Nokea
A child with a cast should be taught to report
- A. Discomfort
- B. Numbness
- C. Tingling
- D. All of the above
Correct Answer: D
Rationale: All D may indicate circulation issues, per document p28, .
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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.
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 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.
A 6-month-old infant presents with wheezing and retractions. Chest x-ray shows hyperinflation. Most likely diagnosis is:
- A. Pneumonia
- B. Bronchiolitis
- C. Cystic fibrosis
- D. Asthma
Correct Answer: B
Rationale: Bronchiolitis features wheezing and hyperinflation, per AAP. A, C-E differ.
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.