Le3 PEDIA

Question 1

4. The most common complication of recurrent acute pharyngitis, if not treated with antibiotics, is:

A. Glomerulonephritis
B. Peritonsillar abscess
C. Rheumatic fever
D. Scarlet fever

Answer 1

C. Rheumatic fever
Rationale: The primary benefit of treating streptococcal pharyngitis with antibiotics is to prevent acute rheumatic fever, a serious complication that can affect the heart, joints, skin, and brain.

Question 2

5. A one-year-old child, while playing with candies and toys, suddenly developed respiratory distress. On auscultation, there was unilateral wheezing. You request a chest x-ray. What is the most likely finding?

A. Progressive pneumonia
B. Bronchial asthma
C. Foreign body aspiration
D. Bronchiolitis

Answer 2

C. Foreign body aspiration
Rationale: Unilateral wheezing in a young child, particularly after playing with small objects or food, strongly suggests foreign body aspiration. A chest x-ray might reveal hyperinflation on the affected side or a radiopaque foreign body.

Question 3

41. You are treating a 12-year-old boy who has purpura. His BP is 68/43 mm Hg, ABG reveals pH 7.20, PaO₂ 160, and PaCO₂ 21. Following intubation, administration of antibiotics, 20 mL/kg NSS, and dopamine at 10 mcg/kg/min, the BP is 72/56 mm Hg and pulses are easily felt, but acidosis persists. The most appropriate next step is to:

A. Administer a bolus of 5% albumin
B. Administer another bolus of plain NSS
C. Begin dobutamine infusion at 15 mcg/kg/min
D. Increase dopamine infusion to 15 mcg/kg/min

Answer 3

C. Begin dobutamine infusion at 15 mcg/kg/min
Rationale: Dobutamine is indicated when the patient’s blood pressure remains low despite volume resuscitation and dopamine administration, suggesting cardiac dysfunction. It helps enhance cardiac output and systemic perfusion in the setting of persistent acidosis and shock.

Question 4

42. A 2-year-old child presents with a 2-day history of fever, fussiness, and decreased oral intake. On examination, the child is pale, irritable, with dry mucous membranes, cool extremities, weak peripheral pulses, CRT of 4 seconds, HR 180 beats/min, BP 100/70, RR 35 bpm. The most appropriate initial management of this child is to administer:

A. Intravenous dexamethasone
B. An IV bolus of 10 mL/kg D5Water
C. An IV bolus of 20 mL/kg D5 0.18 NaCl
D. An IV bolus of 20 mL/kg of 0.9% Normal saline

Answer 4

D. An IV bolus of 20 mL/kg of 0.9% Normal saline
Rationale: The child is in shock with signs of dehydration. The first-line treatment for pediatric shock, especially when hypovolemia is suspected, is an IV bolus of isotonic fluids (0.9% NSS) to restore intravascular volume and improve perfusion.

Question 5

45. According to WHO, the criteria for hypotension in healthcare systems without an ICU is defined as the presence of the following, EXCEPT:

A. Rapid pulse
B. Cold distal and proximal extremities
C. Prolonged capillary refill time
D. Systolic blood pressure of less than 70 mmHg for a 1-year-old child

Answer 5

D. Systolic blood pressure of less than 70 mmHg for a 1-year-old child
Rationale: Hypotension in children is a late sign of shock and occurs when the compensatory mechanisms fail. Although rapid pulse, cold extremities, and prolonged capillary refill are consistent with shock, a systolic BP <70 mmHg is not the threshold used for all age groups. In a 1-year-old, a systolic BP <70 mmHg would be concerning for hypotension, but not necessarily part of the WHO hypotension definition.

Question 6

46. The best method to perform chest compressions on an infant who had a cardiopulmonary arrest with 2 or more rescuers is:

A. Two fingers in the center of the chest
B. Two thumb-encircling hands in the center of the chest
C. Two hands on the lower half of the sternum
D. One hand on the lower half of the sternum

Answer 6

B. Two thumb-encircling hands in the center of the chest
Rationale: For infants during CPR with 2 or more rescuers, the two-thumb encircling technique is preferred because it provides more effective chest compressions, better depth, and allows for better control and pressure.

