A 3-Day-Old Boy Is Seen in the Nursery Due to Vomiting

question 480

Multiple Choice

A 3-day-old boy is seen in the nursery due to vomiting.  He has had 2 episodes of nonprojectile vomiting of green fluid and has developed abdominal distension over the last hour.  The patient is breastfed and initially nursed every 2 hours but is now nursing less frequently.  The infant passed a small amount of meconium immediately after delivery but has passed no other stool.  He is voiding adequately.  The patient was delivered vaginally at 38 weeks gestation without complications.  Apgars were 8 and 9 at 1 and 5 minutes, respectively.  Temperature is 36.7 C (98 F) .  On examination, the infant is asleep but easily roused.  The anterior fontanelle is open and flat, and the mucous membranes are moist.  Cardiac examination is normal.  The lungs are clear to auscultation bilaterally.  The abdomen is distended with hypoactive bowel sounds.  The liver and spleen are not palpable.  Abdominal x-ray findings include dilated, gas-filled loops of small bowel; absent air-fluid levels; and a "ground-glass" mass in the right side of the abdomen.  Further history-taking should focus on which of the following factors?

• A)Family history of congenital cataracts
• B)Family history of recurrent sinus infections
• C)In utero opioid exposure
• D)Maternal age ≥35
• E)Maternal macrolide use during pregnancy

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Definitions:

Hearing

The ability to perceive sound by detecting vibrations through an organ such as the ear.

Synesthesia

A condition in which one sense is simultaneously perceived as if by one or more additional senses, such as seeing colors when hearing music.

Different Smells

The perception of various odors, which are interpreted by the brain through the olfactory system.

Colors

The perception of different wavelengths of light by the visual system, leading to the ability to distinguish objects based on the wavelengths they reflect, emit, or transmit.