A child with secondary enuresis who reports of dysuria or urgency should be evaluated for what condition? (Select all that apply.)

The correct answer is Choice D: Jaundice.

Choice A rationale:

Vomiting can occur in biliary atresia due to the blockage of bile flow, but it is not the earliest clinical manifestation. Jaundice tends to precede vomiting and is a more characteristic early sign of biliary atresia.

Choice B rationale:

Hepatomegaly (enlargement of the liver) is a common finding in biliary atresia, but it usually occurs after the onset of jaundice. Jaundice is an earlier and more specific manifestation of this condition.

Choice C rationale:

Absence of stooling is a sign that might occur in biliary atresia due to the obstructed bile flow, but it is not typically the earliest clinical manifestation. Jaundice is generally the first noticeable sign.

Choice D rationale:

Jaundice is the earliest clinical manifestation of biliary atresia. It is caused by the buildup of bilirubin in the blood due to impaired bile flow from the liver. The jaundice in biliary atresia is typically progressive and can be one of the key indicators for further evaluation and diagnosis.

The correct answer is choice C: Concrete operations stage.

Choice A rationale:

The preoperational stage, which occurs roughly between ages 2 and 7, is characterized by egocentrism, animism, and a lack of conservation. Children in this stage struggle with understanding that quantities can remain the same even if their appearance changes. For instance, they might think that pouring water from a tall glass into a short, wide glass somehow changes the amount of water. This stage does not demonstrate the mental understanding required for the examples given in the question.

Choice B rationale:

The intuitive thought stage, which typically spans from ages 4 to 7, is marked by increased symbolic thinking but still lacks the capacity for logical and systematic reasoning. Children in this stage might be able to count and perform basic arithmetic, but they struggle with more complex operations and understanding the underlying principles of mathematical operations. This stage is not where the ability to understand the given math operations is firmly established.

Choice C rationale:

The concrete operations stage, which encompasses ages 7 to 11, is characterized by the development of logical and systematic thinking. Children in this stage are capable of understanding basic mathematical principles and operations, such as conservation of quantity and simple arithmetic. They can mentally manipulate numbers and understand that reversing an operation will yield the original quantity. Therefore, this stage is when the ability to understand that 1 + 3 = 4 and 4 - 3 = 1 occurs.

Choice D rationale:

The formal operations stage, typically beginning around age 11, is characterized by abstract and hypothetical thinking. This is when adolescents and adults can engage in complex reasoning and consider multiple possibilities and outcomes. The given math operations are not the focus of this stage; rather, it pertains to more advanced cognitive abilities like hypothetical problem-solving and deductive reasoning.