A 4 years old boy presents with low grade fever and malaise. Throat examination reveals a grayish white membrane which is tightly adherent and bleeds on an attempt to remove. The most likely diagnosis is:

Correct Answer: B

Rationale: The correct answer is B) Diphtheria. Diphtheria is a serious bacterial infection caused by Corynebacterium diphtheriae. The grayish white membrane seen in the throat is a classic hallmark of diphtheria. This membrane is tightly adherent and can cause bleeding if attempted to be removed. A) Acute Follicular tonsillitis typically presents with inflamed and enlarged tonsils with pus-filled pockets, not with a grayish white membrane. C) Herpetic infection would present with vesicles or ulcers in the throat and is usually painful, unlike the description given in the question. D) Infectious mononucleosis is characterized by symptoms like fever, sore throat, and swollen lymph nodes, but it does not typically cause the formation of a grayish white membrane in the throat. In an educational context, it is crucial for healthcare providers, especially those working with pediatric populations, to be able to recognize the classic presentations of various diseases. Understanding the key clinical features of diphtheria, such as the characteristic membrane formation in the throat, is essential for making an accurate diagnosis and initiating appropriate treatment promptly, which can be life-saving in cases of diphtheria.

Correct Answer: A

Rationale: The correct answer is A) Only the affected kidney will be removed. In the case of a child with Wilms tumor, which is a type of kidney cancer typically found in children, the standard treatment involves surgical removal of the affected kidney while preserving the healthy kidney whenever possible. This approach aims to effectively treat the cancer while maintaining kidney function and reducing the risk of complications like renal failure. Option B) Both kidneys will be removed is incorrect because removing both kidneys would result in complete loss of kidney function, leading to the need for dialysis or kidney transplantation to sustain life. This is an extreme measure reserved for specific conditions where both kidneys are severely compromised. Option C) Only the tumor mass will be excised is incorrect as Wilms tumor treatment typically involves removing the entire affected kidney to ensure complete removal of the cancerous tissue and reduce the risk of recurrence. Option D) The tumor is removed, and a biopsy of the unaffected kidney is done is also incorrect because in the case of Wilms tumor, the focus of surgery is on removing the affected kidney rather than performing a biopsy on the healthy kidney. Biopsies are usually done on suspicious tissues to confirm a diagnosis, not on healthy organs. In an educational context, understanding the appropriate surgical approach for Wilms tumor is crucial for healthcare providers working with pediatric patients. This knowledge ensures the best possible outcome for the child by following evidence-based treatment guidelines and preserving renal function whenever feasible. It also highlights the importance of tailored treatment plans based on the specific diagnosis and individual patient needs in pediatric oncology.

Correct Answer: B

Rationale: In a child with hepatitis, it is crucial to offer easily digestible and gentle foods to prevent further stress on the liver. Option B, clear liquids such as broth and Jell-O, is the most appropriate choice because these foods are light, easily digestible, and provide hydration without overloading the liver. Broth is rich in nutrients and helps maintain electrolyte balance, while Jell-O provides a source of energy without being too heavy. Option A, a tuna sandwich on whole-wheat bread and skim milk, may be too heavy and difficult to digest for a child with hepatitis. The protein in tuna and the fat in milk could strain the liver, which is already compromised due to hepatitis. Option C, a hamburger, French fries, and a diet soda, is high in fat, salt, and processed ingredients, which can be challenging for the liver to process and may exacerbate symptoms of hepatitis. Option D, a peanut butter sandwich and a milkshake, contains high-fat foods that may be difficult for a liver with hepatitis to metabolize. The rich content in peanut butter and milkshake can be taxing on the liver and should be avoided. Educationally, it is important for healthcare providers and caregivers to understand the dietary considerations for children with hepatitis to support the liver's recovery and overall health. Providing appropriate foods can help manage symptoms, promote healing, and prevent further complications in pediatric patients with hepatitis.

Correct Answer: B

Rationale: The correct answer is B) fathers. In cases of physical abuse towards children, research shows that fathers are more likely to cause serious injuries such as head or abdominal trauma. This is due to various factors including physical strength, aggression tendencies, and historical societal roles that have attributed more physical discipline to fathers. It is important to recognize this trend in order to effectively address and prevent child abuse. Option A) mothers are less likely to inflict serious physical injuries compared to fathers. While mothers can also engage in child abuse, severe physical harm is statistically more common with fathers. Option C) old brothers are not as commonly associated with serious physical abuse towards children as fathers are. Typically, older siblings may engage in rough play or minor conflicts, but the likelihood of causing serious injuries like head or abdominal trauma is lower. Option D) grandmothers are also less likely to inflict serious physical harm on children compared to fathers. While grandparents may play a role in caregiving, the statistics and research point towards fathers as being more prone to causing severe injuries. Educationally, understanding the patterns and risk factors of child abuse can aid healthcare professionals, educators, and social workers in early identification, intervention, and prevention strategies. By recognizing the higher risk posed by fathers in causing serious physical harm to children, appropriate support and resources can be directed towards at-risk families to ensure the safety and well-being of children.

Correct Answer: C

Rationale: The correct answer is C) etoposide. Etoposide is known to be associated with secondary acute myelogenous leukemia (AML) as a long-term complication of its use in cancer therapy. Etoposide can cause damage to the DNA of hematopoietic stem cells, leading to the development of AML later on. A) Cyclophosphamide is not typically associated with secondary AML as a long-term complication. B) Vincristine is not known to cause secondary AML. D) Doxorubicin is not commonly associated with secondary AML. In an educational context, it is essential for healthcare providers to be aware of the potential long-term side effects of chemotherapeutic agents. Understanding the specific risks associated with each drug can help in making informed decisions when selecting treatment options for pediatric patients. Monitoring for late effects, such as secondary malignancies, is crucial in survivorship care for pediatric oncology patients.