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A child is diagnosed with hypoalbuminemia. Her total serum calcium level is normal. Most likely associated finding that may be missed is:
- A. Hypocalcemia
- B. Hypercalcuria
- C. Hypomagnesemia
- D. Hypercalcemia
Correct Answer: D
Rationale: Hypoalbuminemia lowers bound calcium; a normal total calcium suggests hypercalcemia in ionized form, often missed (UpToDate). A-C, E don’t fit.
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A 3-month-old infant presents with poor feeding and lethargy. Labs show hypoglycemia and lactic acidosis. Most likely diagnosis is:
- A. Sepsis
- B. Glycogen storage disease
- C. Galactosemia
- D. Fatty acid oxidation disorder
Correct Answer: D
Rationale: FAOD causes hypoglycemia and lactic acidosis, per NORD. A-C, E differ.
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 5-year-old girl presents with abdominal pain and vomiting. CT shows a twisted mesentery. Most likely diagnosis is:
- A. Appendicitis
- B. Intussusception
- C. Malrotation with volvulus
- D. Meckel diverticulum
Correct Answer: C
Rationale: Malrotation with volvulus features pain, vomiting, and twisted mesentery, per AAP. A, B, D, E differ in CT.
A 14-year-old boy appears with tall stature, long limbs, and a heart murmur. Echocardiogram reveals aortic root dilation. Most likely diagnosis is:
- A. Klinefelter syndrome
- B. Marfan syndrome
- C. Growth hormone excess
- D. Hyperthyroidism
Correct Answer: B
Rationale: Marfan syndrome fits tall stature, long limbs, and aortic dilation, per AAP (doc p151, Q606).
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.