Answer: E. Subnormal visual acuity in one or both eyes despite correction of refractive error

Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to process inputs from one eye and over time favors the other eye. It results in decreased vision in an eye that otherwise typically appears normal

• Amblyopia is not correctable by refractive means
• Amblyopia occurs in early childhood when nerve pathways between the brain and an eye aren’t properly stimulated
• It may be caused by strabismus (crossed eye); uremia; or toxins, such as alcohol, tobacco, lead, and other toxic substances
• Symptoms include a wandering eye, eyes that may not appear to work together, poor depth perception, blurred vision, or double vision. Both eyes may be affected

DX: Screening to detect amblyopia in all children younger than five years of age

• Screening includes vision risk assessment at all health maintenance visits and vision screening at age three, four, and five years of age

TX: Treatment includes correction of refraction error as well as forced use of the amblyopic eye by patching the better eye

• Some children cannot tolerate the patch, in which case the good eye is blurred with glasses or drops (penalization therapy) to stimulate proper visual development of the more severely affected eye
• It is more resistant to treatment at an older age; thus, children should be treated early

View lesson: Amblyopia

Answer: C. Toxic megacolon

The hallmarks of toxic megacolon (toxic colitis) are nonobstructive colonic dilatation (>6 cm) and signs of systemic toxicity. It occurs following complications from causes of colitis e.g. ulcerative colitis as is the case in the index patient.

Incorrect Answers:

• Hirschsprung’s disease (choice A) presents with chronic constipation. Patients are not usually toxic except when intestinal perforation occurs.
• Cytomegalovirus colitis and Kaposi’s sarcoma (choice B and D) Occurs in immunocompromised persons.

View lesson: Toxic megacolon

Answer: A. Hepatitis A

Hepatitis A is transmitted via the fecal-oral route

Incorrect Answers:

• Hepatitis B can be transmitted via blood and blood products through close living quarters/playground play as a toddler, vertical transmission, infected unscreened blood, needle stick injury, etc.
• Hepatitis D is transmitted via blood.
• Hepatitis C is transmitted via blood and blood products through Intravenous drug misuse, unscreened blood products, needle stick injury, vertical transmission etc

View lesson: Acute and Chronic Hepatitis

Answer: B. 24 to 48 h after birth

In the US and many developed countries,