Which finding requires immediate attention in a child with glomerulonephritis?

Correct Answer: C

Rationale: In a child with glomerulonephritis, the finding that requires immediate attention is option C: complaining of a severe headache and photophobia. This is indicative of elevated intracranial pressure, a serious complication of glomerulonephritis known as hypertensive encephalopathy. Immediate medical attention is crucial to prevent further complications like seizures, stroke, or even death. Option A is incorrect because while a high blood pressure of 170/90 is concerning in a child with glomerulonephritis, it is not the most urgent issue compared to the neurological symptoms in option C. Option B, urine output of 190 mL in 8 hours with dark-colored urine, indicates possible hematuria or proteinuria, common in glomerulonephritis. While significant, it does not pose an immediate threat like the neurological symptoms in option C. Option D, refusing breakfast and lunch with a lack of appetite, could be related to the child's overall condition but does not raise immediate concerns like the neurological symptoms in option C. Educationally, this question highlights the importance of recognizing and prioritizing critical symptoms in pediatric patients with glomerulonephritis. Understanding the potential complications and knowing when to seek urgent medical intervention is vital for healthcare providers caring for these vulnerable populations.

Correct Answer: B

Rationale: Necrotizing enterocolitis (NEC) is a serious gastrointestinal emergency in neonates, particularly preterm infants. The correct answer is B) Bloody diarrhea. This manifestation suggests NEC due to the characteristic intestinal mucosal damage and necrosis that occurs in this condition. Bloody diarrhea is a hallmark sign of NEC and indicates significant gastrointestinal pathology. Option A) Faster absorption of orogastric feedings is incorrect because it does not specifically indicate NEC. NEC is characterized by intestinal ischemia and inflammation rather than altered absorption. Option C) Increased bowel sounds are non-specific and can be present in a variety of gastrointestinal conditions. It is not a distinguishing feature of NEC. Option D) Appearing hungry before feeding is also non-specific and does not directly correlate with the pathophysiology of NEC. Infants with NEC may have feeding intolerance but hunger before feeding is not a specific indicator of NEC. Educational Context: Understanding the clinical manifestations of NEC is crucial for healthcare providers caring for neonates, especially those in the NICU. Recognizing signs like bloody diarrhea can prompt early intervention, which is essential for improving outcomes in infants with NEC. Educating healthcare professionals on the specific symptoms of NEC can lead to timely diagnosis and treatment, ultimately improving patient outcomes.

Correct Answer: D

Rationale: In managing gastroesophageal reflux (GER) in a 2-month-old, holding the infant in an upright position for 30 minutes following a feeding (Option D) is crucial. This position helps prevent the regurgitation of stomach contents into the esophagus, reducing symptoms of GER. Placing the infant in an infant seat immediately after feedings (Option A) may worsen GER by compressing the abdomen, causing reflux. Placing the infant prone immediately after feeding (Option B) is unsafe due to the risk of aspiration. Encouraging parents not to worry (Option C) is incorrect as GER can lead to complications if not managed properly. Educationally, it's important to understand the physiological basis of GER in infants, emphasizing the role of gravity in preventing reflux. Teaching caregivers proper positioning techniques can significantly improve the infant's symptoms. Understanding these principles helps healthcare providers optimize care and educate families effectively on managing pediatric GU disorders like GER.

Correct Answer: B

Rationale: In the context of pediatric GU disorders, understanding the process of active hydrogen ion secretion in the urinary system is crucial. The correct answer to the question is B) collecting ducts. The collecting ducts play a key role in the final acidification of urine by actively secreting hydrogen ions into the tubular fluid. This process helps in maintaining the acid-base balance in the body by regulating the pH of urine. Now, let's delve into why the other options are incorrect: A) The distal convoluted tubule primarily regulates electrolyte balance rather than being directly involved in hydrogen ion secretion for acidification of urine. C) The loop of Henle is involved in creating a concentration gradient in the kidney and reabsorption of water and electrolytes, but it is not the primary site for hydrogen ion secretion. D) The distal tubule is involved in fine-tuning electrolyte balance and water reabsorption but is not the primary site for active hydrogen ion secretion. Educational context: Understanding the specific functions of different parts of the nephron in the kidney is foundational in comprehending how the urinary system maintains homeostasis. Knowing the role of each segment in processes like acidification of urine is essential for diagnosing and managing pediatric GU disorders effectively.

Correct Answer: D

Rationale: In the context of pediatric GU disorders, understanding the distinction between intrinsic renal diseases (primary) and those arising from systemic conditions (secondary) is crucial for proper diagnosis and treatment. In this question, the correct answer is D) Congenital nephrotic syndrome. Congenital nephrotic syndrome is a primary renal disorder characterized by proteinuria, hypoalbuminemia, and edema in infancy. It is an example of an intrinsic renal disease, where the kidney itself is primarily affected. This condition is typically genetic in nature and not secondary to a systemic condition. A) Polycystic kidney disease is a genetic disorder characterized by the formation of fluid-filled cysts in the kidneys, which is also a primary renal disease but not typically seen in the pediatric population. B) Cystinosis is a rare genetic disorder leading to the accumulation of cystine within cells and can cause renal impairment. While it is a primary renal disorder, it is not typically associated with congenital nephrotic syndrome. C) Alport syndrome is a genetic condition affecting the kidneys, characterized by glomerulonephritis, hearing loss, and ocular abnormalities. While it is a primary renal disease, it is not synonymous with congenital nephrotic syndrome. Educationally, this question highlights the importance of recognizing different types of pediatric renal disorders, understanding their etiology (primary vs. secondary), and being able to differentiate between them based on clinical presentations. This knowledge is vital for healthcare providers involved in the care of pediatric patients with GU disorders to ensure accurate diagnosis and appropriate management.