Pediatrics Flashcards

Question

Which condition requires immediate emergency intervention in a child with diarrhea? A. Presence of blood in the stool B. Sunken eyes, dry oral mucosa, no tears C. Abdominal distension D. Painless recurrent unformed stools for over 4 weeks

Answer 1

**B: Correct. Severe dehydration indicated by sunken eyes, dry oral mucosa, and no tears necessitates immediate medical care.**These signs indicate an urgent need for medical intervention, such as intravenous fluids and monitoring of electrolytes, to prevent complications. A: Blood in the stool is concerning but does not always require emergency intervention unless severe. C: Abdominal distension could indicate other issues but is not immediately life-threatening. D: Chronic diarrhea requires evaluation but is not an emergency.

Answer 2

**B: Correct. Biopsy findings of villous atrophy and intraepithelial lymphocytes confirm Celiac disease.** A: A positive dietary response supports the diagnosis but is not definitive. C: Genetic testing helps rule out Celiac disease but is not definitive for diagnosis. D: Elevated serum IgA antibodies support diagnosis but require biopsy confirmation.

Answer 3

Differential Diagnoses for Inconsolable Crying It's crucial to rule out serious underlying conditions when an infant presents with inconsolable crying. Here’s a breakdown of conditions that can mimic or coexist with colic: 1. Meningitis Definition: Inflammation of the membranes surrounding the brain and spinal cord. Signs: Fever, lethargy, poor feeding, irritability, bulging fontanelle, seizures, nuchal rigidity (stiff neck). Why It Matters: Life-threatening; requires immediate medical attention. 2. Nasal Obstruction Definition: Blockage of the nasal passages, commonly due to mucus or congenital issues. Signs: Noisy breathing, difficulty feeding, nasal flaring. Why It Matters: Infants are obligate nasal breathers, so even minor obstruction can cause distress. 3. Pneumonia Definition: Infection or inflammation of the lungs. Signs: Fever, rapid or labored breathing, retractions, nasal flaring, poor feeding, cyanosis (blue lips or skin). Why It Matters: Can cause respiratory distress and requires treatment with antibiotics or oxygen. 4. Heart Failure Definition: The heart's inability to pump effectively, leading to poor oxygen delivery. Signs: Poor feeding, excessive sweating, rapid breathing, failure to thrive, hepatomegaly (enlarged liver), edema. Why It Matters: Congenital heart defects may present with these symptoms and require urgent intervention. 5. Intussusception Definition: Telescoping of one segment of the intestine into another, causing obstruction. Signs: Sudden, severe abdominal pain, blood-streaked stools ("currant jelly stools"), vomiting, abdominal mass. Why It Matters: Surgical emergency. 6. Volvulus Definition: Twisting of the intestine, leading to obstruction and compromised blood flow. Signs: Abdominal distension, bilious vomiting, severe pain, shock. Why It Matters: Surgical emergency; delay can lead to bowel necrosis. 7. Testicular Torsion Definition: Twisting of the spermatic cord, cutting off blood flow to the testicle. Signs: Acute scrotal pain, swelling, redness, irritability. Why It Matters: Requires immediate surgical intervention to save the testicle. 8. Sepsis Definition: A systemic inflammatory response to infection, leading to organ dysfunction. Signs: Fever or hypothermia, lethargy, irritability, poor feeding, mottled skin, tachycardia, hypotension. Why It Matters: Life-threatening condition requiring antibiotics and supportive care. 9. Hypoglycemia Definition: Low blood glucose levels. Signs: Lethargy, jitteriness, seizures, poor feeding, irritability. Why It Matters: Immediate correction of glucose levels is crucial to prevent permanent neurological damage. 10. Failure to Thrive (FTT) Definition: Poor growth due to inadequate nutrition or underlying medical conditions. Signs: Weight below the 3rd percentile, developmental delays, poor feeding, frequent illness. Why It Matters: Indicates an ongoing issue that needs investigation to determine the cause.

Answer 4

**C) Correct: Severe symptoms like difficulty breathing indicate an emergency, and immediate action (calling 911 or going to the emergency department) is necessary.** A) Incorrect: Severe symptoms, such as difficulty breathing, indicate anaphylaxis and require immediate medical attention. B) Incorrect: Benadryl is insufficient for severe allergic reactions, and reintroducing the food could be life-threatening. D) Incorrect: Waiting for symptoms to worsen can delay critical care, which can be life-threatening.

Answer 5

**(b) Correct: Rhinosinusitis is characterized by symptoms lasting 10 days or more or worsening within 10 days, with symptoms like nasal congestion, facial pain, headache, fever, and cough.** (a) Acute viral rhinitis typically resolves within 7-10 days, and the symptoms described here have lasted longer than 10 days. (c) Influenza typically presents with fever, chills, myalgia, and can have gastrointestinal symptoms in children, but the timeline and symptoms here align more with rhinosinusitis. (d) Allergic rhinitis would typically present with clear nasal discharge and sneezing, without the persistent fever and facial pain.

Answer 6

**(b) Correct: Rhinovirus is the most common viral cause of the common cold, presenting with clear to mucoid rhinorrhea, nasal congestion, sore throat, and sometimes a mild fever.** (a) Streptococcus pneumoniae is a bacterial pathogen, not the primary cause of viral rhinitis. (c) Influenza virus causes more severe symptoms, including fever, malaise, and myalgia, and is not the primary cause of the common cold. (d) Haemophilus influenzae can cause bacterial respiratory infections but is not a primary cause of viral rhinitis.

Answer 7

**Answer: c) Bronchiolar** Explanation: it is not a recognized stage of lung development. The five correct stages are Embryonic, Pseudoglandular, Canalicular, Saccular, and Alveolar. Embryonic Stage (Weeks 4–7) The lung bud arises from the foregut and branches into the two primary bronchial buds. These buds grow into the surrounding mesoderm and form the trachea, bronchi, and pleura. Any defects in this stage can lead to tracheoesophageal fistulas or atresia. Pseudoglandular Stage (Weeks 5–17) Conducting airways (bronchi, terminal bronchioles) develop and branch extensively. The lung resembles an exocrine gland, but gas exchange is not yet possible. Airways are lined with columnar epithelial cells. Errors in this stage can result in bronchogenic cysts or congenital airway malformations. Canalicular Stage (Weeks 16–26) Terminal bronchioles divide into respiratory bronchioles. Capillaries invade, forming primitive air-blood barriers. Type I pneumocytes (gas exchange cells) and Type II pneumocytes (surfactant producers) begin to appear. By the end of this stage, some limited gas exchange becomes possible, making survival possible (though unlikely) by 22–24 weeks. Saccular Stage (Weeks 24–38) Terminal sacs (primitive alveoli) form and begin to expand. Capillaries grow closer to alveoli, improving gas exchange. Surfactant production increases, preventing alveolar collapse. Premature infants born after 28–30 weeks may survive with surfactant therapy. Alveolar Stage (Week 36–8 years postnatally) Alveoli continue to form and mature, increasing in number (from ~20 million at birth to ~300 million by 8 years old). Secondary septation (formation of additional alveolar walls) occurs, optimizing gas exchange. Surfactant levels reach full maturity by 35 weeks, ensuring alveolar stability at birth. How These Stages Are Studied Histological Examination Lung tissue samples from fetal specimens or animal models are stained and analyzed under a microscope to observe developmental stages. Genetic & Molecular Studies Genes like FGF10, SHH, BMP4, and VEGF are studied to understand their roles in lung branching and alveolarization. Imaging Techniques (Ultrasound, MRI) High-resolution fetal imaging allows observation of lung growth and abnormalities. Surfactant Testing in Amniotic Fluid The Lecithin-to-Sphingomyelin (L/S) Ratio is measured to assess lung maturity in premature infants. A ratio >2.0 indicates sufficient surfactant production.

Answer 8

**Answer: b) Tympanic (hyperresonant) percussion note** Explanation: (b) Tympanic (hyperresonant) percussion note is characteristic of a pneumothorax due to the presence of excess air in the pleural space. (a) Dull percussion note is associated with pleural effusion rather than pneumothorax. (c) Fine crackles are usually seen in interstitial lung disease or pulmonary edema, not pneumothorax. (d) Increased tactile fremitus occurs in consolidation (e.g., pneumonia), whereas pneumothorax typically decreases tactile fremitus.

Answer 9

**Answer: b) Asthma** Explanation: (b) Asthma is an obstructive lung disease where FEV1 is reduced due to airway narrowing and increased resistance. (a) Interstitial lung disease is a restrictive lung disease, which affects total lung volume more than airflow obstruction. (c) Pneumothorax and (d) Pulmonary embolism are not primarily diagnosed with spirometry; imaging studies like chest X-ray and CT scans are more useful for these conditions.

