Which finding in a newborn is suggestive of tracheoesophageal fistula?
Choking on the first feeding
Palpable mass in the sternal area
Visible peristalsis across abdomen
Failure to pass meconium in 24 hours
The Correct Answer is A
Choice A reason: Tracheoesophageal fistula (TEF) involves an abnormal tracheoesophageal connection, causing aspiration during feeding. In newborns, choking on the first feeding occurs as milk enters the airway via the fistula, leading to respiratory distress. This is a hallmark sign, requiring urgent evaluation to confirm TEF and prevent complications like pneumonia.
Choice B reason: A palpable mass in the sternal area may indicate a congenital anomaly like a sternal cleft or tumor, but it is not associated with tracheoesophageal fistula. TEF affects airway and esophageal function, causing choking during feeding, not palpable masses, making this finding irrelevant to the condition’s pathophysiology.
Choice C reason: Visible peristalsis across the abdomen suggests gastrointestinal motility issues, like hypertrophic pyloric stenosis, but is not specific to tracheoesophageal fistula. TEF causes respiratory symptoms like choking due to airway aspiration, not abdominal motility changes, making this finding incorrect for diagnosing this congenital airway-esophageal defect.
Choice D reason: Failure to pass meconium in 24 hours suggests Hirschsprung’s disease or intestinal atresia, affecting bowel motility. Tracheoesophageal fistula primarily impacts feeding and respiration due to airway-esophageal connection, not meconium passage, making this finding unrelated to the condition’s presentation in a newborn during feeding.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: A respiratory rate of 24/min is normal for a 3-year-old but does not specifically indicate rehydration success. Dehydration may cause tachypnea due to acidosis, but a normal rate is non-specific. Urine specific gravity better reflects fluid status, as it directly measures renal response to rehydration in diarrhea.
Choice B reason: Urine specific gravity of 1.015 indicates normal hydration, as kidneys produce appropriately concentrated urine after rehydration therapy corrects fluid loss in diarrhea. Values above 1.020 suggest persistent dehydration. This finding confirms effective restoration of fluid balance, making it the best indicator of successful oral rehydration in this child.
Choice C reason: Capillary refill greater than 3 seconds indicates poor perfusion, suggesting ongoing dehydration despite therapy. Effective rehydration restores perfusion, reducing refill time to less than 2 seconds. This finding suggests therapy failure, making it an incorrect indicator of successful oral rehydration in a child with diarrhea.
Choice D reason: A heart rate of 130/min suggests tachycardia, indicating persistent dehydration or stress in a 3-year-old, where normal rates are 80-120/min. Effective rehydration lowers heart rate by restoring volume. Urine specific gravity better confirms hydration status, making tachycardia an incorrect indicator of therapy success.
Correct Answer is A
Explanation
Choice A reason: Intussusception causes bowel obstruction, leading to mucus in stools, often mixed with blood (“currant jelly” stools) due to mucosal irritation and ischemia. This results from the telescoping of intestinal segments, impairing blood flow and causing tissue damage, making mucus a hallmark sign expected in a toddler with this condition.
Choice B reason: Increased appetite is unlikely in intussusception, as bowel obstruction causes pain, vomiting, and reduced intestinal function, leading to anorexia. The toddler’s discomfort and nausea from ischemia and obstruction suppress appetite, making this an incorrect manifestation compared to mucus, which directly reflects the intestinal pathology.
Choice C reason: Jaundice results from bilirubin accumulation, typically in liver or biliary disorders, not intussusception. This condition affects the intestines, causing obstruction and mucosal bleeding, not hepatic dysfunction. Mucus in stools is a direct consequence of intussusception, making jaundice an unrelated and incorrect expected finding.
Choice D reason: Drooling is associated with upper airway or esophageal issues, like tracheoesophageal fistula, not intussusception. This intestinal condition causes abdominal symptoms like mucus in stools, not salivary pooling. Drooling is irrelevant to the pathophysiology of bowel obstruction, making it an incorrect manifestation for this toddler.
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