Edited Text
What is the most concerning statement by a child with a newly placed long leg cast after repair of the tibia?

Choice A reason:

Compartment syndrome is a condition where increased pressure within a muscle compartment leads to decreased blood flow, which can cause muscle and nerve damage. It is typically associated with severe trauma, fractures, or crush injuries. The symptoms include severe pain, swelling, and decreased sensation or movement in the affected limb. In this case, the child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are more indicative of an infection rather than compartment syndrome.

Choice B Reason:

Osteomyelitis is an infection of the bone, which can occur following an injury or infection elsewhere in the body. The symptoms include redness, swelling, tenderness, and pain in the affected area, along with fever and elevated WBC. Given the child’s history of a spider bite and the presence of redness, swelling, tenderness, and elevated WBC, osteomyelitis is the most likely diagnosis. The unremarkable X-ray does not rule out osteomyelitis, as early stages of the infection may not show changes on X-ray.

Choice C Reason:

Osteogenesis imperfecta, also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. It is not associated with infections or elevated WBC. The symptoms of osteogenesis imperfecta include frequent fractures, blue sclerae, and hearing loss. The child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are not consistent with osteogenesis imperfecta.

Choice D Reason:

Juvenile idiopathic arthritis (JIA) is a type of arthritis that occurs in children. It is characterized by persistent joint inflammation, pain, and swelling. While JIA can cause joint tenderness and swelling, it is not typically associated with a recent injury or infection, such as a spider bite. Additionally, JIA does not usually cause elevated WBC. The child’s symptoms are more indicative of an infection, making osteomyelitis the more likely diagnosis.

Choice A reason:

Jaundice can be an assessment finding in infants with a urinary tract infection (UTI). UTIs can cause systemic symptoms in infants, including jaundice, especially in newborns. This is due to the immature liver function and the body’s response to infection1. Jaundice in the context of a UTI requires prompt medical evaluation and treatment to prevent complications.

Choice B reason:

Failure to gain weight is another possible assessment finding in infants with a UTI. Infants with UTIs may experience poor feeding, irritability, and lethargy, which can contribute to inadequate weight gain2. Monitoring an infant’s growth and development is crucial, and any signs of failure to thrive should prompt further investigation for underlying conditions such as UTIs.

Choice C reason:

Swelling of the face is not typically associated with UTIs in infants. While facial swelling can be a sign of other medical conditions, it is not a common symptom of UTIs. UTIs primarily affect the urinary system and may cause symptoms such as fever, irritability, and poor feeding.

Choice D reason:

Persistent diaper rash can be an assessment finding in infants with a UTI. The presence of a UTI can lead to increased urine output and changes in urine composition, which can irritate the skin and contribute to diaper rash. Persistent or recurrent diaper rash in conjunction with other symptoms may warrant further evaluation for a UTI.

Choice E reason:

Vomiting is a common symptom in infants with UTIs. The infection can cause gastrointestinal symptoms such as vomiting, diarrhea, and poor feeding. These symptoms, along with fever and irritability, are often seen in infants with UTIs and should prompt medical evaluation.