Category: Pediatric


A child has a 2-week history of spiking fevers, which have been as high as 40°C (104°F). She has spindle-shaped swelling of finger joints and complains of upper sternal pain. When she has fever, the parents note a faint salmon-colored rash that resolves with the resolution of the fever. She has had no conjunctivitis or mucositis, but her heart sounds are muffled and she has increased pulsus paradoxus. Which of the following is the most likely diagnosis?

a. Rheumatic fever

b. Juvenile rheumatoid arthritis

c. Toxic synovitis

d. Septic arthritis

e. Osteoarthritis

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A 4-year-old girl is brought to the pediatrician’s office. Her father reports that she suddenly became pale and stopped running while he had been playfully chasing her and her pet Chihuahua. After 30 min, she was no longer pale and wanted to resume the game. She has never had a previous episode and has never been cyanotic. Her physical examination was normal, as were her chest x-ray and echocardiogram. The electrocardiographic pattern in the figure shows the configuration of preexcitation, which indicates which of the following?

a. Paroxysmal ventricular tachycardia

b. Paroxysmal supraventricular tachycardia

c. Wolff-Parkinson-White syndrome

d. Stokes-Adams pattern

e. Excessive stress during play

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A 2-year-old boy is brought into the emergency room with a complaint of fever for 6 days and the development of a limp. On examination, he is found to have an erythematous macular exanthem over his body, ocular conjunctivitis, dry and cracked lips, a red throat, and cervical lymphadenopathy. There is a grade 2/6 vibratory systolic ejection murmur at the lower left sternal border. A white blood cell count and differential show predominant neutrophils with increased platelets on smear. Which of the following is the most likely diagnosis?

a. Scarlet fever

b. Rheumatic fever

c. Kawasaki disease

d. Juvenile rheumatoid arthritis

e. Infectious mononucleosis

the answer is below…

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A 15-month-old boy is brought to the emergency room because of fever and a rash. Six hours earlier he was fine, except for tugging on his ears; another physician diagnosed otitis media and prescribed amoxicillin. During the interim period, the child has developed an erythematous rash on his face, trunk, and extremities. Some of the lesions, which are of variable size, do not blanch on pressure. The child is now very irritable, and he does not interact well with the examiner. Temperature is 39.5°C (103.1°F). He continues to have injected, immobile tympanic membranes, but you are concerned about his change in mental status. Which of the following is the most appropriate next step in the management of this infant?

a. Begin administration of intravenous ampicillin

b. Begin diphenhydramine

c. Discontinue administration of ampicillin and begin trimethoprim with sulfamethoxazole

d. Perform bilateral myringotomies

e. Perform a lumbar puncture

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A 12-month-old girl has been spitting up her meals since 1 month of age. Her growth is at the ninety-fifth percentile, and she is otherwise asymptomatic and without findings on physical examination. Which of the following is the most likely diagnosis?

a. Pyloric stenosis

b. Partial duodenal atresia

c. Hypothyroidism

d. Gastroesophageal reflux disease

e. Tracheoesophageal fistula

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During a regular checkup of an 8-year-old child, you note a loud first heart sound with a fixed and widely split second heart sound at the upper left sternal border that does not change with respirations. The patient is otherwise active and healthy. Which of the following heart lesions most likely explains these findings?

a. Atrial septal defect

b. Ventricular septal defect

c. Isolated tricuspid regurgitation

d. Tetralogy of Fallot

e. Mitral valve prolapse

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A 2-year-old boy is brought into the emergency room with a complaint of fever for 6 days and the development of a limp. On examination, he is found to have an erythematous macular exanthem over his body, ocular conjunctivitis, dry and cracked lips, a red throat, and cervical lymphadenopathy. There is a grade 2/6 vibratory systolic ejection murmur at the lower left sternal border. A white blood cell count and differential show predominant neutrophils with increased platelets on smear. Which of the following is the most likely diagnosis?

a. Scarlet fever

b. Rheumatic fever

c. Kawasaki disease

d. Juvenile rheumatoid arthritis

e. Infectious mononucleosis

the answer is below…

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A 16-day-old infant presents with fever, irritability, poor feeding, and a bulging fontanelle. Spinal fluid demonstrates gram-positive cocci. Which of the following is the most likely diagnosis?

a. Listeria monocytogenes

b. Group A streptococcus

c. Group B streptococcus

d. Streptococcus pneumoniae

e. Staphylococcus aureus

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Two weeks ago, a 5-year-old boy developed diarrhea, which has persisted to the present time despite dietary management. His stools have been watery, pale, and frothy. He has been afebrile. Microscopic examination of his stools is likely to show which of the following?

a. Salmonella sonnei

b. Enterobius vermicularis

c. Sporothrix schenckii

d. Toxoplasma gondii

e. Cryptosporidium

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A 2-year-old presents to the emergency center with several days of rectal bleeding. The mother first noticed reddish-colored stools 2 days prior to arrival and has since changed several diapers with just blood. The child is afebrile, alert, and playful, and is eating well without emesis. He is slightly tachycardic, and his abdominal examination is normal. Which of the following is the best diagnostic study to order at this time?

a. Exploratory laparotomy

b. Barium enema

c. Ultrasound of the abdomen

d. Radionucleotide scan

e. Stool culture

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