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A 4-year-old girl presents with fever and conjunctivitis. Exam shows a rash and swollen hands. Most likely diagnosis is:
- A. Measles
- B. Kawasaki disease
- C. Scarlet fever
- D. Rubella
Correct Answer: B
Rationale: Kawasaki disease includes fever, conjunctivitis, rash, and swollen hands, per AHA. A, C-E differ.
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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.
A child with diabetes should be taught to recognize
- A. Shakiness
- B. Sweating
- C. Weakness
- D. All of the above
Correct Answer: D
Rationale: All D are hypoglycemia signs, per document p60, 9.
A 3-year-old girl presents with recurrent ear infections and speech delay. Audiometry shows conductive hearing loss. Most likely diagnosis is:
- A. Sensorineural hearing loss
- B. Otitis media with effusion
- C. Cholesteatoma
- D. Mastoiditis
Correct Answer: B
Rationale: OME causes conductive loss post-infections, per AAP. A, C-E differ.
A child with a history of cystic fibrosis suddenly develops right-sided chest pain and shortness of breath. Physical examination reveals decreased breath sounds on the right side and mediastinal shift to the left side. Most likely diagnosis is:
- A. Pneumonia
- B. Asthma exacerbation
- C. Foreign body aspiration
- D. Pneumothorax
Correct Answer: D
Rationale: Pneumothorax matches unilateral findings and mediastinal shift in cystic fibrosis, per CFF. A-C, E don’t fit.
A child with nephrotic syndrome requires
- A. High-protein diet
- B. Low-salt diet
- C. Steroids
- D. All of the above
Correct Answer: D
Rationale: All D manage nephrotic syndrome, per document p60, 3.