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Q1A 6-month-old male infant presents for a well-child check. Examination reveals a palpable right testis in the inguinal canal that cannot be manipulated into the scrotum. The left testis is normal. What is the most appropriate next step in management?
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✓ Correct answer: Refer to pediatric urology
The correct answer is to refer to pediatric urology. Spontaneous descent of undescended testes is rare after 6 months of age. Guidelines recommend referral at this age to facilitate timely surgical correction (orchiopexy), typically performed between 6 and 18 months to preserve fertility and monitor for malignancy risk. Distractor 1 is incorrect because waiting until 1 year delays necessary planning for surgery. Distractor 2 is incorrect because hormonal therapy is not a standard first-line treatment for anatomical cryptorchidism. Distractor 3 is wrong because imaging is generally not indicated for palpable testes before referral.
Q2A 3-year-old child presents with a firm, non-tender abdominal mass discovered by a parent during bathing. The child is hypertensive but otherwise asymptomatic. Which initial diagnostic step is prioritized to maximize patient safety?
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✓ Correct answer: Abdominal ultrasound
The correct answer is abdominal ultrasound. This presentation is highly suspicious for Wilms tumor (nephroblastoma). Ultrasound is the safest first-line imaging modality to confirm the mass without radiation or invasion. Distractor 1 is incorrect because vigorous palpation can rupture the tumor and upstage the disease. Distractor 2 is incorrect because biopsy is generally contraindicated due to spill risk before surgical excision. Distractor 3 is inappropriate as it delays diagnosis of a potential malignancy. Distractor 4 is insufficient given the palpable mass and hypertension.
Q3A stable newborn male has a prenatal history of unilateral hydronephrosis. To ensure accurate assessment and minimize false negatives due to transient physiological oliguria, when should the postnatal renal ultrasound be obtained?
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✓ Correct answer: After 48 hours of life
The correct answer is after 48 hours of life (often 48-72 hours or later). Newborns experience physiological dehydration and transient oliguria in the first 2 days, which can underestimate the degree of hydronephrosis. Imaging too early may yield a false-negative result. Distractor 1 is incorrect because immediate imaging is prone to this dehydration artifact. Distractor 2 is incorrect as waiting 4 weeks is too long for an initial postnatal evaluation of significant antenatal findings. Distractor 3 and 4 are incorrect because the timing is dictated by physiology, not discharge convenience or symptoms.
Q4During the newborn exam of a male infant, the nurse notes the urethral meatus is located on the ventral aspect of the penis and the prepuce is incompletely fused ventrally. Parents request circumcision before discharge. What is the appropriate response?
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✓ Correct answer: Defer circumcision
The correct answer is to defer circumcision. The findings describe hypospadias. The foreskin (prepuce) is often essential for future surgical reconstruction of the urethra and should not be removed. Distractor 1 is incorrect because proceeding would remove tissue critical for repair. Distractor 2 refers to a specific device but is still contraindicated. Distractor 3 is irrelevant to the structural anomaly. Distractor 4 is incorrect because imaging is not the immediate priority; stopping the circumcision is.
Q5A 9-month-old febrile female infant requires a urine culture to rule out pyelonephritis. Which method of specimen collection provides the most reliable result for culture in this non-toilet-trained patient?
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✓ Correct answer: Catheterized specimen
The correct answer is a catheterized specimen. For non-toilet-trained children, catheterization (or suprapubic aspiration) is required to avoid contamination from skin flora. Bag specimens have a high false-positive rate and are unacceptable for culture diagnosis of UTI. Distractor 1 is incorrect due to high contamination rates. Distractor 2 is not feasible for an infant who cannot void on command. Distractor 3 and 4 describe unreliable methods that mix urine with skin or fiber contaminants.
Q6An infant with a history of ureteropelvic junction (UPJ) obstruction has serial ultrasounds showing an increase in anteroposterior (AP) renal pelvic diameter from 12 mm to 25 mm over 3 months. Which study is indicated to assess functional drainage?
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✓ Correct answer: Diuretic renogram
The correct answer is a diuretic renogram (e.g., MAG-3 scan). Worsening hydronephrosis (increasing AP diameter) requires functional assessment to determine if obstruction is significant enough to damage renal function. The renogram measures split function and drainage time. Distractor 1 is a reflux study, not primarily for obstruction. Distractor 2 exposes the child to high radiation and is not first-line for functional assessment. Distractor 3 is incorrect as the worsening trend mandates evaluation, not just observation. Distractor 4 is invasive and premature.
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