A 3-week-old neonate is brought to the emergency department because of a three-day history of intermittent vomiting. His mother reports that he has not urinated for eight hours. On physical examination, his eyes are sunken. Which of the following will MOST likely require correction before surgery is performed?

Correct Answer: A

Rationale: In this scenario, the correct answer is hypochloremia (option A). Hypochloremia, or low chloride levels, can lead to metabolic alkalosis, which is a condition where there is an excess of bicarbonate in the blood. Surgery can exacerbate this imbalance due to factors like stress, anesthesia, and fluid shifts. Therefore, correcting hypochloremia before surgery is crucial to prevent further complications. Option B, hyperkalemia, is less likely in this case because vomiting typically leads to potassium loss. Hypernatremia (option C) is also less likely as the presentation suggests dehydration and loss of electrolytes rather than excess sodium. Option D is N/A, which is incorrect as addressing electrolyte imbalances is essential before surgery to optimize the patient's condition. Educationally, understanding the impact of electrolyte imbalances on surgical outcomes is vital for healthcare providers caring for pediatric patients. This question highlights the importance of recognizing and correcting electrolyte abnormalities in infants before surgical interventions to ensure better perioperative outcomes and prevent potential complications.

Correct Answer: B

Rationale: The correct response is option B: "Newborns can lose up to 10% of their birth weight and regain it by 2 weeks of age." This response is the best because it provides accurate and reassuring information to the first-time mother. It educates her on the normal weight loss pattern for newborns and helps alleviate any unnecessary worries she may have. Option A is incorrect as notifying the doctor immediately may cause undue alarm before considering the normal weight loss in newborns. Option C is inappropriate as it dismisses the mother's concerns without providing any helpful information. Option D is not the best response as it jumps to a conclusion without first educating the mother on the normal weight loss pattern in newborns. In pediatric primary care, it is essential to educate parents, especially first-time mothers, on common newborn behaviors and characteristics. Understanding newborn weight loss patterns can help parents feel more confident and reduce unnecessary anxiety. Providing accurate information empowers parents to care for their newborns effectively and fosters a positive relationship between parents and healthcare providers.

Correct Answer: A

Rationale: The correct answer is option A) Mild proteinuria, hematuria, decreased urine output, and lethargy. This combination of signs is commonly associated with glomerulonephritis in pediatric patients. Mild proteinuria and hematuria are classic signs of glomerulonephritis, indicating inflammation and damage to the glomeruli in the kidneys. Decreased urine output is a result of impaired kidney function, leading to reduced filtration and urine formation. Lethargy can be present due to the underlying illness and potential electrolyte imbalances associated with kidney dysfunction. Option B is incorrect as massive proteinuria and increased urine output are not typically seen in glomerulonephritis. Massive proteinuria is more characteristic of nephrotic syndrome, a different renal condition. Option C is incorrect as increased urine output is not a common feature of glomerulonephritis; instead, decreased urine output is more typical due to impaired kidney function. Option D is incorrect as hypotension is not commonly associated with glomerulonephritis in pediatric patients. Decreased output may be seen, but massive proteinuria is not typically accompanied by decreased output and hypotension. Educationally, understanding the classic signs and symptoms of glomerulonephritis in pediatric patients is crucial for primary care providers to recognize and manage this condition promptly to prevent complications and promote optimal outcomes for their patients.

Correct Answer: A

Rationale: In pediatric primary care, managing birth brachial plexus palsy (BBPP) requires early intervention to optimize outcomes. The correct answer, A) 1 week of age, is appropriate because initiating occupational or physical therapy early can help prevent contractures, improve range of motion, and promote proper muscle development in affected limbs. Option B) 2 weeks of age, C) 3 weeks of age, and D) 4 weeks of age are incorrect because waiting until these time points delays crucial therapeutic interventions that can aid in preventing long-term complications associated with BBPP, such as muscle atrophy and joint contractures. Educationally, it is essential for healthcare providers to understand the time-sensitive nature of initiating therapy for BBPP to ensure optimal functional outcomes for infants. Early intervention not only addresses physical limitations but also supports the infant's overall development. This knowledge can guide healthcare professionals in advocating for timely therapeutic interventions and collaborating with families to provide comprehensive care for infants with BBPP.

Correct Answer: D

Rationale: Rationale for Question on ADHD Features: Correct Answer (D): Lead intoxication is not a feature of ADHD. The other options are indeed associated with ADHD. ADHD is known to have a multifactorial origin involving genetic, environmental, and neurobiological factors. The female to male ratio of ADHD is approximately 1:3, not 2:6 as mentioned in option B. Prenatal exposure to nicotine has been linked to an increased risk of ADHD due to its impact on fetal development, particularly the developing brain. Educational Context: Understanding the features and risk factors of ADHD is crucial for healthcare providers working in pediatric primary care. It helps in early identification, diagnosis, and management of ADHD in children. Knowing that lead intoxication is not a feature of ADHD is important to avoid misdiagnosis or overlooking other potential health concerns related to lead exposure. Educators can use this question to highlight the importance of thorough assessment and differential diagnosis in pediatric patients presenting with symptoms suggestive of ADHD.