Which immunization produces a permanent scar?

Correct Answer: B

Rationale: The correct answer is B: BCG. Bacille Calmette-Guérin (BCG) vaccine for tuberculosis is administered through intradermal injection, which often results in a permanent scar due to the formation of a small blister and subsequent scabbing. DPT (A), Measles vaccination (C), and Hepatitis B vaccination (D) are typically administered intramuscularly or subcutaneously, which do not usually leave permanent scars. The scarring left by BCG vaccination is a distinctive feature that can help identify individuals who have received this specific immunization.

Correct Answer: A

Rationale: The correct answer is A because using the Integrated Management of Childhood Illness (IMCI) guidelines, the respiratory rate of a 4-month-old infant is crucial in determining the severity of illness. IMCI guidelines help classify respiratory rates as fast, normal, or slow based on age-specific ranges. By following these guidelines, healthcare providers can accurately assess the infant's respiratory status and provide appropriate interventions. Choice B is incorrect as simply stating "fast" does not provide a standardized assessment based on guidelines. Choice C is incorrect as labeling the respiratory rate as "slow" without reference to guidelines can lead to misinterpretation. Choice D is incorrect as it does not specify the assessment based on IMCI guidelines, which are essential for accurate evaluation in pediatric cases.

Correct Answer: C

Rationale: The correct classification for this infant based on the symptoms described is severe dehydration. According to the Integrated Management of Childhood Illness (IMCI) guidelines, severe dehydration is characterized by skin pinch returning slowly, sunken eyes, and frequent diarrhea. These signs indicate significant fluid loss and the need for immediate intervention. No signs of dehydration (choice A) would not be accurate given the symptoms presented. Some dehydration (choice B) may not fully capture the severity of the infant's condition. The data being insufficient (choice D) is incorrect as the symptoms provided clearly indicate severe dehydration.

Correct Answer: D

Rationale: The correct answer is D: Edema. In severe protein energy malnutrition like kwashiorkor, edema is a hallmark sign due to low protein levels causing fluid to leak into tissues. A: Voracious appetite is incorrect as malnourished children often have reduced appetite. B: Wasting is more associated with marasmus, another form of malnutrition. C: Apathy can be seen in malnourished children, but it is not specific to kwashiorkor. In summary, edema is the most apparent sign in a child with 3rd-degree protein energy malnutrition, distinguishing it from other forms of malnutrition.

Correct Answer: D

Rationale: The correct answer is D: Conjunctival xerosis. This is the earliest sign of xerophthalmia as it indicates dryness and thickening of the conjunctiva due to lack of vitamin A. Keratomalacia (A) and corneal opacity (B) occur at later stages and are more severe manifestations. Night blindness (C) is a symptom of vitamin A deficiency but typically appears after conjunctival xerosis. Therefore, observing conjunctival xerosis during a physical examination of a young child would be the earliest sign of xerophthalmia.