Question 7

49. A 6-month-old infant has had a 3-day history of fever, hoarseness, a barking cough, and stridor. You suspect viral croup. This infection is most commonly caused by:

A. Measles virus
B. Adenovirus
C. Influenza virus
D. Parainfluenza virus

Answer 7

D. Parainfluenza virus
Rationale: Viral croup is most commonly caused by the parainfluenza virus. It typically presents with a barking cough, stridor, and hoarseness in young children, and symptoms often worsen at night. Other viruses like adenovirus and influenza can cause similar symptoms but are not the primary cause of croup.

Question 8

50. The best maneuver to expel a foreign body airway obstruction in a child who is conscious is:

A. Remove obstruction by hand and intubation
B. Heimlich maneuver
C. Back blows and chest thrusts
D. Abdominal thrusts in the supine position

Answer 8

B. Heimlich maneuver

Rationale: The Heimlich maneuver (abdominal thrusts) is the most effective method for expelling a foreign body from the airway of a conscious child. By applying pressure just above the navel, this maneuver forces air from the lungs, creating an upward force that can dislodge the obstruction from the airway. It is recommended for children over 1 year of age.

Question 9

51. For high-flow oxygen delivery in a child with severe respiratory distress, the best device to use is:

A. Nasal cannula
B. Simple face mask
C. 100% FIO2; Non-rebreather mask
D. Venturi mask

Answer 9

C. Non-rebreather mask
Rationale: A non-rebreather mask delivers high concentrations of oxygen and is ideal for patients in severe respiratory distress. It allows for high-flow oxygen while minimizing the re-inhalation of exhaled gases.

Question 10

52. What is a sign of a displaced endotracheal (ET) tube?

A. Equal breath sounds in both lungs
B. Presence of breath sounds in the stomach
C. Chest rise and fall with each breath
D. Symmetrical chest movement

Answer 10

B. Presence of breath sounds in the stomach
Rationale: Breath sounds heard in the stomach indicate that the ET tube may be misplaced in the esophagus. This is a sign that the tube needs to be repositioned.

Question 11

57. An 18-year-old girl is rushed to the ER after a possible suicide attempt. She admitted to swallowing 100 aspirin tablets 4 hours ago. You obtained ABG. What would be the expected result of this study?

A. Metabolic alkalosis and respiratory acidosis
B. Metabolic alkalosis and respiratory alkalosis
C. Metabolic acidosis and respiratory acidosis
D. Metabolic acidosis and respiratory alkalosis

Answer 11

D. Metabolic acidosis and respiratory alkalosis
Rationale: In aspirin (salicylate) overdose, early respiratory alkalosis occurs due to hyperventilation, followed by metabolic acidosis as the body accumulates acid. This combination of metabolic acidosis and respiratory alkalosis is typically seen in aspirin toxicity.

Question 12

58. What is the most likely type of shock in a 10-month-old infant who presents with hypotension and an ECG revealing supraventricular tachycardia?

A. Cardiogenic shock
B. Hypovolemic shock
C. Neurogenic shock
D. Septic shock

Answer 12

A. Cardiogenic shock
Rationale: Supraventricular tachycardia in a hypotensive infant is indicative of cardiogenic shock, where the heart’s pumping function is compromised, leading to inadequate perfusion of tissues.

Question 13

59. Which of the following statements is correct regarding cardiopulmonary (CP) arrest in children?

A. CP arrest is a sudden event
B. Often the end result of progressive deterioration of CP function
C. Most CP emergencies are primarily cardiac in origin
D. The final pathway is death in 95% of all cases

Answer 13

B. Often the end result of progressive deterioration of CP function
Rationale: In children, cardiopulmonary arrest is most often the result of progressive respiratory failure or shock, rather than a sudden event of cardiac origin as seen in adults. CP emergencies in children are typically due to respiratory causes rather than primary cardiac issues.

