Which of the following would be the most appropriate play activity for a 3-year-old in a spica cast, considering both safety and development?

The correct answer is c. “My toes feel like they are sleeping and won’t wiggle when I tell them to.”

Choice A reason:

“Watch how well I blow these bubbles” is not a concerning statement. It indicates that the child is engaging in normal activities and is not experiencing any distress related to the cast or the injury.

Choice B Reason:

“My skin is so itchy under there” is a common complaint among children with casts. Itchiness can be managed with appropriate care, such as using a hair dryer on a cool setting to blow air under the cast. However, it is not an immediate cause for concern.

Choice C Reason:

“My toes feel like they are sleeping and won’t wiggle when I tell them to” is a concerning statement. This could indicate nerve compression or impaired circulation, which are serious complications that require immediate medical attention. Prompt evaluation is necessary to prevent permanent damage.

Choice D Reason:

“I was able to ride on the scooter with the PT person’s help” is not a concerning statement. It suggests that the child is participating in physical therapy and is able to move with assistance, which is a positive sign of recovery.

The correct answer is a) Androgens.

Choice A reason:

Congenital adrenal hyperplasia (CAH) is a group of genetic disorders affecting the adrenal glands, which are responsible for producing vital hormones such as cortisol, aldosterone, and androgens. In CAH, there is a deficiency of the enzyme 21-hydroxylase, which is crucial for the synthesis of cortisol and aldosterone. As a result, the adrenal glands overproduce androgens, leading to symptoms such as ambiguous genitalia in newborns, early puberty, and rapid growth. Androgens are male sex hormones, including testosterone, which play a significant role in the development of male characteristics.

Choice B reason:

Vitamin K is a fat-soluble vitamin essential for blood clotting and bone health. It is not related to the overproduction of hormones in congenital adrenal hyperplasia. Vitamin K deficiency can lead to bleeding disorders, but it does not cause the symptoms associated with CAH, such as ambiguous genitalia or early puberty. Therefore, this choice is incorrect.

Choice C reason:

Gonadotropins are hormones produced by the pituitary gland that stimulate the gonads (ovaries and testes) to produce sex hormones and gametes (eggs and sperm). While gonadotropins play a role in sexual development and reproduction, they are not overproduced in congenital adrenal hyperplasia. The primary issue in CAH is the overproduction of androgens due to enzyme deficiencies in the adrenal glands. Therefore, this choice is incorrect.

Choice D reason:

Vitamin D is a fat-soluble vitamin essential for calcium absorption and bone health. It is not related to the overproduction of hormones in congenital adrenal hyperplasia. Vitamin D deficiency can lead to bone disorders such as rickets in children and osteomalacia in adults, but it does not cause the symptoms associated with CAH. Therefore, this choice is incorrect.