Answer 10

**Answer: a) Autogenic drainage** Explanation: (a) Autogenic drainage is a technique where patients actively control their breathing at different lung volumes to mobilize mucus without excessive coughing. (b) Postural drainage uses gravity-assisted drainage but does not require active breathing control. (c) Manual percussion is a passive technique where a caregiver or therapist applies rhythmic clapping to the chest to loosen mucus. (d) Bronchodilators help open the airways but do not physically remove secretions. **Air Clearance Therapy** * Removal of airway secretions or debris * Innate: mucociliary clearance and cough * Manual percussion * Chest physiotherapy * Postural drainage * Forced expiratory technique (huff cough) * Autogenic drainage * Positive expiratory pressure with ventilation * Manual or mechanical insufflation-exsufflation * Bronchodilators/mucolytics given prior to therapy Postural Drainage ✅ How it's done: The patient is positioned so that gravity helps drain mucus from specific lung areas. Positions vary based on the lung segment being targeted (e.g., lying on the side, stomach, or back at different angles). Often combined with chest physiotherapy (percussion or vibration). 💡 Used for: Cystic fibrosis, bronchiectasis, pneumonia, chronic lung conditions with mucus buildup. If you roll to the right, gravity pulls mucus down from the smaller airways into larger ones, where it's easier to clear by coughing or using other airway clearance techniques (e.g., huff coughing). Each position targets a specific lung segment to optimize drainage. For example: Lying on your left side helps drain the right lung. Head-down positions help drain lower lung lobes. Sitting upright helps clear upper lobes. 💡 Why it works: Mucus naturally moves toward the trachea, where it can be coughed out. Gravity helps bring it from deeper parts of the lungs, making clearance more effective. 2. Forced Expiratory Technique (Huff Cough) ✅ How it's done: Patient inhales deeply and then exhales forcefully with an open mouth, saying "huff" instead of coughing. This prevents airway collapse and helps move mucus up the airways. Often followed by a regular cough to clear loosened secretions. 💡 Used for: Clearing mucus in COPD, bronchiectasis, and cystic fibrosis. 3. Autogenic Drainage ✅ How it's done: A controlled breathing technique using different lung volumes: Unsticking phase: Slow, deep breaths into low lung volumes to loosen mucus. Collecting phase: Medium-sized breaths to move mucus up the airways. Autogenic Drainage – Collecting Phase Collecting phase = Both inhaling and exhaling, but focus on controlled breathing How it's done: After loosening mucus in the unsticking phase, you take medium-sized breaths in to move the mucus higher in the airways. Breathing out is slow and controlled (not forceful), so the mucus doesn’t move back down. 💡 Goal: Gradually shift mucus upward before the final evacuating phase, where huff coughing clears it out. Evacuating phase: Larger breaths and huff coughing to clear mucus. 💡 Used for: Patients with bronchiectasis or cystic fibrosis to self-clear mucus efficiently. 4. Positive Expiratory Pressure (PEP) with Ventilation ✅ How it's done: Patient breathes out against resistance (via a mask, mouthpiece, or oscillating PEP device like the Flutter or Acapella). Keeps airways open, allowing air to get behind mucus and move it out. 💡 Used for: Chronic lung diseases like COPD, cystic fibrosis, and atelectasis prevention. 5. Manual or Mechanical Insufflation-Exsufflation (MI-E, aka Cough Assist) ✅ How it's done: A mechanical device delivers a deep breath in (insufflation) and then rapidly switches to negative pressure to help expel secretions (exsufflation). Manual version involves a bag-mask device to mimic this effect. 💡 Used for: Patients with neuromuscular disorders (ALS, spinal cord injury, muscular dystrophy) who can't cough effectively. 6. Bronchodilators/Mucolytics Given Prior to Therapy ✅ How it's done: Bronchodilators (e.g., albuterol, salbutamol): Relax the airway muscles and open up airways before clearance techniques. Mucolytics (e.g., hypertonic saline, N-acetylcysteine, dornase alfa): Thin mucus to make it easier to clear. 💡 Used for: Cystic fibrosis, COPD, bronchiectasis—given before postural drainage or airway clearance therapy.

Answer 11

**Answer: b) Essential oil diffusion** Explanation: (b) Essential oil diffusion can release volatile organic compounds (VOCs) that act as irritants, worsening conditions like asthma and chronic lung disease. (a) High humidity can promote mold growth, but it is not a direct airway irritant. (c) Airplane cabin pressure affects oxygen levels, but is not a common environmental trigger for airway inflammation. (d) Cold weather can worsen lung disease symptoms, but it does not directly cause airway inflammation like indoor pollutants.

Answer 12

**Answer: a) Laryngomalacia: is the most common congenital cause of stridor in infants and is characterized by worsening symptoms in the supine position due to airway collapse.- From birth or first few weeks of life - Intermittent high pitched inspiratory stridor worse In supine - Moderate to severe sxs require visualization of airway - Resolved by 2 yoa - Severe: surgical supraglottaoplasty recommended: stridor each breath, retractions, increased work, feeding difficulties** (b) Laryngeal atresia is a severe and fatal complete high airway obstruction syndrome (CHAOS), at birth, requiring immediate emergency tracheostomy. (c) Laryngeal cleft leads to aspiration and dysphagia, rather than intermittent inspiratory stridor. (d) Subglottic hemangioma may cause airway obstruction, but it is not typically associated with positional worsening like laryngomalacia. It's cutaneous vascular lesions, need propranolol, steroids, laser ablation

Answer 13

**Answer: b) Noisy breathing during inspiration Correct: Upper airway obstruction (nose, mouth, pharynx, larynx) disrupts inspiration, leading to stridor or noisy breathing.** Incorrect Choices: a) Wheezing occurs with intrathoracic airway obstruction (bronchi, bronchioles), affecting expiration. Wheezing typically occurs in expiration because during exhalation, the intrathoracic airways narrow, making it harder for air to escape c) Normal breathing pattern is not expected in airway obstruction. d) Productive cough is more common in lower respiratory tract infections, not upper airway obstructions.

Answer 14

**Answer: b) Respiratory syncytial virus (RSV) is the most common viral cause of bronchiolitis and pneumonia in infants under 2 years old.** Incorrect Choices: a) Streptococcus pneumoniae is the most common bacterial cause, not viral. c) Mycoplasma pneumoniae causes atypical pneumonia and is more common in older children (>5 years old). d) Neisseria meningitis is linked to meningitis rather than pneumonia.

Answer 15

Answer: c) Steeple sign on anteroposterior neck X-ray Correct: Croup (parainfluenza virus) causes subglottic edema, leading to the steeple sign (narrowing of the upper trachea). Incorrect Choices: a) Thumbprint sign is seen in epiglottitis, not croup. b) Air-fluid levels indicate lung abscess, not croup. d) Bilateral infiltrates suggest pneumonia, not croup.

Answer 16

**Answer: b) Antibiotics and airway management. Epiglottitis is a life-threatening bacterial infection (e.g., Haemophilus influenzae), requiring IV antibiotics (ceftriaxone or cephalosporins) and airway support (intubation if needed).** Incorrect Choices: a) Steroids and epinephrine are used for croup, not epiglottitis. c) Antiviral therapy is ineffective since epiglottitis is bacterial. d) Observation alone is not safe due to the risk of sudden airway obstruction.

Answer 17

**Correct Answer: a) Subglottic hemangioma Explanation for Each Option: A subglottic hemangioma is a benign vascular tumor that appears as a superficial, fluid-filled lesion in the subglottic region of the larynx. It commonly presents in infants with progressive stridor, which worsens over weeks to months as the hemangioma enlarges. These lesions can obstruct the airway, leading to respiratory distress. Treatment: Most cases require laser therapy or surgical excision if the airway is significantly compromised. Propranolol may also be used as a medical treatment.** b) Laryngocele (Incorrect) A laryngocele is an air-filled dilation of the laryngeal saccule, which can cause hoarseness, cough, and airway obstruction. Unlike a fluid-filled lesion, laryngoceles contain air and may not necessarily present with stridor. Treatment is typically surgical, but it is not the same pathology as a subglottic hemangioma. c) Laryngeal cleft (Incorrect) A laryngeal cleft is a congenital defect in which there is an abnormal opening between the larynx and esophagus, allowing food and liquids to enter the airway. It presents with chronic aspiration, recurrent pneumonia, and feeding difficulties, rather than stridor. Surgical repair is needed, but it is not a superficial, fluid-filled lesion. d) Acute bacterial tracheitis (Incorrect) Acute bacterial tracheitis is a severe bacterial infection of the trachea, most commonly caused by Staphylococcus aureus. It presents with high fever, stridor, toxic appearance, and purulent tracheal secretions. This is an infectious process, not a structural lesion requiring laser therapy or surgery. Treatment includes IV antibiotics and airway management, not laser therapy. Summary: Subglottic hemangioma is the only fluid-filled lesion associated with stridor that may require laser therapy or surgery. The other options (laryngocele, laryngeal cleft, acute bacterial tracheitis) involve different pathophysiological processes and do not fit the description given in the question.

Answer 18

**Answer: b) Epiglottitis. Explanation: Epiglottitis, caused by Haemophilus influenzae, presents with drooling, muffled voice, and a cherry-red swollen epiglottis. Also the patient leans forward because it utilizes gravity in keeping the epiglotis open.** Rationale for other choices: a) Croup: Causes stridor and barking cough, but not a cherry-red epiglottis. c) Laryngeal cleft: A congenital anomaly causing aspiration, but not epiglottitis symptoms. d) Acute bacterial tracheitis: Presents with high fever and stridor but does not cause a cherry-red epiglottis.

Answer 19

**Answer: b) Secure the airway with endotracheal intubation** Rationale for other choices: a) Obtain a throat culture: This delays airway management and is unsafe. c) Administer oral dexamethasone: Steroids may help, but securing the airway is the priority. d) Perform a CT scan: Imaging delays treatment and may worsen obstruction.

Answer 20

b) Prematurity and chronic cardiopulmonary disease → Correct ✅ Why? These conditions increase the risk of severe bronchiolitis, hospitalization, and respiratory failure. Risk factors include: Premature birth (<37 weeks gestation) → smaller airways, weaker lung function Congenital heart disease (CHD) → poor oxygenation, increased risk of respiratory distress Chronic lung disease (e.g., bronchopulmonary dysplasia) Immunodeficiency a) Age > 5 years → Incorrect Why? Bronchiolitis primarily affects infants and young children (<2 years old). Older children (>5 years)* have larger airways, so they are less susceptible to severe airway obstruction. Most common age group: 3–6 months old (due to smaller airways and immature immune system). c) Recent antibiotic use → Incorrect Why? Bronchiolitis is viral (most commonly RSV) → antibiotics do not treat viral infections. When are antibiotics considered? Only if there is secondary bacterial pneumonia. d) Vaccination history → Incorrect Why? Vaccines reduce the risk of infections, but lack of vaccination is not a direct risk factor for bronchiolitis hospitalization. Exception: Lack of palivizumab prophylaxis in high-risk infants increases RSV risk.

