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A 4-year-old boy presents with fever, limp, and hip pain. Hip x-ray is normal, but ESR is elevated. Most likely diagnosis is:
- A. Septic arthritis
- B. Transient synovitis
- C. Osteomyelitis
- D. Slipped capital femoral epiphysis
Correct Answer: B
Rationale: Transient synovitis is common in preschoolers with limp and fever, often post-viral, with normal x-ray, per AAP. A, C-E have different presentations or imaging.
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What is the most likely cause of her pancreatitis?
- A. Bile duct adenoma
- B. Choledochal cyst
- C. Neonatal sclerosing cholangitis
- D. Sphincter of Oddi dysfunction
Correct Answer: B
Rationale: A 2-year-old with acute abdominal pain and pancreatitis, with ultrasound showing a significantly dilated common bile duct tapering distally and dilated intrahepatic ducts, suggests a structural anomaly. Choledochal cyst (Choice B) is a congenital dilatation of the bile ducts, often presenting in young children with pancreatitis, jaundice, or abdominal pain due to bile stasis or obstruction. Bile duct adenoma (Choice A) is a benign tumor, rare in children, and typically asymptomatic unless obstructive, which doesn’t align with the ultrasound findings. Neonatal sclerosing cholangitis (Choice C) is a rare progressive disease usually presenting in infancy with cholestasis, not typically acute pancreatitis or this ultrasound pattern. Sphincter of Oddi dysfunction (Choice D) causes biliary or pancreatic obstruction in adults but is uncommon in children and lacks the structural ductal dilatation seen here. Thus, Choledochal cyst is the most likely cause.
The responsibility of a mandatory reporter is to:
- A. Report actual abuse to legal authorities
- B. Provide evidence of suspected child abuse to legal authorities
- C. Report actual or suspected abuse to legal authorities
- D. Investigate suspected child abuse
Correct Answer: C
Rationale: Mandatory reporters (e.g., nurses) must report actual or suspected abuse to authorities, as per legal and ethical standards. Reporting only actual abuse misses suspicion, providing evidence exceeds their role, and investigating is for authorities, not reporters.
A one-year-old girl with dysentery is discharged. The most important information for the mother is
- A. Place child on NPO for 8 hours if diarrhea occurs
- B. Don’t wait long before bringing child to hospital
- C. Observe good hygiene to reduce faeco-oral spread
- D. Start anti-diarrhea meds before hospital
Correct Answer: C
Rationale: Hygiene C prevents reinfection, critical in dysentery, per document 0.
Most common endocrine abnormality in patients with cystic fibrosis is:
- A. Hypothyroidism
- B. Diabetes mellitus
- C. Adrenal insufficiency
- D. Hyperthyroidism
Correct Answer: B
Rationale: Cystic fibrosis-related diabetes is the most common endocrine issue, from pancreatic damage, per CFF. A, C-E are less frequent.
Body mass index (BMI) should be calculated starting at age:
- A. 6 months
- B. 1 year
- C. 2 years
- D. 3 years
Correct Answer: C
Rationale: BMI screening starts at age 2 , per AAP, as it aligns with standardized growth charts. Earlier ages (A, B) use weight-for-length, and later starts (D, E) delay assessment.