Question 14

60. A 5-year-old boy presents with acute onset of wheezing, urticaria, stridor, and hypotension. What type of shock is this child experiencing?

A. Septic shock
B. Distributive shock
C. Neurogenic shock
D. Hypovolemic shock

Answer 14

B. Distributive shock
Rationale: The child is most likely experiencing anaphylactic shock, a form of distributive shock, characterized by wheezing, urticaria, stridor, and hypotension due to a severe allergic reaction. This leads to widespread vasodilation and increased capillary permeability.

Question 15

61. You witnessed a 3-year-old boy collapse, and you are concerned that he may be in cardiac arrest. Which of the following is the correct order of steps in the initial management of a child in cardiopulmonary arrest?

A. Open the airway, check for pulse, administer rescue breaths, and start chest compressions
B. Check the pulse, open the airway, start chest compressions, and administer rescue breaths
C. Check for breathing and pulse and start chest compressions
D. Open the airway, administer rescue breaths, start chest compressions, and check for pulse

Answer 15

C. Check for breathing and pulse and start chest compressions
Rationale: According to current guidelines, the initial steps in managing pediatric cardiac arrest are to check for breathing and a pulse, and if neither is present, immediately start chest compressions. The priority is ensuring circulation (chest compressions), followed by airway and breathing.

Question 16

62. Which of the following statements is TRUE about caustic ingestion in children?

A. Ingestion of caustic materials may produce whitish plaques around the mouth secondary to burns.
B. Caustic ingestions are usually more severe in young children.
C. Acid and alkali ingestion differ significantly in severity and frequency of injuries.
D. Toddlers usually ingest large quantities.

Answer 16

C. Acid and alkali ingestion differ significantly in severity and frequency of injuries.

Rationale: Acids and alkalis differ in the types of injuries they cause. Alkalis cause liquefaction necrosis, which allows deeper tissue penetration and increases the risk of perforation, while acids cause coagulative necrosis, which limits deeper tissue damage but still carries a risk of perforation. Alkali ingestions generally tend to cause more severe injuries due to their ability to penetrate deeper into tissues, and they are more likely to result in significant complications.

Question 17

A stable child with a mid-sized ventricular septal defect (VSD) presents for dental cleaning due to multiple caries. What is the appropriate management?

A. Digoxin
B. Ibuprofen
C. Amoxicillin
D. Acetaminophen

Answer 17

C. Amoxicillin
Rationale: Children with congenital heart defects such as a VSD may require antibiotic prophylaxis (like amoxicillin) before certain dental procedures to prevent infective endocarditis. Digoxin, ibuprofen, and acetaminophen are not appropriate for this indication.

Question 18

A 6-year-old boy is diagnosed with acute rheumatic fever with arthritis and carditis. The parents are worried about heart lesions. The most appropriate statement describing the prognosis of heart disease is:

A. A chronic disease which may lead to valve stenosis
B. The chance of cure is minimal and long-term prophylaxis is indicated
C. Prednisone treatment can cure almost all cases
D. Most patients will recover

Answer 18

D. Most patients will recover

Rationale: Most patients with acute rheumatic fever, particularly with proper treatment (e.g., antibiotics, anti-inflammatory medications), will recover from the initial episode. While acute carditis can lead to long-term heart valve damage in some cases, particularly without prophylaxis, many children with rheumatic fever do not develop chronic rheumatic heart disease. The key is to prevent recurrences through long-term prophylaxis with antibiotics (such as penicillin), which significantly reduces the risk of heart damage. Therefore, most patients recover well with appropriate treatment and follow-up.

