In which subtype of juvenile idiopathic arthritis (JIA) is there a highest prevalence of AA amyloidosis?

Correct Answer: A

Rationale: In the context of pediatric rheumatology, understanding the subtypes of juvenile idiopathic arthritis (JIA) and their associated complications is crucial. The correct answer is A) systemic JIA. AA amyloidosis is a serious complication that can occur in systemic JIA due to chronic inflammation. Systemic JIA is characterized by systemic symptoms such as fever, rash, and arthritis, and it has the highest risk for developing AA amyloidosis. Option B) oligoarticular JIA typically involves fewer than five joints and is less likely to lead to systemic complications like AA amyloidosis. Option C) polyarticular JIA affects five or more joints but is less commonly associated with AA amyloidosis compared to systemic JIA. Option D) psoriatic arthritis is a distinct subtype of JIA associated with psoriasis and usually does not have a high prevalence of AA amyloidosis. Educationally, knowing the association between systemic JIA and AA amyloidosis reinforces the importance of early recognition and aggressive treatment of this subtype to prevent serious long-term complications. Understanding the distinctions between JIA subtypes and their potential complications is essential for healthcare providers caring for pediatric patients with rheumatologic conditions.

Correct Answer: D

Rationale: In the case of suspected child abuse in a 3-month-old with a severe head injury, the most helpful study to support this suspicion is a radionuclide bone scan (Option D). This is because a radionuclide bone scan can detect skeletal injuries that may not be visible on X-rays, especially in infants where their bones are still developing and may not show fractures easily. Choosing Option A, an infantogram, is not the best choice as it provides an overall body image but may miss specific bone injuries. Option B, X-rays of the spine, and Option C, X-rays of the skull, are limited in their ability to detect subtle fractures or injuries in other parts of the body. Educationally, understanding the importance of choosing the most appropriate diagnostic study in cases of suspected child abuse is crucial for healthcare providers working with pediatric patients. It highlights the need for thorough evaluation and consideration of imaging modalities that can provide the most comprehensive information to support a diagnosis and ensure the safety and well-being of the child.

Correct Answer: A

Rationale: In this scenario, the correct Apgar score for the infant is 7. The Apgar score is a quick assessment tool used to evaluate a newborn's physical condition at one minute and five minutes after birth. It consists of five components: heart rate, respiratory effort, muscle tone, reflex irritability, and color. For the given infant: - Pulse rate: at least 100 beats per minute (2 points) - Cyanotic hands and feet indicate some central cyanosis (1 point) - Good muscle tone and a strong cry and grimace suggest good reflex irritability (2 points) - However, the infant may lose 1 point for color if they are cyanotic (blue) in the extremities. So, the Apgar score calculation would be 2 + 1 + 2 - 1 = 4 + 3 = 7. Option B) 8 would be incorrect because cyanosis in the extremities would lead to a deduction in the color component, resulting in a score of 7, not 8. Option C) 9 would also be incorrect as the presence of cyanosis in the extremities would still lead to a slight deduction in the color component, making the score 7, not 9. Educationally, understanding the Apgar score is crucial for healthcare providers working with newborns to quickly assess their well-being and determine if immediate interventions are needed. It helps in identifying infants who may require additional support or monitoring after birth. Interpreting Apgar scores correctly is essential for providing appropriate care and support to newborns during a critical period of transition.

Correct Answer: C

Rationale: The correct answer is C) Renal ultrasonography. In this case, the patient presents with multiple congenital anomalies including a ventricular septal defect, cleft lip and palate, and imperforate anus. Renal ultrasonography is not necessary in the initial workup of these specific conditions. A) A karyotype analysis would be appropriate to check for any chromosomal abnormalities that may be associated with multiple congenital anomalies. B) TORCH titer is important to rule out infections such as toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus which can cause congenital defects. D) Ultrasonography of the brain can help in assessing for any structural abnormalities in the brain that could be associated with the other congenital anomalies present. Educationally, understanding the rationale behind selecting appropriate laboratory tests based on the clinical presentation is crucial in pediatric nursing practice. It helps in providing comprehensive care and early interventions for newborns with complex medical conditions.

Correct Answer: A

Rationale: In this scenario, the most likely diagnosis is Stage I hypoxic ischemic encephalopathy (HIE). Apgar scores of 9 and 9 at 1 and 5 minutes indicate good initial adaptation to extrauterine life. However, the clinical presentation of hyperalertness, hyperactive deep tendon reflexes, and mydriasis suggests central nervous system irritability, which is consistent with Stage I HIE. Option A is correct because Stage I HIE typically manifests with central nervous system signs such as irritability and hyperreflexia. Options B, C, and D are incorrect because they represent more severe stages of HIE or a different condition like kernicterus, which is characterized by bilirubin-induced brain damage, not the acute hypoxic insult seen in this case. Educationally, understanding the progression of HIE stages is crucial for pediatric nurses and nurse practitioners. Recognizing subtle neurological signs and symptoms can lead to early intervention and prevention of further brain injury in neonates. This knowledge is essential for providing safe and effective care to infants at risk for HIE.