AIIMS Nagpur NO- 2020
Child Health Nursing (Pediatrics)
Easy
Additional defects associated with exstrophy of bladder is:
Appeared in: AIIMS Nagpur NO- 2020
Explanation
- Bladder exstrophy is a congenital anomaly where the bladder protrudes through a defect in the lower abdominal wall.
- A defining characteristic of bladder exstrophy is a malformation of the pelvic bones.
- Specifically, the pubic bones are widely separated (a condition called pubic diastasis), which is a direct consequence of the developmental failure.
- This bony defect is clearly visible in the provided diagram and is a consistent finding in this condition.
Why Other Options Were Wrong
- Option A: Congenital heart disease is not considered a primary or hallmark associated defect of classic bladder exstrophy.
- Option C: In classic bladder exstrophy, the upper urinary tracts, including the kidneys, are usually normal at birth. Unilateral renal agenesis is not a typical associated finding.
- Option D: Imperforate anus is a key feature of a different, more severe condition known as cloacal exstrophy (or OEIS complex), not classic bladder exstrophy.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Associated anomalies in bladder exstrophy as background academic context rather than a clinical decision trigger.
- Immediate nursing care for a newborn with bladder exstrophy involves protecting the exposed bladder mucosa from injury, infection, and drying. This is done by covering the bladder with a sterile, non-adherent plastic wrap or film.
- The pubic bone malformation is clinically significant as it necessitates a pelvic osteotomy during surgical repair to provide a stable foundation for the bladder and abdominal wall closure.
- Long-term, the altered pelvic anatomy can lead to a characteristic waddling gait, although most children adapt well without significant disability.
How to Approach the Question
- First, analyze the question, which asks for a defect associated with bladder exstrophy.
- Next, carefully examine the provided image. Identify the key anatomical abnormalities shown: an exposed bladder on the abdomen and a clear separation between the pelvic bones.
- Evaluate each option against your visual analysis and clinical knowledge.
- Option B, 'Pubic bone malformation,' directly corresponds to the separated pelvic bones seen in the image.
- Consider the other options. Congenital heart disease and absence of a kidney are not classic features. 'Imperforate anus' (corrected from 'rash') is a feature of a different, more severe condition (cloacal exstrophy).
- Conclude that the pubic bone malformation is the most consistent and defining associated defect of bladder exstrophy.
Concept Tested & Keywords
- Concept Tested: Associated anomalies in bladder exstrophy
- Stem keywords: exstrophy of bladder, additional defects
- Lead-in keywords: is
- Clinical cues: The image shows a newborn with an exposed bladder and separated pubic bones, which are classic signs of bladder exstrophy.
Question ID
QEwT8tbx26vevh6W1xoc9X
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1088-1090
E6 Obstetrics Williams p. 24-43
E6 Gynecology Williams p. 12
Practise the full AIIMS Nagpur NO- 2020
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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