Improving examination performance using Exam Analysis.

The Exam Analysis is a diagnostic and prescriptive program in which a student and an instructor identify why the student failed to answer specific questions correctly on an examination. Problems related to incorrect answers are then categorized into five problem areas. This analysis is used to develop a plan which will help the student utilize specific skills in order to improve examination performance. This article describes the Exam Analysis program, gives specific information which will enable an instructor to assist a student in completing an Exam Analysis, and discusses the results of a survey in which 105 nursing students evaluated the impact of participating in the program on subsequent examination performance. A large majority of the students surveyed agreed that participation in the Exam Analysis program resulted in improved examination performance. Improved exam-taking skills, better study skills, decreased test anxiety and increased self-confidence were identified as Exam Analysis program outcomes by the students included in the study.

Congenital chest wall mesenchymal hamartoma.

The case of an infant with mesenchymal hamartoma of the chest wall is presented, and the role of conservative diagnostic and therapeutic intervention is emphasized. A large mass that involved the right hemithorax and chest wall was detected in utero on routine ultrasonographic studies and diagnosed as mesenchymal hamartoma by percutaneous fine needle biopsy at 4 days after birth. The mass did not enlarge after birth, but surgical debulking was necessary at 1 month because of progressive respiratory compromise. Tumor regrowth was noted over the ensuing 8 months, and a second debulking at 9 months has been followed by a 6-year interval without evidence of recurrence.

Assessing student outcomes in a nursing learning assistance program.

This study measured the apparent effectiveness of a Learning Assistance Program (LAP) in second-year baccalaureate nursing students using a process-outcome design. Seventy-eight students participated in LAP and 98 did not. SAT/ACT scores and freshman GPA were the cognitive "input" variables and the end-of-sophomore-year GPA the cognitive "outcome" variable. Affective variables at the beginning and end of the test year were the Study Attitudes and Methods Survey (SAMS) and the Survey of Reading and Study Efficiency (SR/SE). Statistical analysis included stepwise multiple regressions for evaluating the relationship between the process (LAP participation) and outcomes when the entry variables had been accounted for. Attending LAP improved participants' study attitudes and skills scores. There was a significant negative correlation between the degree of LAP participation by lower achieving students and their sophomore-year-ending GPA. This may be related to the fact that students who perform poorly on tests are encouraged to participate in LAP.

Spontaneous perforation of the common bile duct in children.

The authors describe radiologic findings in five patients with spontaneous perforation of the common bile duct (a rare disorder). The patients were 5 weeks, 9 weeks, 3 months, 11 months, and 2 1/2 years old at presentation. The most common presenting complaints were jaundice and abdominal distention (due to ascites). Sonographic findings included ascites in three patients, a loculated fluid collection around the gallbladder in two patients, and both in one patient. The biliary tree was undilated in all patients. Results of hepatobiliary scintigraphy definitely demonstrated that intraperitoneal fluid originated from the biliary tract. Intraoperative cholangiography was used to confirm the diagnosis at surgery. All children were successfully treated with surgery. Recognition of these findings on sonograms and subsequent confirmation with scintigraphy are important to prevent delays in diagnosis of a potentially fatal condition.

Catheter removal of blunt esophageal foreign bodies in children. Survey of the Society for Pediatric Radiology.

The membership of the Society for Pediatric Radiology was surveyed to determine the safety and efficacy of the Foley catheter technique. Completed questionnaires were returned from 148 institutions. Sixty-four institutions reported that they were currently removing blunt esophageal foreign bodies utilizing the balloon catheter. Over 2500 patients were reported as having been treated utilizing this technique. Only one potentially serious but reversible complication was observed.

Trampoline fracture of the proximal tibia in children.

Seven children (aged 2-5 years) sustained fractures of the proximal tibial metaphysis while jumping on a trampoline with a heavier child or adult. Most impaction fractures were transverse and neither angulated nor displaced. None of the children developed permanent disability or impairment. Parents and physicians should be aware of the possible danger to small children while tandem jumping on a trampoline with a heavier partner.

Clubfoot deformity and tibiofibular diastasis.

Four children with distal tibiofibular diastasis associated to talipes equinovarus deformity are described. Tibial hypoplasia resulting in tibiofibular diastasis is believed to be the underlying cause of the deformity. This complex deformity is usually associated with other congenital malformations including congenital cardiac defects and other limb anomalies. Surgical therapy has centered on establishment of an ankle mortise; however, several authors believe that the best treatment is early ankle disarticulation rather than reconstructive surgery. Radiographs should be made of all apparent clubfoot deformities in order to rule out the more serious distal tibiofibular diastasis deformity.