Question 19

66. The criterion for acute rheumatic fever that does not need evidence of recent group A strep infection is:

A. Sydenham chorea
B. Pancarditis
C. Erythema marginatum
D. Migratory arthritis
E. Subcutaneous nodules

Answer 19

A. Sydenham chorea
Rationale: Sydenham chorea, one of the major criteria for diagnosing rheumatic fever, does not require evidence of a recent group A streptococcal infection. It can present months after the initial infection, making the strep infection difficult to confirm at that stage. The other major criteria typically require evidence of a preceding streptococcal infection.

Question 20

69. A 10-year-old boy with anorexia, abdominal discomfort, and vomiting is noted to have marked cardiomegaly on chest x-ray. In addition to jugular venous distention and hepatomegaly, the clinical findings that are most suggestive of congestive heart failure from dilated cardiomyopathy include:

A. Distant heart sounds
B. Pulsus Paradoxus
C. Prominent S3 gallop
D. Prominent S4 sound

Answer 20

C. Prominent S3 gallop
Rationale: The presence of an S3 gallop is a hallmark of heart failure due to volume overload, which is commonly seen in dilated cardiomyopathy. It indicates early diastolic filling of a dilated, noncompliant ventricle. An S4 sound is more associated with stiff ventricles and conditions like hypertrophic cardiomyopathy or longstanding hypertension.

Question 21

70. What palliative surgical procedure is indicated for a patient with pulmonary stenosis, a cyanotic type lesion, who experiences hypoxic spells, frequent polycythemia, and has small-sized pulmonary arteries?

A. Balloon atrial septostomy (BAS)
B. Blalock-Taussig shunt (BTS)
C. Glenn shunt
D. Pulmonary artery banding (PAB)

Answer 21

B. Blalock-Taussig shunt (BTS)
Rationale: The Blalock-Taussig shunt is used in cyanotic heart lesions, such as pulmonary atresia or Tetralogy of Fallot, to improve pulmonary blood flow and oxygenation in patients who have inadequate pulmonary circulation. It is a palliative procedure used to alleviate hypoxic spells and improve oxygen delivery until definitive surgery can be performed.

Question 22

A child with a large ventricular septal defect (VSD), poor feeding, apathy, and tachypnea. What is the most appropriate management?

A. Oxygen therapy
B. Surgical closure of the VSD
C. Propranolol
D. Furosemide
E. Digoxin

Answer 22

D. Furosemide

Rationale: In children with a large VSD, poor feeding, apathy, and tachypnea are signs of heart failure due to pulmonary overcirculation. The most appropriate initial management in this case is to use diuretics such as Furosemide. Furosemide helps reduce the fluid overload caused by the left-to-right shunt, thereby improving symptoms of heart failure by reducing pulmonary congestion and relieving symptoms like tachypnea and poor feeding.

Question 23

A 2-year-old child with minimal cyanosis has an S3 and S4 (a quadruple rhythm), a systolic murmur along the left sternal border, right atrial hypertrophy, and a bundle branch block pattern on ECG. The most likely diagnosis is:

A. Tetralogy of Fallot
B. Pulmonary valve stenosis
C. Ebstein’s anomaly of the tricuspid valve
D. Atrial septal defect
E. Ventricular septal defect

Answer 23

Ebstein’s anomaly is characterized by the downward displacement of the tricuspid valve leaflets into the right ventricle, leading to right atrial enlargement and symptoms like murmurs, quadruple heart rhythm (S3, S4), and ECG findings such as right atrial hypertrophy and bundle branch block.

Question 24

89. Permanent pacemaker insertion is best indicated in one of the following conditions:

A. Patient with surgically induced complete heart block
B. Asymptomatic infants with a heart rate <90 beats/min
C. TOF patients with complete right bundle branch block

Answer 24

A. Patient with surgically induced complete heart block
Rationale: A permanent pacemaker is indicated in patients with surgically induced complete heart block, which can occur after procedures such as VSD repair where the conduction system is damaged. A pacemaker is necessary to maintain a stable heart rate and prevent complications from the complete heart block.

