A 7 year old boy came to OPD with history of difficulty in rising up from sitting position. Examination reveals hypertrophy of calf muscles with trendelenburg gait. The most likely diagnosis is:

Correct Answer: B

Rationale: The correct answer is B) Duchenne muscular dystrophy. This progressive genetic disorder primarily affects boys and is characterized by muscle weakness that typically begins in early childhood. The presentation of difficulty in rising from a sitting position, calf muscle hypertrophy, and a trendelenburg gait are classic signs of Duchenne muscular dystrophy. Option A) Becker's muscular dystrophy is a milder form of muscular dystrophy compared to Duchenne and typically presents later in childhood or adolescence, with a slower progression of symptoms. The absence of severe muscle weakness and early onset in this case make Becker's less likely. Option C) Myotonic muscular dystrophy is a separate genetic disorder characterized by muscle stiffness and myotonia, which is a delayed relaxation of muscles after contraction. The symptoms described in the question do not align with the typical presentation of myotonic muscular dystrophy. Option D) Cerebral palsy is a non-progressive neurological disorder that affects movement and posture. While it can also present with difficulty in walking and abnormal gait patterns, the hypertrophy of calf muscles seen in the question is not a typical feature of cerebral palsy. Educationally, understanding the clinical manifestations and key features of various neuromuscular disorders is crucial for pediatric nurses to provide timely and appropriate care. Recognizing the specific signs and symptoms of Duchenne muscular dystrophy can lead to early intervention and management to improve the quality of life for affected children.

Correct Answer: C

Rationale: The correct answer is C) Limit fluids in the evening and consider a reward system for dry nights. Explanation: Limiting fluids in the evening is a practical step to reduce the likelihood of bed-wetting by decreasing the amount of urine produced during the night. Additionally, implementing a reward system for dry nights positively reinforces the desired behavior and motivates the child to stay dry. Why the other options are wrong: A) Medication like DDAVP may help decrease urine volume but should be considered after behavioral interventions have been tried. B) Being firm and showing the work involved in changing sheets may create a negative association with bedtime and worsen the situation. D) Bed-wetting alarms can be effective but are typically used when behavioral strategies have not been successful. Educational context: In pediatric nursing, addressing bed-wetting requires a holistic approach involving behavioral modifications, fluid management, and positive reinforcement techniques. It is essential to consider the emotional well-being of the child and involve the family in developing a supportive plan to manage bed-wetting effectively. By understanding the underlying causes and implementing appropriate strategies, healthcare providers can help children and families navigate this common issue with empathy and evidence-based interventions.

Correct Answer: A

Rationale: In a 4-week-old with biliary atresia, the correct finding would be option A: abdominal distention, enlarged liver and spleen, clay-colored stools, and tea-colored urine. This is because biliary atresia is a condition characterized by the obstruction or absence of the bile ducts, leading to impaired bile flow from the liver to the intestine. As a result, bile accumulates in the liver, causing liver damage and leading to symptoms such as abdominal distention due to enlarged liver and spleen, clay-colored (pale) stools due to absence of bile in the intestines, and tea-colored urine due to the presence of conjugated bilirubin. Option B is incorrect because abdominal distention with bruises and hematuria are not typical findings in biliary atresia. Bruises and hematuria may indicate other underlying issues such as bleeding disorders or trauma, but they are not specific to biliary atresia. Option C is also incorrect as yellow sclera/skin, oily skin, and prolonged bleeding times are more indicative of liver dysfunction or other conditions affecting the blood clotting mechanisms rather than biliary atresia specifically. Option D is incorrect because biliary atresia typically presents with symptoms in infancy, such as the ones described in option A. Delayed manifestations until advanced disease are not characteristic of biliary atresia. In an educational context, understanding the clinical manifestations of biliary atresia is crucial for pediatric nurses to recognize and intervene early to prevent further liver damage and complications in infants. By knowing the specific signs and symptoms associated with biliary atresia, nurses can facilitate prompt diagnosis and appropriate management to optimize patient outcomes.

Correct Answer: B

Rationale: The correct answer is B) head trauma. In cases of physical abuse, head trauma is a significant contributor to mortality due to the vulnerability of a child's developing brain. Head injuries can result in severe consequences, including brain damage and death. It is crucial for healthcare providers, especially pediatric nurses, to be vigilant in identifying signs of head trauma in abused children to intervene promptly and prevent further harm. Option A) rib fractures are a common injury in physically abused children, but they are not as likely to be fatal compared to head trauma. Rib fractures can cause pain and respiratory issues, but they are not typically a leading cause of mortality in abuse cases. Option C) abdominal injury is another possible outcome of physical abuse, but it is less likely to be a leading cause of mortality compared to head trauma. While abdominal injuries can be severe and require medical attention, they are generally not as immediately life-threatening as head trauma. Option D) hot tap water burn is a serious injury that can occur due to neglect or abuse, but it is less common as a leading cause of mortality compared to head trauma. Burns can cause significant morbidity and long-term complications, but they are not typically as immediately life-threatening as head injuries. In an educational context, understanding the specific types of injuries that result from child abuse is crucial for healthcare providers working with pediatric populations. By recognizing the significance of head trauma in cases of physical abuse, nurses can advocate for these vulnerable children and ensure they receive the necessary interventions and protection to prevent further harm.