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Test Bank For Pediatrics 19th Edition By Nelson 2024.Test Bank For Pediatrics 19th Edition By Nelson 2024.
, Test Bank For Pediatrics 19th Edition By Nelson 2024.
Which phase of Kawasaki disease is associated with coronary aneurysms?
A. Acute febrile phase
B. Subacute phase
C. Convalescent phase
D. Phase of complications
E. All of the above - ANSWER - 1 B.
Kawasaki disease presents with characteristically high, unremitting fever and 4 out of the 5
principal features:
Bilateral nonexudative bulbar conjunctival injection with limbal sparing;
Erythema of the oral and pharyngeal mucosa with strawberry tongue and dry, cracked lips;
Edema and erythema of the hands and feet;
Rash of various forms (scarlatiniform, maculopapular, erythema multiforme);
Nonsuppurative cervical lymphadenopathy (usually unilateral, with node size >1.5cm).
Acute febrile phase - fever and the acute signs of illness and usually lasts 1-2wks
Subacute febrile phase - desquamation, thrombocytosis, coronary aneurysms and highest
risk of sudden death usually lasts 2 wks
Convalescent phase - All clinical signs have disappeared until ESR normalizes typically 6-
8wks after onset on illness
Source: Nelson's Textbook of Pediatrics 19th edition p864
A four year old presents with low-grade fever, intermittent crampy abdominal pain with
emesis and swollen knees of 3 days duration. A purpuric rash distributed below the knees of
both lower extremities is noted on physical examination. This patient most likely has:
A. Meningococcemia
B. Idiopathic thrombocytopenic purpura
C. Henoch-Scholein purpura
D. SLE E. Juvenile Rheumatoid arthritis - ANSWER - 2 C.
HSP is a common vasculitis among children and presents with the classic findings of
abdominal pain with or without rectal bleeding, vasculitis rash, arthritis and nephritis. The
platelet count is normal. Gastrointestinal involvement may progress to intussusception.
Source: Nelson's Textbook of Pediatrics 19th edition p868
A 3 year old female presents with 1 week history of daily (quotidian) fever associated with
arthritis of both ankles and her right knee. Her mother notes that she has decreased activity
Test Bank For Pediatrics 19th Edition By Nelson 2024.
, Test Bank For Pediatrics 19th Edition By Nelson 2024.
and also notes rashes that come and go in different parts of her body but not on the face. On
physical examination, salmon colored patches were noted on the trunk and extremities.
Palpation revealed splenomegaly. What is the diagnosis?
A. Henoch Schoenlein Purpura
B. Systemic Lupus Erythematosus
C. Juvenile Rheumatoid arthritis
D. Juvenile Dermatomyositis
E. Dengue fever - ANSWER - 3 C.
Don't forget to study rheumatic diseases of childhood even if it's not your favorite topic.
Familiarize yourself with the relatively common ones like JRA, SLE and dermatomyositis,
HSP and scleroderma. Pay attention to the characteristics of the rash and other features.
(Don't fall for the trap of rash + arthritis = SLE.. It's not always SLE!)
JRA - Salmon colored patch, evanescent, spares the face
SLE - Malar rash, photosensitive
Dermatomyositis - heliotrope (periorbital) rash, gottron papules (rash on the knuckles)
HSP - purpura in dependent portions
For JRA, know the differences between subtypes (oligoarticular vs polyarticular vs systemic
onset)
This case in particular is a case of systemic onset Juvenile Rheumatoid arthritis (also called
Still's Disease)
Source: Nelson's Textbook of Pediatrics 19th edition p830
A 4 yr old boy presents with his third episode of painful cervical lymphadenitis. Each was
treated with incision and drainage and grew S. aureus. He also experiences recurrent skin
infections. A year ago, he was hospitalized for osteomyelitis. The most important laboratory
test is:
A. PCR for ADA deficiency
B. Nitroblue tetrazolium test
C. MAC-I assay
D. Neutrophil count
E. Genetic chromosomal analysis - ANSWER - 4 B. This is a case of chronic granulomatous
disease (CGD) wherein patients are susceptible to catalase positive organisms like S. aureus.
The nitroblue tetrazolium tests the neutrophils ability to generate superoxide anion and thus
kill ingested bacteria.
Source: Nelson's Textbook of Pediatrics 19th edition p746
Test Bank For Pediatrics 19th Edition By Nelson 2024.
, Test Bank For Pediatrics 19th Edition By Nelson 2024.
Which among the following is not a prominent feature of Wiskott-Aldrich syndrome?
A. X-linked recessive inheritance
B. Atopic dermatitis
C. Thrombocytopenia
D. Recurrent infections with encapsulated bacteria
E. Leukopenia - ANSWER - 5 E.
Note: The prominent immunologic impairment in Wiskott Aldrich Syndrome is against
polysaccharides of encapsulated organisms
Source: Nelson's Textbook of Pediatrics 19th edition p734
A 12 year old seeks consult for 1 day history of sneezing, clear rhinorrhea and nasal itching
not associated with fever or any other systemic symptoms. PE reveals boggy, pale nasal
edema with a clear discharge. The most likely diagnosis is?
A. Foreign body
B. Vasomotor rhinitis
C. Allergic rhinitis
D. Neutrophilic rhinitis
E. Rhinitis medicamentosa - ANSWER - 6 C.
Allergic rhinitis is often seasonal and associated with allergic conjunctivitis. Eosinophils
predominate in the nasal secretions. It is classified as:
Seasonal (cyclical) or perennial (all year)
Intermittent (symptoms occur <4 days per week or <4 consecutive weeks) or persistent
(symptoms occur >4 days per week or >4 consecutive weeks)
Mild-moderate (no impairment) or severe (with impairment of daily living/sleep)
Source: Nelson's Textbook of Pediatrics 19th edition p775
The Kasai procedure is indicated for which of the following?
A. Neonatal hepatitis
B. Biliary atresia
C. Metabolic liver disease
D. Fulminant hepatic failure
E. None of the above - ANSWER - 7 B.
Despite initial success of the Kasai operation, patients with biliary atresia eventually get liver
transplantation.
Source: Nelson's Textbook of Pediatrics 19th edition 1387
Test Bank For Pediatrics 19th Edition By Nelson 2024.
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