Question 25

90. Which of the following statements regarding tuberculous pericarditis is FALSE?

A. It is developed through retrograde spread from peribronchial or paratracheal mediastinal lymph nodes
B. It may arise through hematogenous spread from primary tuberculosis
C. The end result is constrictive pericarditis
D. It is best treated with continuous drainage of pericardial fluid

Answer 25

D. It is best treated with continuous drainage of pericardial fluid
Rationale: Continuous drainage is not the preferred treatment for tuberculous pericarditis, which often involves fibrinous pericarditis. The treatment of choice may involve pericardiectomy if constrictive pericarditis develops. While pericardial effusion may be drained if significant, continuous drainage is not the recommended approach due to the fibrin deposits typically associated with TB pericarditis.

Question 26

96. What is the most common cause of chest pain in pediatrics?

A. Ischemic
B. Musculoskeletal
C. Chronic cough
D. None of the above

Answer 26

B. Musculoskeletal
Rationale: The most common cause of chest pain in children and teenagers is musculoskeletal, particularly chest wall pain, which includes conditions like costochondritis and muscle strains. These typically result from overuse or minor injuries and are not related to heart problems. Precordial catch syndrome is also a common cause, often presenting as sharp, localized chest pain at rest.

Question 27

98. Which of the following statements regarding the treatment of patients with atrial septal defect (ASD) is accurate?

A. Medical management is advocated first, then surgery for unresponsive cases
B. Medical management is effective in all cases
C. Spontaneous closure is common, watchful observation is recommended into adolescence
D. Surgical or catheter closure for moderate and large ASDs

Answer 27

D. Surgical or catheter closure for moderate and large ASDs
Rationale: For moderate and large ASDs, surgical or catheter-based closure is the recommended treatment. While small ASDs may close spontaneously during childhood, larger defects often persist and require intervention to prevent complications like heart failure or pulmonary hypertension.

Question 28

97. A large ventricular septal defect (VSD) causing pulmonary overcirculation is usually indicated by which of the following symptoms?

A. Fever
B. Poor breathing
C. Chest pain
D. Cyanosis

Answer 28

B. Poor breathing
Rationale: A large VSD can result in excessive blood flow to the lungs, leading to increased pressure in the pulmonary circulation. This results in symptoms such as fast and labored breathing (tachypnea) and difficulty breathing. Larger VSDs may require surgical intervention to prevent further complications like pulmonary hypertension.

Question 29

100. A previously healthy 8-year-old boy cannot walk due to right ankle pain. His left knee was sore and swollen 3 days ago. Findings include a temperature of 39°C, BP 102/64 mm Hg, HR 112 beats/min, and a Grade 3/6 holosystolic murmur at the apex radiating to the left axilla. There is swelling, warmth, and tenderness of the right ankle. The laboratory finding most likely associated with these findings is:

A. Blood culture showing Streptococcus viridans
B. Positive rheumatoid factor
C. Urinalysis showing microscopic hematuria
D. Elevated antistreptolysin O (ASO) titer

Answer 29

D. Elevated antistreptolysin O (ASO) titer
Rationale: The symptoms and findings suggest acute rheumatic fever, which is often preceded by a streptococcal infection. The elevated antistreptolysin O (ASO) titer indicates a recent streptococcal infection. The migratory arthritis (pain moving from one joint to another) and heart murmur suggest carditis, both of which are major criteria for diagnosing acute rheumatic fever.

Question 30

1. You witnessed a 3 year old boy collapse and you are concerned that he may be in cardiac arrest. Which of the following is the correct order of steps in the initial management of child in cardiopulmonary arrest?
   a. Open the airway, check for pulse, administer rescue breaths and start chest compressions
   b. Check the pulse, open the airway, start chest
   compression and administer rescue breaths
   c. Check for breathing and pulse and start chest compression
   d. Open the airway administer rescue breaths, start chest compression and check for pulse

Answer 30

c. Check for breathing and pulse and start chest compression.

In a child suspected of being in cardiac arrest, the first step is to check for breathing and pulse. If there is no breathing or pulse, immediate chest compressions should be started.