Menetrier's disease in children: report of a case and review of the pediatric literature.

A case of Menetrier's disease (giant hyperplasia of the gastric mucosa) in a 2-day-old infant is presented. The lesion was primarily confined to the gastric antrum. It resulted in outlet obstruction and necessitated partial gastrectomy. The pertinent literature is critically evaluated, and probably only 2 of the 9 previously reported cases of Menetrier's disease in children qualify fully.

Fetal pancreatic hamartoma.

Pancreatic masses are uncommon lesions in the newborn infant. The authors present the first reported case of neonatal pancreatic hamartoma and describe its interesting clinical, histologic, and radiographic aspects.

Computed tomographic findings of neonatal lung abscess.

A 3-week-old child with respiratory distress had an air-fluid level on chest roentgenogram. Computed tomography of the chest distinguished the mass as a discrete lung abscess, without underlying abnormality. Due to failure of the child's condition to improve with medical therapy, a limited thoracotomy and drainage of the lung abscess was performed; Escherichia coli and no anaerobic organisms grew from cultures of abscess material. We believe computed tomography to be of great benefit in defining suspected lung abscess in the neonate.

Infants of diabetic mothers: radiographic manifestations.

The radiographic findings of a series of infants of diabetic mothers and a review of the literature are presented to illustrate the wide spectrum of abnormalities that may be seen with this condition. Congenital anomalies of the spine and skeletal, genitourinary, and cardiovascular systems and visceral situs inversus are significantly more frequent among infants of diabetic mothers than normal. The most specific anomaly is sacral agenesis. Renal vein thrombosis and adrenal hemorrhage are also more common and may be diagnosed by sonography. Over one-half of the cases of the small left colon are associated with maternal diabetes and may be diagnosed and treated with a contrast enema. The incidence of the respiratory distress syndrome is higher in infants of diabetic mothers than other premature infants, and the disease may occur in the presence of reliable indicators of lung maturity. Other common causes of dyspnea include cardiomyopathy, congenital heart disease, wet lung syndrome, hyperviscosity syndrome, and persistence of fetal circulation. Echocardiography is the most valuable adjunct in differentiating cardiac from pulmonary problems.

Patterns of postcibal gastroesophageal reflux in symptomatic infants.

Symptomatic infants displayed three patterns of gastroesophageal reflux after drinking apple juice (20 ml/kg or 300 ml/m2 of body surface area). The type I pattern occurred in patients who had continuous postcibal gastroesophageal reflux, large hiatal hernias and frequently required an antireflux operation. A functional motility disorder suggesting delayed gastric emptying appeared to be important in infants with discontinuous reflux (type II pattern). These infants had frequent gastroesophageal reflux for only 2 3/4 hours postcibally, antral-pylorospasm, increased low esophageal sphincter pressures, and a high incidence of pulmonary symptoms and non-specific watery diarrhea. The mixed (type III) pattern of gastroesophageal reflux occurred in a small number of infants and exhibited features of both type I and II patterns.

Unusual features of pulmonary sling.

Patients with an anomalously placed left pulmonary artery ("pulmonary sling") typically have signs and symptoms of respiratory obstruction in the neonatal period. Experience with four previously unreported patients confirmed this. Typical radiographic features include unilateral air trapping (usually on the right side), an abnormal position of the esophagus, and a soft tissue mass interposed between the trachea and esophagus. Less common findings include a normal esophageal position, left-side air trapping, and delayed egress of neonatal pulmonary fluid. Both typical and atypical features were seen; the more unusual aspects are emphasized.

Familial hyperphosphatasemia: diagnosis in early infancy and response to human thyrocalcitonin therapy.

Familial hyperphosphatasemia is an uncommon hereditary disorder of membranous bone with concurrent overproduction and overdestruction of bone and bone collagen by osteocytes. This process does not allow normal maturation into compact lamellar bone. Two cases of severely affected children are presented which demonstrate that the condition can be diagnosed in early infancy by abnormalities in the long bones. At this stage the skull may appear normal and the characteristic thickening of the calvarium appears later. The disease is treatable with human thyrocalcitonin; these and previously reported cases have responded favorably.

Peritoneographic demonstration of femoral hernia.

Four cases of congenital hernia demonstrated by positive-contrast peritoneography are reported. Its differentiation from indirect inguinal hernia is described.