Answer 21

**b) Streptococcus pneumoniae → Correct ✅** S. pneumoniae is the most common bacterial cause of community-acquired pneumonia (CAP) in children worldwide. Features: Lobar pneumonia with fever, productive cough, pleuritic chest pain Crackles, decreased breath sounds, dullness to percussion Can progress to complications like pleural effusion or empyema * Prevention: Pneumococcal vaccine (PCV13, PPSV23) c) Klebsiella pneumoniae → Incorrect Why? Klebsiella is rare in healthy children; it typically causes pneumonia in: Adults with alcoholism or diabetes Hospitalized or immunocompromised patients Classic feature: "Currant jelly" sputum due to necrotizing pneumonia d) Mycoplasma pneumoniae → Incorrect (but common in older children) Why? M. pneumoniae is a leading cause of atypical pneumonia but is more common in school-aged children and teenagers, not young children. Features: Walking pneumonia with a persistent dry cough, malaise, low-grade fever X-ray findings often look worse than symptoms Treated with macrolides (azithromycin, clarithromycin)

Answer 22

Answer: b) Amoxicillin. Explanation: Amoxicillin is the first-line treatment for community-acquired pneumonia in young children. a) Macrolides: Used for atypical pneumonia (e.g., Mycoplasma), but not first-line in infants. c) Ciprofloxacin: Not used in children due to risk of cartilage damage. d) Vancomycin: Used for MRSA pneumonia but not first-line.

Answer 23

**Answer: b) Parainfluenza virus Rationale for other choices:** a) Influenza A: Can cause severe pneumonia and bronchiolitis but is not the main cause of croup. c) RSV (Respiratory Syncytial Virus): More common in bronchiolitis, not croup. d) Streptococcus pneumoniae: A bacterial pathogen causing pneumonia, not viral croup.

Answer 24

**Answer: b) Monthly palivizumab prophylaxis. Explanation: Palivizumab is a monoclonal antibody used to prevent severe RSV infection in high-risk infants.** a) Routine influenza vaccination: Prevents flu, not RSV. c) Daily antibiotic prophylaxis: Antibiotics do not prevent RSV. d) Vitamin D supplementation: Important for bone health, but not for RSV prevention.

Answer 25

(a) Lung abscess – Incorrect (Common complication of pneumonia) Why? A lung abscess forms when necrotic lung tissue develops due to inadequate bacterial clearance. Seen in: Aspiration pneumonia, anaerobic infections. (b) Pulmonary embolism – Correct (NOT a direct complication of pneumonia) Why? Pneumonia does not directly cause PE, but inflammation and immobilization may increase clot risk. True cause of PE: Deep vein thrombosis (DVT), not lung infection. (c) Bacterial superinfection – Incorrect (Common complication of pneumonia) Why? A secondary bacterial infection may develop if the primary infection weakens immune defenses. Example: Influenza pneumonia can be followed by Staphylococcus aureus or Streptococcus pneumoniae superinfection. (d) Pleural effusion – Incorrect (Common complication of pneumonia) Why? Pneumonia can cause fluid accumulation in the pleural space, leading to parapneumonic effusion or empyema. Diagnosed by: Chest X-ray or ultrasound.

Answer 26

**(a) Ampicillin and aminoglycoside → Correct ✅ Neonates (<4 weeks old) are at risk for Group B Streptococcus (GBS), E. coli, and Listeria. Ampicillin covers GBS and Listeria, while aminoglycosides cover Gram-negative organisms like E. coli.** (b) Macrolides → Incorrect Macrolides (e.g., azithromycin) are used for atypical pneumonia (Mycoplasma, Chlamydia), not neonatal pneumonia. (c) IV ceftriaxone → Incorrect Ceftriaxone is avoided in neonates due to the risk of kernicterus and interactions with calcium-containing IV fluids. (d) Oral amoxicillin → Incorrect Not suitable for neonates; severe infections require IV treatment

Answer 27

**(b) Anaerobic and Gram-negative bacteria → Correct ✅ In immunocompromised patients, lung abscesses are more often caused by Nocardia, Mycobacteria, Legionella, and fungi.** (a) Staphylococcus aureus → Incorrect S. aureus can cause lung abscesses, but it’s more common in healthy individuals or post-viral pneumonia. (c) Streptococcus pneumoniae → Incorrect S. pneumoniae causes lobar pneumonia, not typically cavitary lung abscesses. (d) Influenza virus → Incorrect Influenza is viral and does not cause lung abscesses directly.

Answer 28

**(b) History of ICU admission for asthma → Correct ✅ Past severe exacerbations (e.g., intubation, ICU stay) strongly predict future severe attacks.** (a) Use of ICS → Incorrect ICS are protective against exacerbations, not a risk factor. (c) Exposure to pets → Incorrect Exposure may trigger asthma in allergic individuals, but it’s not a primary risk factor for life-threatening events. (d) Mild intermittent symptoms → Incorrect Severe, poorly controlled asthma is the main risk factor.

Answer 29

(a) Beta-2 agonists (SABAs) should be used as the sole treatment → Incorrect SABAs provide quick relief, but ICS are essential for long-term inflammation control. (b) Avoiding all exposure to animals is necessary → Incorrect Exposure to dogs may reduce asthma risk, but avoiding allergens is helpful for sensitized individuals. (c) Tracking FEV1 pre- and post-bronchodilator can help monitor lung function over time → Correct ✅ Spirometry is key for tracking disease progression. (d) Asthma does not cause chronic airway inflammation → Incorrect Asthma is characterized by chronic inflammation, not just episodic symptoms.

Answer 30

**(b) Tension pneumothorax → Correct ✅ Abscess rupture can lead to pneumothorax and mediastinal shift.** (a) Pulmonary embolism → Incorrect PE is not a direct complication of lung abscess. (c) Hemothorax → Incorrect Hemothorax is typically from trauma, aortic dissection, or malignancy, not lung abscess. (d) Pericarditis → Incorrect Pericarditis is more associated with viral infections or post-MI Dressler syndrome, not lung abscess.

Answer 31

(b) Macrolides → Correct ✅ Azithromycin or clarithromycin treat atypical pathogens (e.g., Mycoplasma, Chlamydia pneumoniae). (a) Amoxicillin → Incorrect Amoxicillin targets typical bacteria (e.g., S. pneumoniae) but does not cover Mycoplasma. (c) IV vancomycin → Incorrect Used for MRSA pneumonia, not atypical pneumonia. (d) Ceftriaxone → Incorrect Ceftriaxone covers typical bacteria (S. pneumoniae, H. influenzae) but not Mycoplasma.

Answer 32

**(c) Hypoxemia with respiratory alkalosis → Correct ✅ Hyperventilation leads to respiratory alkalosis (low PCO2, high pH).** (a) Normal PCO2 → Incorrect Early on, PCO2 is low due to hyperventilation. If PCO2 is normal in a worsening patient, it suggests impending respiratory failure. (b) Metabolic alkalosis → Incorrect Asthma affects the lungs, not metabolism. (d) Leukopenia → Incorrect Leukocytosis may be present due to stress or corticosteroids.

Answer 33

Answer: (a) Respiratory acidosis. (✅) a) Correct → Severe asthma can cause hypercapnia (high CO₂) and respiratory acidosis, signaling impending failure. (❌) b) Wrong → Hyperoxia is not a typical asthma complication (patients have hypoxia, not excessive oxygen). (❌) c) Wrong → Asthma causes bronchoconstriction and airway inflammation, not increased lung compliance (seen in emphysema). (❌) d) Wrong → Pulmonary embolism is not a direct complication of asthma.

Answer 34

✅ Correct Answer: A) Pulsus paradoxus 🔹 Pulsus paradoxus (drop in systolic BP during inspiration) occurs in moderate-severe asthma attacks due to air trapping and increased intrathoracic pressure. ❌ Why the others are wrong? B) Increased PCO2 in early stages → Early stages show low PCO2 due to hyperventilation; high PCO2 indicates respiratory failure. C) Absence of wheezing → No wheezing in a severe attack is a bad sign—silent chest means near-complete airway obstruction. D) Normal oxygen saturation → Severe asthma causes hypoxia, leading to low O2 saturation.

Answer 35

✅ Correct Answer: B) GINA (Global Initiative for Asthma) 🔹 GINA provides global guidelines for asthma diagnosis and management. ❌ Why the others are wrong? A) NAEPP → US-based National Asthma Education Prevention Program (not global). C) WHO → Guides public health policies but does not provide specific asthma management protocols. D) CDC → Focuses on disease surveillance, not direct management guidelines. * Management of Acute Asthma episodes - At home: SABA (Albuterol) 2-6 puffs q 20 mins up to 3x, continue q 3-4 hrs for 24-48 hours if sxs improve a) >12 puffs/d > 24 hours seek medical advice - In office/emergency department: functional tests are done PEFR, FEV1, flow volume loops, oxygen saturation, blood gases, a) SABA by puffer or inhaler in the first hr 4-8 puffs up to 3 doses b) Oxygen given to maintain O2 sat >90% c) Oral Coricosteroids if poor response to therapy 60mg/kg/d for <12 80mg/kg/d > 12 d) Severe: high dose SABA + ipratropium bromide q 20 mins 3 doses - Hospitalization: worst case scenario, education for parents to continue at home care, compliancy is key

Answer 36

Correct Answer: B) Height velocity ✅ Height velocity is the most critical factor because it reflects ongoing growth patterns rather than just a single measurement. A child who falls off their growth curve is more concerning than a child who is simply short but growing steadily. ❌ A) Absolute height is less useful because some children may be naturally short due to genetics rather than pathology. ❌ C) Bone age is helpful but not the most critical factor. Some children may have delayed bone maturation but still reach normal height. ❌ D) Parental height helps predict a child’s expected height but does not directly indicate if abnormal growth is occurring.

