Extrusion of some or all of the rectal mucosa through the external anal sphincter in children is most commonly associated with:
Correct Answer C:
Rectal prolapse seldom occurs in children who do not have an underlying predisposing condition and usually occurs between infancy and four years of age, with the highest incidence in the first year of life. The finding of rectal prolapse should be considered as a symptom of an underlying condition that predisposes to rectal prolapse [1-4,14-16]. These conditions include:
Rectal prolapse occurs in 20% of patients with cystic fibrosis who are aged 6 months to 3 years. The appropriate intervention when encountering a child with rectal prolapse is to order a sweat chloride test to see if the child has cystic fibrosis.
A 4-year-old boy develops a headache, cough, myalgia and a fever. He has been a healthy child with all immunizations up to date. He is given a decongestant and an aspirin for his symptoms with some relief. However, 3 days later, he is brought back by his parents because of persistent vomiting and irritability. On physical examination, he is found to be semicomatose, becoming combative on stimulation.
Which of the following levels should be measured to aid in the diagnosis of this patient?
Correct Answer A: The child is presenting with symptoms of Reye syndrome, which is an acute encephalopathy associated with high ammonia levels. It most commonly occurs in young children after a viral illness. Administration of aspirin increases the risk of developing this disorder. The vomiting is characteristic.
A fourteen-year-old boy is seen because he is constantly blinking. You note that he frequently clears his throat, yet he denies sore throat or other upper respiratory tract symptoms. He blinks frequently, yet is able to hold his eyes open during examination with an ophthalmoscope. His fundi, visual acuity, extraocular movements, visual fields, eyelids and eyelashes are normal. He also exhibits intermittent facial grimacing without apparent pain.
This boy’s eye movements are most consistent with which of the following?
Correct Answer B: Tourette's syndrome often begins with simple muscle tics, such as grimacing, head jerking, and blinking. Simple tics may be only a nervous habit and may disappear with time. Such tics do not necessarily lead to Tourette's syndrome, which involves more than a simple tic. For example, people with Tourette's syndrome may repeatedly move their head from side to side, blink their eyes, open their mouth, and stretch their neck.
The disorder may progress to bursts of complex tics, including vocal tics, hitting, kicking, and sudden, irregular, jerky breathing. Vocal tics may start as grunting, snorting, humming, or barking noises and progress to compulsive, involuntary bouts of cursing. For no apparent reason and often in the midst of conversation, some people with Tourette's syndrome may call out obscenities or words related to feces (called coprolalia).
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