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The school nurse has been following a child who frequently complains of dizziness and headache. Today, she is brought in after fainting in the cafeteria following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse suspects she has:
- A. Transposition of the great vessels
- B. Coarctation of the aorta (COA)
- C. Aortic stenosis (AS)
- D. Pulmonic stenosis (PS)
Correct Answer: B
Rationale: In older children, COA can cause elevated blood pressure, headache, fainting, and bounding radial pulses.
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True statements about the use of the new Child Health Foundation growth charts include:
- A. Immediate referral is advised if the height of a child is on the second centile
- B. The midparental height of a child, whose parents are 176 and 160 cm tall, is 175 cm
- C. They can be used for all children including those with Down's syndrome
- D. The target centile range for a girl is midparental height ± 10 cm
Correct Answer: C
Rationale: The growth charts are designed to be inclusive and can be used for children with Down's syndrome, among others.
Triggers of the alternate pathway of complement are:
- A. Bacterial lipopolysaccharide
- B. Interleukin 2
- C. Macrophages
- D. Properdin
Correct Answer: A
Rationale: The correct answer is A because bacterial lipopolysaccharide is a known trigger of the alternate complement pathway. The other options (b-e) are not primary triggers.
A pediatric patient is scheduled for a noninvasive procedure to determine if his heart is structurally normal and to localize a murmur. What diagnostic test does the nurse anticipate?
- A. Barium swallow
- B. Chest x-ray
- C. Electrocardiogram
- D. Echocardiogram
Correct Answer: D
Rationale: Echocardiography is a noninvasive procedure that localizes murmurs and determines if the heart is structurally normal.
Indications for an exchange transfusion include:
- A. ABO incompatibility
- B. Acute chest syndrome
- C. Sepsis
- D. Polycythaemia
Correct Answer: A
Rationale: Exchange transfusion is indicated in conditions like ABO incompatibility to prevent severe hemolytic disease in newborns. Acute chest syndrome sepsis polycythaemia and sickle nephropathy are not typical indications for exchange transfusion.
The MOST common cause of syncope in children is
- A. Wolff-Parkinson-White syndrome
- B. prolonged QT syndrome
- C. atrioventricular block
- D. neurocardiogenic syncope
Correct Answer: D
Rationale: Neurocardiogenic syncope is the most common cause of syncope in children due to autonomic dysfunction.