Answer 37

**Correct Answer: C) The Greulich & Pyle method is used to compare bone age standards** ✅ C) The Greulich & Pyle method is used to compare bone age standards – This method compares a child’s hand and wrist X-rays to standardized images representing different stages of bone development. ❌ A) Bone age is assessed using radiographs of the right hand and wrist – The left hand and wrist are typically used for assessment. ❌ B) Children with delayed bone age always remain short in adulthood – Many children with constitutional growth delay catch up later and reach a normal adult height. ❌ D) Skeletal maturation cannot change over time once determined – Growth potential can change, especially in cases of delayed puberty or hormonal interventions.

Answer 38

Correct Answer: D) CGD children have a delay in skeletal maturation and puberty onset ✅ D) CGD is characterized by delayed bone age and delayed puberty, but these children continue to grow beyond the average stop point, eventually reaching their genetic height potential. ❌ A) Both CGD and FSS children have normal birth weight and length, so this does not differentiate them. ❌ B) While final height is usually appropriate, it is the growth pattern (late blooming) that distinguishes CGD. ❌ C) Unlike FSS, CGD children initially follow a growth percentile below what is expected based on parental height.

Answer 39

Correct Answer: C) Parental short stature ✅ C) Parental short stature is a feature of Familial Short Stature (FSS), which is a normal variation, not a pathological cause of short stature. ❌ A) Chronic illnesses (e.g., celiac disease, inflammatory conditions) can impair growth. ❌ B) Intrauterine growth restriction (IUGR) can result in persistent short stature if catch-up growth does not occur. ❌ D) Chromosomal defects like Turner syndrome are well-known causes of growth failure.

Answer 40

Correct Answer: B) It is often associated with excess truncal adiposity ✅ B) GH deficiency leads to decreased lipolysis, which can cause increased truncal fat accumulation. ❌ A) IGF-1 production is actually reduced in GHD because GH stimulates IGF-1 release. ❌ C) Random GH levels are unreliable since GH secretion is pulsatile; IGF-1 levels provide a better estimate. ❌ D) GH therapy is ineffective in cases of GH resistance, where children do not respond to treatment. Truncal adiposity refers to excessive fat accumulation around the abdomen and torso. In Growth Hormone Deficiency (GHD), truncal adiposity occurs because GH plays a key role in lipolysis (fat breakdown). When GH levels are low: **more on truncal adiposity** Fat metabolism is impaired, leading to increased fat storage, especially in the trunk area. Lean muscle mass decreases, making the body composition more fat-heavy. Insulin resistance may develop, as GH normally helps regulate glucose metabolism. This results in a characteristic "chubby" appearance in children with GHD, even though their overall growth is stunted.

Answer 41

Correct Answer: C) Serum IGF-1 level ✅ C) IGF-1 is a more stable marker of GH secretion and is the first step in screening. ❌ A) MRI is used later if GHD is confirmed, to check for pituitary abnormalities. ❌ B) Random GH levels are not useful due to pulsatile secretion. ❌ D) Stimulation tests are done if IGF-1 is low but not as a first step. **Insulin-like Growth Factor 1 (IGF-1) is preferred over direct GH measurement because:** GH secretion is pulsatile – It fluctuates throughout the day, making random serum GH levels unreliable. A low GH level at any given moment may not mean true deficiency. IGF-1 levels reflect overall GH activity – IGF-1 is produced in the liver in response to GH, so its levels remain relatively stable over time. Easier to interpret – Unlike GH, which varies widely throughout the day, IGF-1 provides a better estimate of average GH function over time. Less invasive – GH stimulation tests (which require multiple blood draws over hours) are only done if IGF-1 is low.

Answer 42

✅ Correct Answer: B) Height velocity over time 🔹 Height velocity (rate of growth over time) is the best indicator of whether a child is growing normally or has a growth disorder. ❌ A) Absolute height at a given age – A child's height alone doesn’t determine abnormal growth because children grow at different rates. A short child may still have normal growth velocity. ❌ C) Parental height – While genetics influence height, growth velocity changes are more useful for detecting abnormalities. ❌ D) Mid-parental height calculation – This estimates expected height but does not indicate current growth issues.

Answer 43

✅ Correct Answer: A) These children have different growth patterns from the general population 🔹 Turner syndrome, Down syndrome, and some ethnic groups have distinct growth patterns, so using standard growth charts can lead to misinterpretation. ❌ B) Standard growth charts underestimate final height potential – This isn’t always true; rather, they don’t accurately reflect expected growth for these conditions. ❌ C) It helps diagnose conditions earlier – Growth charts are for monitoring, but diagnosis requires genetic and medical evaluation. ❌ D) Growth hormone therapy is only used if these charts show low height percentiles – GH therapy decisions involve clinical assessment, not just chart placement.

Answer 44

✅ Correct Answer: B) Children with CGD have delayed puberty and skeletal maturation 🔹 CGD is characterized by slower-than-expected growth with delayed puberty, but they eventually reach their genetic height potential. ❌ A) Children with CGD follow their genetic percentile from birth – No, they initially grow below their expected percentile but later catch up. ❌ C) FSS children never reach a normal growth curve – FSS children do settle into a normal growth pattern that aligns with their genetics. ❌ D) CGD results in permanent short stature – CGD kids tend to catch up after puberty and achieve normal final height.

Answer 45

✅ Correct Answer: B) They may have normal growth velocity but remain below their expected height percentile 🔹 Some SGA infants fail to catch up and track a lower height percentile, but this doesn’t always indicate a growth disorder. ❌ A) They are always diagnosed with GH deficiency – Not all SGA children have GH deficiency. Some have other causes of short stature. ❌ C) They never achieve normal adult height – Some do, especially if treated appropriately. ❌ D) They develop excess adiposity due to metabolic imbalances – While SGA children may have metabolic risks, this is not a universal outcome.

Answer 46

✅ Correct Answer: A) Turner Syndrome 🔹 Turner Syndrome is one of the most common genetic causes of short stature in females, characterized by various physical features like a webbed neck, micrognathia, and low hairline. ❌ B) Down Syndrome – While Down Syndrome can lead to short stature, Turner Syndrome is more commonly associated with it. ❌ C) Noonan Syndrome – Although Noonan Syndrome can cause short stature, it is less frequent compared to Turner Syndrome. ❌ D) Prader-Willi Syndrome – Prader-Willi Syndrome can also cause short stature but is less common than Turner Syndrome. ======================================== B) Down Syndrome Characteristics: Down Syndrome (Trisomy 21) is a genetic condition caused by an extra chromosome 21. It is associated with intellectual disabilities, characteristic facial features (e.g., flattened face, upward slanting eyes, small ears), and various health issues. Short Stature: Children with Down Syndrome typically have short stature, although their growth is usually consistent with a specific growth chart for Down Syndrome. While short stature is common, it is not usually as significant as in Turner Syndrome. Other Features: It is associated with developmental delays, congenital heart defects, and an increased risk of other health conditions (e.g., hearing problems, gastrointestinal issues). C) Noonan Syndrome Characteristics: Noonan Syndrome is a genetic disorder that affects multiple parts of the body. It can cause congenital heart defects, developmental delays, short stature, and characteristic physical features like a webbed neck, wide-set eyes, and low-set ears. Short Stature: Short stature is common in Noonan Syndrome, but it tends to be less pronounced than in Turner Syndrome. The growth may be slow but consistent with the individual's genetic potential. Children with Noonan Syndrome may benefit from growth hormone therapy. Other Features: Noonan Syndrome is also associated with learning disabilities, heart conditions, and other physical abnormalities (e.g., chest deformities, low muscle tone). D) Prader-Willi Syndrome Characteristics: Prader-Willi Syndrome is a genetic disorder caused by a deletion of specific genes on chromosome 15. It leads to a range of physical, mental, and behavioral problems, including obesity, intellectual disabilities, and compulsive eating behaviors. Short Stature: Short stature is often seen in children with Prader-Willi Syndrome, but it is less commonly severe than in Turner Syndrome. Growth hormone therapy can help improve growth and body composition. Other Features: Prader-Willi Syndrome is characterized by an insatiable appetite (leading to obesity), intellectual disabilities, hyperphagia (compulsive eating), and muscle weakness. Monitoring for sleep apnea and other respiratory problems is essential.

Answer 47

✅ Correct Answer: D) Sleep apnea and upper airway obstruction 🔹 Prader-Willi Syndrome is associated with sleep apnea, upper airway obstruction, and other physical features. Monitoring for these issues is important before starting growth hormone therapy. ❌ A) Webbed neck – Webbed neck is a hallmark of Turner Syndrome, not Prader-Willi Syndrome. ❌ B) Intellectual impairment – While intellectual impairment may occur, it is not as prominent a feature as other aspects in Prader-Willi. ❌ C) Increased risk of malignancies – This is associated with Down Syndrome, not Prader-Willi Syndrome.

