A 5-year-old underwent a tonsillectomy and an adenoidectomy under general anesthesia. The parents tell you that the anesthesiologist said that she “fought the mask and cried a lot” on induction. You are the pediatrician for this child, and 8 days after surgery, the parents call to report that the child, who previously slept well at night, now awakens nightly screaming with bad dreams. She is more irritable and cranky than before surgery and has angry outbursts. She is more “clingy” and wants her parents to cuddle her frequently. She reports that in her dreams, she can’t move, there is a tube in her throat, and she feels the surgeon cutting her throat. A review of her anesthetic record suggests an uneventful intraoperative course, with stable vital signs. All of the following statements about this situation are true EXCEPT

Correct Answer: A

Rationale: The described reaction, while distressing, is not necessarily indicative of severe psychiatric illness but rather a response to traumatic anesthesia induction.

Correct Answer: C

Rationale: Severe coarctation of the aorta leads to left ventricular overload and heart failure in neonates. It presents with weak femoral pulses, differential blood pressure, and signs of poor perfusion.

Correct Answer: B

Rationale: Diarrhea is a leading cause of shock in children due to dehydration and electrolyte imbalances, leading to hypovolemic shock. In resource-limited settings, diarrheal diseases remain a major cause of pediatric mortality.

Correct Answer: B

Rationale: Rebound flare-ups often occur after stopping systemic corticosteroids.

Correct Answer: D

Rationale: Nebulized adrenaline is commonly used to treat croup by reducing airway swelling and improving breathing.

Correct Answer: A

Rationale: During acidosis, potassium shifts out of cells, increasing serum levels. Correction reverses this shift, leading to a drop in serum potassium, which may cause hypokalemia.

Correct Answer: D

Rationale: Tentorial herniation compresses the oculomotor nerve, leading to a fixed, dilated pupil. This occurs due to increased intracranial pressure, which causes brain herniation, affecting the parasympathetic fibers controlling pupil constriction.

Correct Answer: D

Rationale: Septic shock can lead to disseminated intravascular coagulation (DIC), a condition where widespread blood clotting occurs throughout the body, exacerbating the shock and damaging organs.

Correct Answer: C

Rationale: Venom from certain insects contains antimicrobial peptides that reduce the risk of infection at sting sites by inhibiting bacterial growth.