Question 31

2. A 3 year old boy was involved in a vehicular accident and he sustained traumatic brain injury. On examination, he is unconscious, but open his eyes, to pain and also has abnormal flexion of his extremities to pain. He does not cry but rather grunts on stimulation. What is his Glasgow coma score?
   а. 3
   b. 5
   c. 7
   d. 9

Answer 31

c. 7

The Glasgow Coma Scale (GCS) assigns points based on three criteria: eye opening, verbal response, and motor response.
Eye opening to pain: 1 point.
Verbal response (grunting, not crying): 2 points.
Motor response (abnormal flexion to pain): 4 points.
Total = 1 (eye) + 2 (verbal) + 4 (motor) = 7.

Question 32

3. Best method to do chest compression among infants who had cardio pulmonary arrest with 2 or more rescuers:
   a. Two fingers in the center of the chest
   b. Two thumb-encircling hands in the center of the chest
   c. Two Hands on the lower half of sternum
   d. One hand on the lower half of the sternum

Answer 32

b. Two thumb-encircling hands in the center of the chest.

The two thumb-encircling hands technique is recommended for infants during CPR when two rescuers are available, as it provides better support and compresses the chest more effectively.

Question 33

1. A 10-year-old girl underwent surgical repair of coarctation of the aorta 3 years ago and followed up in OPD clinic for evaluation. On examination, BP on the right upper arm 170/85 mm Hg, 02 sat 97%. You heard a systolic ejection murmur throughout the precordium. The girl is otherwise asymptomatic. Which of the following is the most appropriate next step in management?
   A. Ask patient to follow-up after 6 months for reevaluation
   B. Check the BP and peripheral pulses in all extremities
   C. Refer immediately to CVS surgery
   D. Do 2D-Echocardiography to rule out bicuspid aortic valve

Answer 33

B. Check the BP and peripheral pulses in all extremities
Rationale: Checking BP and peripheral pulses in all extremities helps assess for recoarctation or residual gradients, which are common complications after coarctation repair.

Question 34

2. A 1 month old infant presents to OPD clinic for evaluation of heart murmur. The infant is otherwise well, thriving and growing normally. 02 sat is 98% at room air. A Grade 4/6 pansystolic murmur with thrill at the LMSB on auscultation.
   Femoral pulses are normal. You suspect small VSD. Which of the following statements about the infant’s condition is accurate?
   A. Refer to CVS surgery for open heart surgery
   B. The murmur may disappear and spontaneously close without intervention
   C. Eisenmenger syndrome will eventually develop
   D. CHF will develop without intervention

Answer 34

B. The murmur may disappear and spontaneously close without intervention
Rationale: Small ventricular septal defects (VSDs) often close spontaneously without the need for surgical intervention, especially when the infant is thriving and asymptomatic.

Question 35

3. Which of the following congenital heart disease as the only cause of cyanosis in the newborn period that manifests with left axis deviation (LAD) and left ventricular hypertrophy
   (LVH) on electrocardiogram (ECG)?
   A. TOF with PS
   B. TOF with PVA
   C. Tricuspid valve atresia
   D. Truncus arteriosus

Answer 35

C. Tricuspid valve atresia
Rationale: Tricuspid atresia presents with left axis deviation (LAD) and left ventricular hypertrophy (LVH) on ECG. It is the only congenital heart defect presenting with these features along with cyanosis in the newborn period.

Question 36

4. A newborn is diagnosed with congenital heart disease. You counsel the family that the risk of CHD after birth of one affected child is
   A. 1.5%
   B. 2-4%
   C. 6-10%
   D. 15%

Answer 36

B. 2-4%
Rationale: The risk of congenital heart disease (CHD) in subsequent pregnancies after one affected child is approximately 2-4%.

