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169304 Medicine

A male born at term after an uncomplicated pregnancy, labor and delivery develops severe respiratory distress within a few hours of bih. Results of routine culture were negative. The chest roengogram reveals a normal hea shadow and fine reticulonodular infiltrates radiating from the hilum. ECHO findings reveal no abnormality. Family history reveals similar clinical course and death of a male and female sibling at 1 month and 2 months of age respectively. The most likely diagnosis is:

ANeonatal Alveolar Proteinosis
BTotal Anomalous Pulmonary Venous Circulation (TAPVC)
CMeconium Aspiration Syndrome
DDiffuse Herpes simplex infection
Medicine
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169305 Pediatrics

A 4-year-old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. His growth velocity is normal. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone but present anal wink, and stool in the rectal vault. The plain film of his abdomen is shown. Which of the following is the most appropriate next step in the management of this child?

ALower gastrointestinal (GI) barium study
BParental reassurance and dietary counseling
CSerum electrolyte measurement
DUpper GI barium study
Pediatrics
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