Nokea
A child aged 10 days has ambiguous genitalia:
- A. If a buccal smear is chromatin negative, there is a serious risk of an Addisonian crisis
- B. A raised urinary output of pregnanetriol would confirm a diagnosis of CAR
- C. The finding of the genotype 45 XO would reliably explain the anomaly
- D. If testicles were present in the 'labia', an acceptable explanation would be Klinefelter's syndrome
Correct Answer: B
Rationale: A raised urinary pregnanetriol indicates congenital adrenal hyperplasia (CAR). Chromatin-negative buccal smear suggests male genotype, and 45 XO is Turner syndrome, not related to ambiguous genitalia. Klinefelter's syndrome does not explain testicles in the labia.
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In 90% of cases of endocarditis, the causative agent is recovered from the first 2 blood cultures. Antimicrobial pretreatment of the patient reduces the yield of blood cultures to
- A. 10%
- B. 20%
- C. 30%
- D. 40%
Correct Answer: A
Rationale: Antimicrobial pretreatment can significantly reduce the yield of blood cultures, often to 10-20%.
Appropriate investigations in the emergency management of a 4-year-old presenting in a coma:
- A. Serum magnesium level
- B. Throat swabs
- C. Arterial blood gas
- D. CT scan
Correct Answer: C
Rationale: Arterial blood gas analysis is crucial in the emergency management of a comatose child to assess oxygenation, ventilation, and acid-base status.
The nurse is teaching a client with glomerulonephritis about self-care. Which dietary recommendations should the nurse encourage the client to follow?
- A. Increase intake of high-fiber foods, such as bran cereal
- B. Restrict protein intake by limiting meats and other high-protein foods
- C. Limit oral fluid intake to 500 ml per day
- D. Increase intake of potassium-rich foods such as bananas or cantaloupe
Correct Answer: B
Rationale: Reducing protein intake helps decrease the workload on the kidneys, which is beneficial in glomerulonephritis.
How long should a 4-year-old child recovering from rheumatic fever need to receive monthly injections of penicillin G?
- A. 1 year
- B. 2 years
- C. 5 years
- D. 10 years
Correct Answer: C
Rationale: Children who recover from rheumatic fever should have a chemoprophylaxis protocol of penicillin G injections (about 200,000 units per dose) for a minimum of 5 years or up to the age of 18 to prevent further bouts of rheumatic fever.
The following drugs may cause long Q-T syndromes (LQTS) EXCEPT
- A. trimethoprim/sulfamethoxazole
- B. erythromycin
- C. imipramine
- D. pentostam
Correct Answer: D
Rationale: Pentostam is not known to cause long Q-T syndromes.