Answer 48

✅ Correct Answer: B) Down Syndrome 🔹 In Down Syndrome, growth hormone therapy may be considered but is not typically necessary unless there is a clear growth hormone deficiency. ❌ A) Turner Syndrome – Growth hormone therapy can improve final height in Turner Syndrome and is often recommended. ❌ C) Prader-Willi Syndrome – Growth hormone therapy is used to improve growth and body composition in Prader-Willi Syndrome. ❌ D) Hypothyroidism – Hypothyroidism requires thyroid hormone replacement, not growth hormone therapy.

Answer 49

**✅ Correct Answer: C) Jaundice and poor muscle tone 🔹 Congenital hypothyroidism presents with thick tongue, large fontanels, hoarseness, poor muscle tone, and jaundice. Early diagnosis and treatment are essential for normal cognitive outcomes.** ❌ A) Delayed bone age – Delayed bone age can occur with hypothyroidism but is not the most characteristic feature of congenital hypothyroidism. ❌ B) Short stature due to undernutrition – This is a characteristic of psychosocial short stature, not congenital hypothyroidism. ❌ D) Increased physical activity – Hypothyroidism generally leads to reduced physical activity due to low metabolism and energy levels.

Answer 50

**✅ Correct Answer: C) Total T4 or TSH screening test 🔹 Newborns are typically screened for hypothyroidism using a total T4 or TSH test to detect potential issues early. If abnormal, confirmation is done with venous T4 and TSH levels.** ❌ A) Serum T3 and T4 levels only – TSH screening is more commonly used in newborn screening as the primary test. ❌ B) Urinalysis and serum electrolytes – These tests are not used for screening hypothyroidism but may be done to assess overall health or other conditions. ❌ D) Bone age X-ray – While bone age may be delayed in hypothyroidism, it is not used as a primary screening method.

Answer 51

✅ Correct Answer: B) Intracranial hypertension 🔹 A rare side effect of recombinant GH therapy is intracranial hypertension, which requires monitoring and early detection to prevent complications. ❌ A) Excessive weight loss – GH therapy typically helps with growth and may improve body composition, but weight loss is not a common side effect. ❌ C) Increased bone density – GH therapy promotes growth and normal bone development, but excessive bone density is not a typical side effect. ❌ D) Decreased bone growth – GH therapy is used to enhance bone growth, especially in children with growth hormone deficiency.

Answer 52

✅ Correct Answer: D) They are usually shorter than their peers 🔹 Children with Klinefelter Syndrome are typically shorter than expected for their age due to the presence of an extra X chromosome, which affects growth. ❌ A) They tend to have a normal height for their age – Children with Klinefelter Syndrome generally have shorter stature than their peers. ❌ B) They often exhibit gigantism or acromegaly – Gigantism or acromegaly is related to GH excess, not Klinefelter Syndrome. ❌ C) They are at risk for tall stature due to GH excess – Klinefelter Syndrome typically causes short stature, not tall stature due to GH excess.

Answer 53

Answer: ✅ D) 11 weeks – TH is produced at 10 weeks and appears in serum at 11 weeks. ❌ A) 6 weeks – Too early; the thyroid gland is still forming. ❌ B) 8 weeks – TH production has not yet started. ❌ C) 10 weeks – This is when TH is produced, but it appears in serum at 11 weeks.

Answer 54

Answer: ✅ A) TSH surges, causing a temporary rise in TH, which normalizes in a few weeks. – This can lead to false-positive newborn screening for hypothyroidism. ❌ B) TH immediately decreases – The TSH surge actually causes an initial increase in TH. ❌ C) TSH and TH remain stable – There is a fluctuation right after birth. ❌ D) TH increases gradually over the first year – TH normalizes within weeks, not over a year.

Answer 55

**Answer: ✅ D) All of the above – All these factors can contribute to decreased T4 levels.** - Causes of low T4: hypothyroidism, prematurity, malnutrition, severe illness, following therapy with T3 a) Situation that decreased TBG: familial TBG deficiency, cirrhosis, renal failure, glucocorticoids, androgens

Answer 56

Answer: ✅ A) Celiac disease – Autoimmune diseases like celiac disease increase the risk of Hashimoto’s thyroiditis. ❌ B) Type 2 diabetes – Type 1 diabetes, not type 2, is linked to Hashimoto’s. ❌ C) Marfan syndrome – Not associated with autoimmune thyroid disorders. ❌ D) Klinefelter syndrome – No strong connection to Hashimoto’s.

Answer 57

Answer: ✅ B) Methimazole – First-line antithyroid drug for controlling hyperthyroidism. ❌ A) Beta-blockers – Used to manage symptoms, but they do not treat the underlying disease. ❌ C) Radioactive iodine – Used when antithyroid drugs fail or in specific cases. ❌ D) Surgery – Reserved for large goiters, nodules, or refractory cases.

Answer 58

**✅ A) Fever, delirium, cardiovascular collapse – Life-threatening hyperthyroidism emergency.** ❌ B) Painless thyroid swelling with normal thyroid function – This describes painless thyroiditis. ❌ C) Cold intolerance and bradycardia – These are signs of hypothyroidism, not thyroid storm. ❌ D) Transient hyperthyroidism followed by hypothyroidism – This describes subacute thyroiditis.

Answer 59

✅ A) Hypoparathyroidism and recurrent laryngeal nerve damage – Removal of the thyroid can accidentally damage the parathyroid glands (leading to hypocalcemia) or the recurrent laryngeal nerve (causing hoarseness). ❌ B) Increased thyroid hormone production – A total thyroidectomy removes hormone production. ❌ C) Spontaneous remission – Graves’ disease can have remissions, but not after thyroid removal. ❌ D) Increased risk of hyperthyroidism – Surgery eliminates hyperthyroidism, but the patient will require lifelong hormone replacement.

Answer 60

Why might a patient with Hashimoto’s thyroiditis develop hyperthyroidism (Hashitoxicosis)? ✅ A) Temporary thyroid inflammation causes excess hormone release – In early Hashimoto’s, thyroid cells break down and release stored hormones, causing transient hyperthyroidism. ❌ B) Overdose of levothyroxine – While this can cause hyperthyroidism, Hashitoxicosis is due to inflammation, not medication. ❌ C) The pituitary overproduces TSH – Hashimoto’s is an autoimmune disease, not a pituitary disorder. ❌ D) The thyroid becomes permanently hyperactive – Hashimoto’s eventually leads to hypothyroidism, not permanent hyperthyroidism.

Answer 61

✅ D) Weight loss – First-line intervention for obese PCOS patients as it improves insulin resistance, hormone balance, and overall symptoms. ❌ A) Spironolactone – Used for hirsutism but does not address underlying metabolic dysfunction. ❌ B) Oral contraceptives – Effective for cycle regulation and hyperandrogenism but do not treat insulin resistance. ❌ C) Metformin – Helps insulin resistance but is not first-line over lifestyle changes like weight loss.

Answer 62

✅ B) Labial fusion and clitoromegaly – Classic signs of CAH due to excess androgen exposure in utero. ❌ A) Hypoglycemia and jaundice – Can be seen in other endocrine or metabolic disorders but are not specific to CAH. ❌ C) Microcephaly and hypotonia – More indicative of genetic or neurological disorders. ❌ D) Hypotension and bradycardia – Would be seen in myxedema coma rather than CAH.

Answer 63

✅ B) Low-dose dexamethasone suppression test – Failure to suppress cortisol confirms Cushing syndrome. ❌ A) Random ACTH level – Used to differentiate between ACTH-dependent vs. independent Cushing but does not confirm the diagnosis. ❌ C) Plasma renin activity – More relevant in conditions like hyperaldosteronism. ❌ D) ACTH stimulation test – Used to diagnose adrenal insufficiency, not Cushing syndrome.

Answer 64

✅ C) GnRH stimulation test – Differentiates between central (gonadotropin-dependent) and peripheral (gonadotropin-independent) precocious puberty. ❌ A) Serum estrogen level – Not the most reliable first-line test. ❌ B) MRI of the brain – Indicated if central precocious puberty is confirmed, but not first-line. ❌ D) Ultrasound of the ovaries – Useful for peripheral causes but not the first step.

Answer 65

✅ C) Constitutional growth delay – Most common cause of delayed puberty, associated with delayed bone age and normal adult height. ❌ A) Klinefelter syndrome – Can cause delayed puberty but is less common and often presents with small testes. ❌ B) Primary hypogonadism – More likely in Turner syndrome (females) or genetic disorders affecting gonads. ❌ D) Pituitary tumor – Can cause delayed puberty but is far less common than constitutional growth delay.

Answer 66

Answer: ✅ B) Congenital Adrenal Hyperplasia (CAH) CAH is the most common cause of ambiguous genitalia in newborn females. 21-hydroxylase deficiency leads to: Excess androgens → Virilization (ambiguous genitalia). Mineralocorticoid deficiency → Salt wasting, hyponatremia, hyperkalemia. Elevated 17-hydroxyprogesterone (diagnostic marker). ❌ A) Turner Syndrome → Causes primary amenorrhea, but NOT virilization or salt wasting. ❌ C) Androgen Insensitivity Syndrome → 46 XY karyotype with female external genitalia, but no uterus. ❌ D) Klinefelter Syndrome → 47 XXY karyotype, causes infertility and gynecomastia, but does not affect genital development at birth.

Answer 67

a) Rolls from back to side ❌ – Rolling requires more developed motor control and typically emerges around 4-5 months. b) Moves arms and legs ✅ – Newborns exhibit spontaneous and reflexive movements of the arms and legs as part of their early motor activity. c) Laughs when spoken to ❌ – Social smiling and laughter usually develop around 2-4 months, so this is too early. d) Sits with support with head and neck control ❌ – Sitting with support and good head control occurs around 4-5 months, making this an inappropriate milestone for a newborn.

