Nokea
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 sickle cell disease should avoid
- A. Cold environments
- B. Dehydration
- C. Stress
- D. All of the above
Correct Answer: D
Rationale: All D trigger crises, per document p53, .
A 2-year-old girl presents with a seizure and fever of 102°F. No focal neurologic signs are noted. Most likely diagnosis is:
- A. Epilepsy
- B. Febrile seizure
- C. Meningitis
- D. Brain tumor
Correct Answer: B
Rationale: Febrile seizure is common in toddlers with fever and no focal signs, per AAP. A, C-E have additional features.
When a parent asks the nurse to describe what is meant by a 'learning disability,' the nurse's most helpful response would be:
- A. It is characterized by inattention, impulsiveness, and hyperactivity'
- B. A child may have difficulty with perception, language, comprehension, or memory'
- C. The child's intellectual ability limits his learning'
- D. The child has difficulty learning because of brain damage'
Correct Answer: B
Rationale: A learning disability (B) involves challenges in perception, language, or comprehension despite normal intelligence. A describes ADHD, C implies low IQ, and D suggests injury, not typical. Document: 'Children with learning disabilities may have… difficulties in perception, language, comprehension.'
A physician should be informed if a 7-year-old with a fractured femur in a cast shows
- A. Cast damp and warm after 24 hours
- B. Increased urinary output
- C. Inability to move toes
- D. Pedal pulse of 90 bpm
Correct Answer: C
Rationale: Inability to move toes C suggests circulation issues, per document p11, .