoscopy was normal. Mother gives history of difficult labor but with normal development, mild hypotonia, and macrocephaly which was reassured initially by general Pediatrician. Of the following, the MOST likely diagnosis is

Correct Answer: D

Rationale: The correct answer is D) glutaric aciduria type 1. In this scenario, the infant's history of difficult labor, macrocephaly, mild hypotonia, and intracranial bleeding following a viral illness suggests an underlying metabolic disorder like glutaric aciduria type 1. This condition can present with macrocephaly, hypotonia, and acute encephalopathy triggered by a catabolic state like a viral illness. The absence of skull fracture and normal fundoscopy point away from trauma. Option A) residual birth trauma is incorrect because the absence of skull fracture and normal fundoscopy do not support this diagnosis. Option B) arteriovenous malformation is less likely given the clinical presentation and absence of predisposing factors. Option C) acute viral encephalitis is less likely as the symptoms are more indicative of a metabolic disorder than an infectious cause. Educationally, this question highlights the importance of recognizing metabolic disorders in pediatric patients presenting with neurological symptoms. Understanding the clinical features, diagnostic clues, and appropriate management of rare conditions like glutaric aciduria type 1 is crucial for pediatric nurses to provide optimal care for infants in critical situations.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Intravenous ampicillin and gentamicin. This treatment is appropriate because the infant is showing signs of respiratory distress and sepsis, which are common complications associated with premature rupture of membranes. Ampicillin and gentamicin are broad-spectrum antibiotics that cover a wide range of potential pathogens that could be causing the sepsis. Option A) Surfactant by aerosol is not the most appropriate choice in this case as the primary issue is likely related to infection rather than respiratory distress syndrome. Option C) Intravenous steroids would not be the first-line treatment in this situation. Steroids are typically used to help with lung development in premature infants at risk for respiratory distress syndrome but are not indicated for the immediate management of sepsis. Option D) Intravenous acyclovir is used to treat viral infections, particularly herpes infections. Since there is no indication of a viral infection in this case, acyclovir would not be the most appropriate treatment. Educationally, this question highlights the importance of recognizing and managing complications in premature infants, such as sepsis, which can quickly become life-threatening. Understanding the appropriate use of antibiotics in neonatal care is crucial for pediatric nurses to provide safe and effective care to this vulnerable population.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Pneumothorax. When a preterm infant is born, especially at 7 weeks' gestation, their lungs are underdeveloped and fragile, making them susceptible to conditions like pneumothorax, which is the accumulation of air in the pleural space causing lung collapse. This condition can lead to respiratory distress due to compromised lung function. Option B) Respiratory distress syndrome (RDS) is a common condition in preterm infants where the lungs lack surfactant, leading to difficulty in breathing. While RDS is a possible cause of respiratory distress in preterm infants, in this case, the presentation is more indicative of pneumothorax. Option C) Patent ductus arteriosus is a heart condition where a blood vessel fails to close after birth, causing circulation issues. While this can lead to respiratory distress in some cases, it is less likely in this scenario compared to pneumothorax. Option D) Group B streptococcal sepsis is a bacterial infection that can affect newborns, but it typically presents with symptoms like fever, lethargy, poor feeding, and respiratory distress may not be the primary symptom, making it less likely in this case. Educationally, understanding the common complications and conditions in preterm infants is crucial for pediatric nurses to provide prompt and effective care. Knowing the specific signs and symptoms of conditions like pneumothorax can help nurses intervene quickly and improve outcomes for these vulnerable patients.

Correct Answer: B

Rationale: Polycythemia is a condition characterized by an excess of red blood cells in the blood. The correct answer, option B, "Intrauterine growth retardation," is not typically associated with polycythemia. In polycythemia, the body produces too many red blood cells, leading to hyperviscosity of blood (option A), which can impact circulation and organ function. Large-for-gestational-age infants (option C) may be associated with maternal diabetes rather than polycythemia. Twin-twin transfusion syndrome (option D) occurs in identical twins sharing a placenta, leading to imbalanced blood flow between the fetuses, but it is not directly related to polycythemia. In an educational context, understanding the associations of polycythemia is crucial for pediatric nurses caring for infants at risk for this condition. Recognizing the signs and symptoms of polycythemia, such as hyperviscosity, helps nurses provide appropriate interventions and prevent complications. By knowing the correct associations and understanding why certain conditions are not linked to polycythemia, nurses can deliver high-quality care to pediatric patients effectively.

Correct Answer: D

Rationale: Rumination disorder is a condition where a person regurgitates and re-chews food, leading to weight loss and nutritional deficiencies. The statement "It can resolve spontaneously" (Option D) is FALSE. This is because rumination disorder typically requires intervention, such as behavioral therapy, to address the underlying causes and modify the individual's behavior. Option A is incorrect because rumination disorder can also be seen in children and adults, not just infants. Option B is incorrect as rumination disorder can vary in its course, with some cases being chronic but others improving with appropriate treatment. Option C is incorrect as rumination disorder is a complex condition that is not solely caused by neglect, but can have various contributing factors including psychological, social, or environmental influences. In an educational context, it is crucial for pediatric nurses to have a solid understanding of childhood feeding and eating disorders like rumination disorder. By knowing the accurate information about these disorders, nurses can effectively assess, intervene, and provide holistic care for pediatric patients facing these challenges. It is important to recognize the nuances of each disorder to ensure appropriate care and support for the children and their families.