Answer 68

**a) Suck well on the nipple ✅ – Newborns have a strong sucking reflex, which is essential for feeding.** b) Say simple words ❌ – Speech development doesn’t begin until around 9-12 months, with simple words like "mama" and "dada" forming later. c) Have a preference for one hand ❌ – Hand preference (dominance) isn’t evident until around 2-3 years old. Early preference may indicate neurological concerns. d) Walk with assistance ❌ – Walking typically begins around 12 months, so this is far too early.

Answer 69

**c) Startles to sounds ✅ – The startle (Moro) reflex is present at birth and causes the baby to react to sudden noises.** a) Ignores sounds ❌ – A baby ignoring sounds at 2 weeks could indicate hearing issues, as newborns should react to sound. b) Turns head towards the sound ❌ – Babies do not consistently turn toward sounds until around 3-4 months when neck control improves. d) Claps in response ❌ – Clapping is a fine motor milestone that usually develops closer to 9-12 months.

Answer 70

**a) Sequence 2 or more sucks before swallowing/breathing ✅ – Coordinating sucking, swallowing, and breathing is a crucial newborn feeding skill.** b) Reach and grasp objects with both hands ❌ – Voluntary reaching and grasping occur around 4 months. Before then, newborns rely on reflexive grasping. c) Vocalize pleasure and displeasure with good eye contact ❌ – Babies typically start cooing and vocalizing socially around 6-8 weeks, so this is premature. d) Walk with assistance ❌ – Again, walking occurs around 12 months, making this option incorrect.

Answer 71

**a) Rolls from back to side ✅ – Some infants may begin to roll partially by 1 month, though full rolling (back to front) usually occurs by 4-5 months.** b) Uses pincer grasp to pick up objects ❌ – The pincer grasp (thumb and forefinger) emerges between 9-12 months, making this incorrect. c) Sits without support ❌ – Sitting independently is a 6-month milestone, though supported sitting starts earlier. d) Says "mama" and "dada" intentionally ❌ – Babies may babble mama/dada sounds around 6-7 months, but they don’t use them meaningfully until 9-12 months.

Answer 72

**a) Reaches/grasps objects with both hands ✅ – At 1 month, babies do not yet have voluntary grasping; they only exhibit a palmar grasp reflex.** b) Hears sounds and laughs when spoken to ❌ – Hearing sounds is expected, but laughing is more common at around 2-4 months. c) Vocalizes pleasure and displeasure with good eye contact ❌ – Some vocalizations may be present, but true social vocalization and eye contact develop closer to 6-8 weeks. d) No persistent closed/fisted hands ❌ – By 1 month, persistent fist-clenching should start decreasing, but full hand relaxation happens later.

Answer 73

✅ Answer: C) Correct – Methylphenidate (e.g., Ritalin) is a stimulant, which is the first-line treatment. Explanation: ❌ A) Incorrect – Guanfacine is a non-stimulant used only if stimulants fail. ❌ B) Incorrect – Atomoxetine (a norepinephrine reuptake inhibitor) is not first-line. ❌ D) Incorrect – Clonidine is another non-stimulant, mainly used for sleep problems or tics. =============================== **Management Medications** 1. Stimulants considered first line: methylphenidate (ritalin) & amphetamine preparations: tablet, capsule, liquid, dermal patch: rapid active i) Enhance dopamine and norepinephrine neurotransmission to improve impulse, attention and hyperactivity ii) Side effects: appetite suppression, sleep disturbances, anxiety, exacerbate or improve motor tics 2. Nonstimulants, Extended release clonidine or guanfacine: a2 presynaptic agonists, atomoxetine: norepinephrine reuptake inhibitor; takes more time to take effect 2-4 weeks i) SE similar to stimulants as well as sedation, dizziness, constipation

Answer 74

**✅ Answer: C) Stimulants suppress appetite, which may lead to weight loss.** Explanation: ❌ A) Incorrect – Stimulants typically cause weight loss, not gain. ❌ B) Incorrect – Non-stimulants (e.g., Atomoxetine, Guanfacine) are more likely to cause constipation. ❌ D) Incorrect – Stimulants do not increase saliva production.

Answer 75

**✅ Answer: B) Stimulants increase blood pressure and heart rate, so heart history should be taken.** Explanation: ❌ A) Incorrect – Stimulants do not cause sudden death unless there is a pre-existing heart condition. ❌ C) Incorrect – Not all heart murmurs are contraindications for stimulants. ❌ D) Incorrect – Stimulants do not permanently change heart structure. ================================== **ADHD Management** - Cardiovascular effects of stimulants 1. Does not increase risk of sudden death 2. Take history of syncope, palpitations, chest pain, family history of sudden death prior to 30 yoa 3. Stimulants not for those with serious heart problems or for those that would cause problems with an increase in BP or HR 4. Consult child’s cardiologist prior to medication administration - Family & Social Support 1. Education on ADHD symptoms; symptoms are part of a neurological disorder that cannot be controlled 2. Education on interventions: compliance with medications, positive behavioural reinforcement

Answer 76

✅ Answer: C) 12-18 months; Atypical communication and interaction appear between 12-18 months. Explanation: ❌ A) Incorrect – Autism is not usually detectable at birth. ❌ B) Incorrect – By 6 months, symptoms are usually not apparent. ❌ D) Incorrect – Most children are diagnosed around 3-4 years, but symptoms appear earlier.

Answer 77

**Answer: A) Yintang, PC 6, auricular Zero, Shen men A is correct because these points are known for their calming and relaxing effects, making them beneficial for ADHD/ASD.** B is incorrect because LI 4 and ST 36 are more commonly used for general vitality and digestion rather than relaxation. C is incorrect because SP 6 and LV 3 are more related to hormonal balance and liver qi stagnation, not specific to relaxation in ADHD/ASD. D is incorrect because HT 7 is calming but the other points are not primarily used for relaxation in ADHD/ASD. **Naturopathic Interventions** * ADHD/ASD - Relaxing acupuncture/acupressure 1. Yintang, PC 6, auricular Zero, Shen men - Botanical nervines/sedatives 1. Melissa officinalis, chamomile, passionflower, valerian, lavender 2. Irritability, aggression, sleep, anxiety - Nutraceuticals 1. Zinc: synergistic with stimulants 2. Multivitamin: poor appetite and low weight 3. Probiotics: help with constipation (diet modifications, water intake) 4. Omega 3 fatty acids: brain cell health 5. Magnesium: deficiencies, muscular tension

Answer 78

**Answer: A) Selective Serotonin Reuptake Inhibitors (SSRIs) because SSRIs are not first-line for mild depression; they are typically reserved for moderate-to-severe cases.** B is correct because CBT is a primary treatment for pediatric depression. C is correct because psychoeducation helps parents support children and recognize symptoms. D is correct because close monitoring is recommended in mild cases before initiating medication. ================================== **Depression Treatment** - Mild: close monitoring + psychoeducation with parents - Moderate-severe: treatment for depressive episode, help family respond to patient’s emotional needs, build supports in the school setting - CBT and interpersonal therapy, psycohotherapy - Toddlers/young children: parent-child relational therapies - Evidence: CBT and interpersonal therapy + Fluoxetine in the first 12 weeks (2 psychotherapy treatments and medication)

Answer 79

**Answer: B) Bupropion B is correct because bupropion lowers seizure threshold and is contraindicated in seizure disorders and bulimia nervosa, both of which increase the risk of seizures.** Explanation: A is incorrect because Fluoxetine is commonly used in depression. C is incorrect because Sertraline is safe in these populations. D is incorrect because Duloxetine is an SNRI, not primarily associated with seizure risk. ================================== **Medications for depression** - SNRIs: venlafaxine, duloxetine etc. 1. Contraindicated in HTN 2. Side effects: nausea, nervousness, sweating, skin issues, suicidal ideation - Bupropion: few anticholinergic and cardiotoxic effects 1. Interferes with sleep 2. Contraindicated with seizure disorder or bulimia nervosa 3. Side effects: psychomotor activation, headache, nausea, anorexia, weight loss, insomnia, seizures (does >450mg/d)

Answer 80

**Answer: A) Increased risk of suicide bcause all antidepressants carry a “black box warning” for increased risk of suicidal ideation in young patients.** Explanation: B is incorrect because weight gain is more common with mirtazapine but not all antidepressants. C is incorrect because hypertension is a concern with SNRIs but not with SSRIs in general. D is incorrect because antidepressants are not addictive, unlike benzodiazepines. ======================= **Depression medication most significant Suicide** - Most significant side effect associated with episodes - Higher risk for substance abuse and self injurious behaviours - Co-exists with ADHD, ODD, anxiety, eating disorders, substance abuse disorders, hypothyroidism - “Black box warning” on all antidepressants * Prognosis - Psychoeducation, psychotherapy, medication assessment, evaluation of school/home environments can lead to remission in 1-2 months, then continued for 6-12 months 1. Reassess every 6 months to help prevent relapses or treat acute episodes

Answer 81

**swer: C) Venlafaxine because Venlafaxine (SNRI) can increase blood pressure and is contraindicated in hypertension.** Explanation: A is incorrect because Sertraline does not raise blood pressure significantly. B is incorrect because Mirtazapine has sedative and weight-gaining effects, but no major hypertensive risk. D is incorrect because Fluoxetine does not significantly affect BP.

