Manifestation of the initial attack of rheumatic fever with carditis may include all Except:

Correct Answer: D

Rationale: Rheumatic fever with carditis often presents with tachycardia, pericardial rub, and heart failure. A harsh systolic murmur at the second right intercostal space is more suggestive of aortic stenosis rather than rheumatic carditis.

Correct Answer: A

Rationale: Dilutional hyponatremia occurs when there is excessive water retention relative to sodium. Conditions like heart failure cause fluid overload, leading to a dilution of serum sodium.

Correct Answer: C

Rationale: A high-grade fever in an asthma patient may suggest pneumonia or another underlying infection, warranting further investigation.

Correct Answer: B

Rationale: Skin testing remains the most reliable method for detecting venom-specific IgE, as it directly assesses cutaneous hypersensitivity responses and is more sensitive than in vitro assays.

Correct Answer: D

Rationale: Rett syndrome primarily affects girls, causing progressive neurological deterioration.