A 2-year-old child is brought to the clinic because the parents noticed a white reflection in the pupil of the eye in photographs and occasional eye crossing. Which of the following is the most likely diagnosis?
Cataract
Retinoblastoma
Strabismus
Glaucoma
The Correct Answer is B
A. Cataract is incorrect because although cataracts can cause a cloudy or white appearance of the lens, they are less commonly associated with leukocoria (white pupillary reflex) seen in photographs and are not typically linked with intermittent eye crossing in toddlers.
B. Retinoblastoma is correct because leukocoria (white reflection in the pupil) is the classic and most common presenting sign of this malignant eye tumor in young children. Strabismus or eye crossing often occurs because the tumor interferes with normal vision. Retinoblastoma is a medical emergency, and early detection is critical to preserve vision and life.
C. Strabismus is incorrect because while it involves misalignment of the eyes, it does not cause a white pupillary reflex. Strabismus may be a symptom of an underlying condition, such as retinoblastoma, but it is not the primary diagnosis given these findings.
D. Glaucoma is incorrect because pediatric glaucoma typically presents with tearing, photophobia, corneal cloudiness, and enlarged eyes, not leukocoria. Eye crossing is also not a primary feature of glaucoma.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Elevated serum carbon dioxide is incorrect because in diabetic ketoacidosis (DKA), serum bicarbonate (CO2 content) is usually decreased, reflecting metabolic acidosis rather than an elevation.
B. No urinary ketones is incorrect because the presence, not absence, of ketones is characteristic of DKA. Children in DKA typically have ketonuria and ketonemia, which contribute to acidosis.
C. Elevated serum phosphorus is incorrect because phosphorus levels in DKA are often normal or low due to urinary losses and shifts associated with acidosis and insulin therapy. It is not a diagnostic marker for DKA.
D. Low arterial pH is correct because DKA is characterized by metabolic acidosis, reflected by a low arterial pH (<7.35). The accumulation of ketone bodies (acetoacetate and beta-hydroxybutyrate) lowers blood pH, confirming the presence of DKA.
Correct Answer is ["A","B","D"]
Explanation
A. Fruity (ketone) breath odor is correct because diabetic ketoacidosis (DKA) causes the production of ketone bodies, including acetone, which gives the breath a sweet, fruity odor. This is a classic and easily recognizable sign of DKA.
B. Dehydration is correct because hyperglycemia leads to osmotic diuresis, causing excessive urination and fluid loss. Children with DKA often present with dry mucous membranes, poor skin turgor, tachycardia, and decreased urine output, all indicating dehydration.
C. Hypotension without dehydration is incorrect because hypotension in DKA is typically secondary to dehydration and volume depletion. Hypotension in the absence of dehydration is not characteristic of DKA.
D. Kussmaul respirations (deep, rapid breathing) are correct because metabolic acidosis in DKA stimulates the respiratory center to blow off excess carbon dioxide. These deep, labored respirations are a compensatory mechanism and are a hallmark sign of severe DKA.
E. Weight gain is incorrect because children with DKA usually experience weight loss, not gain, due to fat and muscle breakdown, dehydration, and insulin deficiency.
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