Question 37

5. Egg-shaped or oval configuration of the heart is characteristic radiographic picture of:
   A. Tricuspid valve atresia
   B. Truncus arteriosus
   C. Transposition of great arteries
   D. Tetralogy of Fallot

Answer 37

C. Transposition of great arteries
Rationale: Transposition of the great arteries (TGA) shows an “egg-shaped” or oval configuration of the heart on chest radiography due to the narrow mediastinum and enlarged right atrium.

Question 38

For children with rheumatic fever without residual valvular disease, the recommended duration of secondary prophylaxis against recurrence is:
a. 2 years
b. 5 years
c. 10 years
d. 15 years

Answer 38

b. 5 years

Rationale: For children with rheumatic fever without residual valvular disease, the recommended duration of secondary prophylaxis is 5 years or until age 21, whichever is longer. The goal is to prevent recurrence of acute rheumatic fever, which can lead to more severe cardiac complications.

Question 39

The most serious major manifestation of acute rheumatic fever that leads to significant morbidity and mortality is:
a. Cardiac involvement
b. Joint involvement
c. Skin involvement
d. Central nervous system (CNS) involvement

Answer 39

a. Cardiac involvement

Rationale: Cardiac involvement (pancarditis) is the most serious major manifestation of acute rheumatic fever, as it can lead to permanent damage to the heart valves, resulting in rheumatic heart disease (RHD). This complication is associated with significant morbidity and mortality due to the risk of heart failure, valvular dysfunction, and other cardiac complications.

Question 40

The mechanism of tissue injury responsible for the major clinical manifestations of acute rheumatic fever (ARF) is:
a. Bacteremia
b. Immunologic reaction
c. Invasion of the heart valves by the streptococcus
d. Exotoxin production by the streptococcus

Answer 40

b. Immunologic reaction

Rationale: The major clinical manifestations of ARF result from an immunologic reaction to a preceding Group A streptococcal (GAS) pharyngitis. The immune system produces antibodies that cross-react with human tissues (molecular mimicry), leading to inflammation and tissue damage, particularly affecting the heart, joints, skin, and central nervous system.

Question 41

In early childhood, the most likely cause of purulent pericarditis is:
a. Haemophilus influenzae type B
b. Streptococcus pneumoniae
c. Streptococcus viridans
d. Staphylococcus aureus

Answer 41

d. Staphylococcus aureus

Rationale: The most likely cause of purulent pericarditis in early childhood is Staphylococcus aureus. Acute bacterial pericarditis is often suppurative and can occur as a complication of septicemia or through direct spread from infections such as pneumonia or osteomyelitis. Staphylococcus aureus is a common and aggressive pathogen that can lead to life-threatening purulent pericarditis, especially in pediatric patients.

Question 42

The most common immediate valvular heart lesion resulting from acute rheumatic fever is:
a. Mitral stenosis
b. Mitral regurgitation
c. Aortic regurgitation
d. Aortic stenosis

Answer 42

b. Mitral regurgitation

Rationale: The most common immediate valvular heart lesion resulting from acute rheumatic fever is mitral regurgitation. Acute rheumatic fever causes inflammation of the mitral valve, leading to valvular insufficiency (regurgitation). Mitral stenosis develops later as a chronic complication due to scarring and fibrosis of the valve.

Question 43

The most common cause of secondary hypertension in children is:
a. Renal parenchymal disease
b. Congenital cardiac defects
c. Endocrine disorders
d. Thyroid disorders

Answer 43

a. Renal parenchymal disease
Explanation: Renal parenchymal disease is the leading cause of secondary hypertension in children, contributing to 60-70% of cases in pre-adolescents.

Question 44

In the pediatric population, which of the following hypertensive patients should NOT be treated?
a. Patients with target organ damage
b. Patients with secondary hypertension (HTN)
c. Obese adolescents with labile hypertension
d. Patients with persistent hypertension

Answer 44

c. Patients who are adolescents obese with labile HTN
Explanation: Adolescents with labile hypertension (fluctuating BP) are generally managed with lifestyle modifications first, and medication is usually reserved for persistent or secondary hypertension or if there are complications such as target organ damage.