Answer 82

**Correct Answer: A) Mirtazapinevbecause Mirtazapine enhances central noradrenergic and serotonin activity.** Explanation: B is incorrect because Sertraline is an SSRI that primarily affects serotonin reuptake. C is incorrect because Bupropion primarily affects dopamine and norepinephrine, not serotonin. D is incorrect because Venlafaxine is an SNRI that inhibits serotonin and norepinephrine reuptake rather than enhancing their activity directly ================ **Depression Medications** - Mirtazapine: enhances central nonadrenergic and serotonin activity 1. Contraindicated with MAOIs 2. Side effects: liver failure, neutropenia, agranulocytosis, dry mouth, increase appetite, constipation, weight gain, increased sedation - Tricyclic Antidepressants (TCAs): imipramine, desipramine, clomipramine, nortriptyline, amitriptyline 1. High risk side effect profile-->not recommended for children and adolescents

Answer 83

**Correct Answer: D) GAD is most commonly diagnosed in infants and toddlers.** Explanation: A is correct because GAD often presents with physical symptoms such as headaches, abdominal pain, and palpitations. B is correct because it is important to investigate physical symptoms to avoid misdiagnosing them as anxiety. C is correct because drugs like caffeine, amphetamines, beta-adrenergic agonists, and thyroid hormones can induce anxiety symptoms. D is incorrect because GAD is more commonly diagnosed in school-age children and adolescents, not infants and toddlers. =============================== * Generalized Anxiety Disorder (GAD) - Anticipation of fear/anxiety that is excessive or persisting beyond the developmentally appropriate period 1. 10% of school age children have some sort of anxiety disorder - Fear/anxiety accompanies by behavioural disturbances or physical manifestations - Symptoms cause functional impairment or significant distress GAD * Diagnosis - Associated symptoms: headaches, abdominal pain, dependance on home/parents, avoidance of anxiety producing stimuli, decreased school performance, self doubt, irritability, frightening themes in play and fantasy, hyperactivity, sleep disturbances, decreased concentration, ritualistic behaviours, dizziness, palpitations, shortness of breath, flushing sweating, dry mouth, panic, nausea, vomiting 1. Very important to not misdiagnose a physical symptom as anxiety -> investigate the root cause of their physical symptoms 2. Drug induced: caffeine, marijuana, amphetamines, cocaine, alcohol, steroids, tacrolimus, B adrenergic agonists, dopamine agonists, angiotesin-converting enzyme inhibitors, thyroids medication, procaine derivatives 3. Illnesses: hyperthyroid, hypoglycemia, hypoxia, pheochromocytoma - Comorbidities: depression

Answer 84

Explanation: A is correct because the need for symmetry is a common obsession in OCD. B is incorrect because repetitive counting is a compulsion, not an obsession. C is incorrect because nail-biting is more commonly associated with general anxiety rather than OCD-specific obsessions. D is incorrect because difficulty focusing on schoolwork is a nonspecific symptom that can be associated with ADHD, anxiety, or depression rather than being a hallmark of OCD. ====================================**Obsessive Compulsive Disorder (OCD)** * Onset: childhood, if untreated can have a lifelong course - Males: earlier onset, <10 yrs - Leads to avoidance of situations which interferes with development * Recurrent obsessive thoughts, impulses or images that are experiences as intrusive at times * Repetitive compulsive behaviours or mental acts that are performed to prevent or reduce distress from obsessive thoughts * Obsessions and compulsions cause distress, time consuming (last >2 hours/day) and interfere with normal activities OCD * Examples of obsessions - Sexual, aggressive or religiously taboo images - Thoughts of contamination - Need for symmetry - Fears of harming others, oneself or loved ones - Obsessions bring about panic, depression, irritability and suicidality - Hard to see in children because of internal thoughts - Adolescence will try to hide their thoughts * Obsessions can change over time * Sudden onset of symptoms: screen child for group A strep infections (PANDAS-pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) Obsessive Compulsive Disorder (OCD) * Onset: childhood, if untreated can have a lifelong course - Males: earlier onset, <10 yrs - Leads to avoidance of situations which interferes with development * Recurrent obsessive thoughts, impulses or images that are experiences as intrusive at times * Repetitive compulsive behaviours or mental acts that are performed to prevent or reduce distress from obsessive thoughts * Obsessions and compulsions cause distress, time consuming (last >2 hours/day) and interfere with normal activities OCD * Examples of obsessions - Sexual, aggressive or religiously taboo images - Thoughts of contamination - Need for symmetry - Fears of harming others, oneself or loved ones - Obsessions bring about panic, depression, irritability and suicidality - Hard to see in children because of internal thoughts - Adolescence will try to hide their thoughts * Obsessions can change over time * Sudden onset of symptoms: screen child for group A strep infections (PANDAS-pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)

Answer 85

**Correct Answer: B) Cognitive Behavioral Therapy (CBT) because CBT is the gold standard treatment for OCD, helping patients manage obsessions and compulsions effectively.** Explanation: A is incorrect because psychoeducation is helpful but insufficient as a standalone treatment. C is incorrect because benzodiazepines are not first-line treatments for OCD and pose a risk of dependency. D is incorrect because antihistamines are sometimes used for anxiety but are not a primary treatment for OCD. ================= **OCD Treatment** - Psychoeducation: puts symptoms in perspective and outline treatment progression - Combination of CBT and medication (severe cases) 1. SSRIs: diminish symptoms, sometimes with higher doses 2. Fluoxetine, fluvoxamine, sertraline for pediatric OCD 3. Tricyclic antidepressants clomipramine for adults 4. Severe cases: gamma knife brain surgery 5. Neurofeedback, transcranial magnetic stimulation: not FDA approved * Comorbidities - Anxiety, ADHD, depression and tics - Differential diagnosis: eating disorders, psychotic disorders, obsessive compulsive personality disorder

Answer 86

**Answer: ✅ A) Many physical symptoms overlap with medical conditions → Correct. GAD presents with symptoms like palpitations, dizziness, and nausea, which can also be seen in conditions like hyperthyroidism, cardiac arrhythmias, or hypoglycemia.** ❌ B) It only presents with psychological symptoms, not physical ones → Incorrect. GAD presents with both psychological (worry, fear) and physical symptoms (headaches, stomachaches, etc.). ❌ C) Anxiety is always easy to distinguish from medical conditions → Incorrect. A careful differential diagnosis is needed to rule out organic causes before concluding that symptoms are due to anxiety. ❌ D) GAD does not cause functional impairment → Incorrect. GAD can significantly impact daily life, including school/work performance, relationships, and overall well-being.

Answer 87

Answer: ✅ B) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) → Correct. TF-CBT is the most evidence-based therapy for PTSD in children and adolescents, helping them process trauma in a structured manner. ❌ A) Exposure therapy → Incorrect. While exposure techniques are used within TF-CBT, general exposure therapy alone may not be as effective for PTSD. ❌ C) Psychoanalysis → Incorrect. There is limited evidence for psychoanalysis in treating PTSD, especially in children. ❌ D) Benzodiazepines → Incorrect. Benzodiazepines are not first-line treatment for PTSD in children due to risks of dependence and limited efficacy. =========================== **PTSD Treatment** - Trauma focused CBT (TF-CBT): most evidence for children and adolescence - Establish daily routines - In severe cases: pharmacology to treat the associated symptoms: antiadrenergic agents, mood stabilizers, 2nd generation antipsychoticsall for treating secondary effects since there is no medication that is FDA approved for treating PTSD specifically in children 1. Children who lived in abusive environments for years and/or who experienced multiple traumas

Answer 88

**Answer: ✅ B) Pediatric OCD can be associated with streptococcal infections (PANDAS) → Correct. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is a subset of OCD that can occur after group A streptococcal infections.** ❌ A) Children with OCD always recognize their compulsions as irrational → Incorrect. Young children may not have full insight into the irrational nature of their compulsions. ❌ C) Obsessions do not change over time → Incorrect. Obsessions can evolve with age and environmental influences. ❌ D) OCD cannot be diagnosed if symptoms last less than 6 months → Incorrect. OCD is diagnosed if symptoms persist for more than 2 hours a day and interfere with daily life, not based on a 6-month duration. ================================== **Obsessive Compulsive Disorder Onset:** childhood, if untreated can have a lifelong course - Males: earlier onset, <10 yrs - Leads to avoidance of situations which interferes with development * Recurrent obsessive thoughts, impulses or images that are experiences as intrusive at times * Repetitive compulsive behaviours or mental acts that are performed to prevent or reduce distress from obsessive thoughts * Obsessions and compulsions cause distress, time consuming (last >2 hours/day) and interfere with normal activities **OCD Examples of obsessions** - Sexual, aggressive or religiously taboo images - Thoughts of contamination - Need for symmetry - Fears of harming others, oneself or loved ones - Obsessions bring about panic, depression, irritability and suicidality - Hard to see in children because of internal thoughts - Adolescence will try to hide their thoughts * Obsessions can change over time * Sudden onset of symptoms: screen child for group A strep infections (PANDAS-pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)

Answer 89

Answer: ✅ C) Hypothyroidism → Correct. Hypothyroidism can cause weight changes but is not a risk factor for eating disorders. Instead, it should be ruled out in patients presenting with significant weight fluctuations. ❌ A) Gymnastics and ballet → Incorrect. Sports that emphasize body weight and shape, like gymnastics and ballet, are associated with higher rates of eating disorders. ❌ B) Genetic predisposition → Incorrect. Family history plays a significant role, with studies showing higher incidence in first-degree relatives. ❌ D) Media influence → Incorrect. Unrealistic portrayals of beauty in media contribute to body dissatisfaction and disordered eating behaviors.

Answer 90

**Answer: ✅ C) Hypothyroidism → Correct. Hypothyroidism can cause weight changes but is not a risk factor for eating disorders. Instead, it should be ruled out in patients presenting with significant weight fluctuations.** ❌ A) Gymnastics and ballet → Incorrect. Sports that emphasize body weight and shape, like gymnastics and ballet, are associated with higher rates of eating disorders. ❌ B) Genetic predisposition → Incorrect. Family history plays a significant role, with studies showing higher incidence in first-degree relatives. ❌ D) Media influence → Incorrect. Unrealistic portrayals of beauty in media contribute to body dissatisfaction and disordered eating behaviors. ============================= Etiology of Eating Disorders - Evidence for genetic component 1. 7% incidence for anorexia in first degree relative 2. Monozygotic twins: 55% concordance rate - Altered serotonergic and dopaminergic function and alterations in neuropeptides and gut peptides 1. Blunted serotonin responses to eating and satiety - Leptin physiology is damaged in anorexia patient - Enmeshment of mother/daughter: no identity - Fear or dislike of body changes in puberty - Transgender youth use food to restriction to control pubertal development - Media: unrealistic constructs of beauty and healthy bodies - Incidence: 1-2% of teenagers develop anorexia and 2-4% develop bulimia, 10% of those patients are male Eating Disorders * Predisposing factors - Gymnastic - figure skating - Ballet - activities that emphasize thin bodies

Answer 91

**Answer: ✅ C) Metabolic alkalosis → Correct. Repeated vomiting leads to loss of stomach acid (HCl), resulting in metabolic alkalosis and hypokalemia.** ❌ A) Hyperkalemia → Incorrect. Bulimia causes hypokalemia due to excessive vomiting and loss of potassium. ❌ B) Metabolic acidosis → Incorrect. Metabolic acidosis occurs with laxative abuse, not vomiting. ❌ D) Hypernatremia → Incorrect. While dehydration may cause hypernatremia in some cases, electrolyte disturbances in bulimia are more commonly characterized by hypokalemia, hypochloremia, and metabolic alkalosis. ================================= **Bulimia Nervosa** * Recurrent episodes of binge eating with - Eating an amount of food that is larger than what most people would eat - Sense of lack of control during the episode * Recurrent inappropriate compensatory behaviour to prevent weight gain: self induced vomiting, laxative misuse, diuretics, overexercising due to extreme guilt * Symptoms occur once a week for 3 months **Bulimia Nervosa Diagnosis** - Difficult unless adolescent is forthcoming: usually normal or slightly overweight - Assess eating patterns, binge eating, loss of control over food, use of laxatives, self induced vomiting - Involuntary vomiting or food coming up is reported - Sialadenitis: parotid gland enlargement and pain - PE: dehydration signs, orthostatic hypotension, tooth enamel loss/dental. Caries, abdominal tenderness * Labs - Electrolytes disturbances - Vomiting: metabolic alkalosis, hypokalemia, hypochloremia - Laxatives: metabolic acidosis, hypokalemia, hypochloremia - Diuretics: hypokalemia, hyponatremia, hypocalcemia, metabolic alkalosis

Answer 92

**Correct Answer: C) Elevated mood and increased energy– PTSD is characterized by negative mood changes, such as fear, irritability, and emotional detachment, not elevated mood or increased energy.** ❌ A) Hypervigilance – PTSD often includes arousal symptoms like being on edge, difficulty sleeping, and being easily startled. ❌ B) Avoidance of trauma-related stimuli – Individuals with PTSD frequently avoid anything that reminds them of the traumatic event. ❌ D) Flashbacks – PTSD is associated with re-experiencing the trauma through nightmares, intrusive thoughts, and flashbacks. ================================= **PTSD characteristics** * Arousal and reactivity such as hypervigilance, difficulty concentrating, sleep disturbance * Avoidance of reminders of the trauma * Negative changes in thought and mood * Flashbacks to a traumatic event such as nightmares, intrusive thoughts or repetitive play * Follows traumatic events: violence, physical or sexual abuse, natural disasters, car accidents, dog bites, unsuspected personal tragedies

Answer 93

**Correct Answer: A) Purging occurs, but there is no binge eating ✅ but there is no binge eating – Purging Disorder is characterized by recurrent purging (vomiting, laxatives, diuretics) without episodes of binge eating.** ❌ B) Purging occurs at least twice a week for 3 months – This was an old DSM-IV criterion for Bulimia Nervosa, but frequency is not a distinguishing factor in Purging Disorder. ❌ C) Purging is followed by excessive exercise – Excessive exercise can be present in various eating disorders but is not a defining feature of Purging Disorder. ❌ D) Purging is only seen in Anorexia Nervosa – Purging is present in multiple disorders, including Bulimia Nervosa and Purging Disorder. ================================== **Other Specified Feeding or Eating Disorders** * Feeding or eating behaviours that cause clinically significant distress and impairment but do not meet criteria for other eating disorders mentioned - Atypical Anorexia: only difference is weight is within or above normal range - Limited duration Bulimia: occurs for less than 3 months - Purging Disorder: recurrent purging but no binge eating - Night Eating Syndrome: excessive eating after waking up in the middle of the night or after the evening meal

Answer 94

**Correct Answer: B) Food restriction leading to weight loss or nutritional deficiency ✅ – ARFID is characterized by avoidance of food due to sensory sensitivities, fear of choking, or lack of interest, leading to weight loss or deficiencies. ❌ A) Intense fear of weight gain – ARFID is not associated with body image concerns, unlike Anorexia or Bulimia. ❌ C) Frequent binge eating episodes – Binge eating is not part of ARFID. ❌ D) Preoccupation with body image – Unlike Anorexia and Bulimia, ARFID is not driven by body dissatisfaction. ================================ **Avoidant/Restrictive Food Intake Disorder** * Avoiding food because of sensory characteristics, concern for averse consequences of eating, failing to meet nutrition requirements, plus one or more of - Weight loss - Nutritional deficiency - Dependance on enteral feeding or oral nutritional supplementation - Interference with psychosocial functioning * Not associated with lack of available food or culturally sanctioned practices * No disturbance in body weight or shape * Not attributed to medical conditions, mental disorder

Answer 95

**Correct Answer: ✅ B) OCD – The child’s repetitive thoughts (obsessions) about time and compulsive behavior (adjusting the clock) strongly suggest OCD.** ❌ A) GAD – While GAD involves excessive worrying, it is usually broader and not tied to specific, compulsive rituals. ❌ C) ADHD – ADHD is marked by inattention and hyperactivity, not obsessive rituals. ❌ D) ASD – While ASD involves restricted interests, OCD’s key feature is distress when routines are disrupted, which fits this case better.

Answer 96

**Correct Answer: ✅ B) Anorexia Nervosa – Social withdrawal, meal avoidance, and baggy clothing (to hide weight loss) strongly suggest Anorexia.** ❌ A) MDD – While depression can cause withdrawal, it does not typically include meal avoidance or preoccupation with weight. ❌ C) Social Anxiety Disorder – Social anxiety is fear-based but does not typically lead to food restriction. ❌ D) ARFID – ARFID lacks body image concerns, while Anorexia does.

Answer 97

Correct Answer: B) Major Depressive Disorder ✅ B) MDD – Persistent low mood, social withdrawal, and weight loss due to loss of appetite are hallmark signs of depression. ❌ A) GAD – GAD involves chronic worry, not necessarily weight loss. ❌ C) Anorexia Nervosa – There is no mention of body image concerns, which are central to Anorexia. ❌ D) Social Anxiety Disorder – While social withdrawal is seen in SAD, the low mood and appetite loss make depression more likely.

Answer 98

**Correct Answer: ✅ A) Barrett esophagitis – Chronic acid reflux from purging can cause esophagitis, which may lead to Barrett esophagus, a precancerous condition.** ❌ B) Osteoporosis – More commonly associated with Anorexia Nervosa due to prolonged malnutrition and low estrogen levels, not a direct short-term complication of Bulimia. ❌ C) Hypoglycemia – Bulimia Nervosa does not primarily cause hypoglycemia; it is more common in Anorexia or insulin-related conditions. ❌ D) Type 2 diabetes – While eating disorders can impact metabolism, Type 2 diabetes is more often linked to prolonged obesity, not Bulimia.

Answer 99

**✅ C) Hypokalemia – Severe electrolyte imbalances, particularly hypokalemia (low potassium), can lead to life-threatening cardiac complications, necessitating inpatient hospitalization.** ❌ A) Presence of depressive symptoms – While depression is common in Bulimia Nervosa, it does not automatically require inpatient care unless there is a risk of self-harm. ❌ B) Failure to gain weight – More characteristic of Anorexia Nervosa, where weight restoration is a priority. Bulimia patients often have normal weight or mild fluctuations. ❌ D) Mild electrolyte imbalances – Mild imbalances can often be managed in outpatient care with dietary and medical interventions.

Answer 100

**Correct Answer: ✅ B) Fluoxetine (Prozac) – Fluoxetine, at a dose of 60 mg/day, is the only FDA-approved SSRI for reducing the binge-purge cycle in adolescents with Bulimia.** ❌ A) Sertraline (Zoloft) – Although an SSRI, it is not specifically FDA-approved for Bulimia. ❌ C) Bupropion (Wellbutrin) – Contraindicated in Bulimia Nervosa due to increased risk of seizures. ❌ D) Venlafaxine (Effexor) – A serotonin-norepinephrine reuptake inhibitor (SNRI) used for depression and anxiety but not first-line for Bulimia Nervosa. ================================== **Bulimia Nervosa** * Short term complications - Esophageal rupture, acute/chronic esophagitis, Barrett esophagitis - Chronic dehydration with laxative use 1. Congestive heart failure * Treatment - Inpatient hospitalization when hypokalemia is present, supplemental potassium - Outpatient management: CBT, nutrition therapy, medical monitoring - SSRIs helps to stop the binge-purge cycle in adolescents 1. Fluoxetine, 60mg/d