Identify the differences between type 1 and type 2 diabetes in pediatric patients.

Choice A rationale

A tick is the arachnid responsible for transmitting Lyme disease. The characteristic rash associated with Lyme disease is erythema migrans, often described as a "bull's-eye" rash, which can appear days to weeks after a bite from an infected blacklegged tick (Ixodes scapularis or Ixodes pacificus). Spending time in wooded areas increases the risk of tick exposure.

Choice B rationale

Spiders are arachnids, but they are not the primary vector for Rocky Mountain spotted fever. Rocky Mountain spotted fever is caused by the bacterium Rickettsia rickettsii and is transmitted to humans through the bite of infected American dog ticks (Dermacentor variabilis) or Rocky Mountain wood ticks (Dermacentor andersoni). The rash associated with this disease typically starts on the wrists and ankles and spreads centrally.

Choice C rationale

Mites are arachnids, and certain types cause scabies, a contagious skin infestation characterized by intense itching and a pimple-like rash due to the burrowing of the Sarcoptes scabiei mite into the skin. While hiking in wooded areas could potentially lead to exposure to some types of mites, the rash of scabies has a distinct presentation and transmission pattern different from Lyme disease.

Choice D rationale

Chiggers are also mites (arachnids) that can be found in wooded areas. Their bites cause chigger dermatitis, characterized by intensely itchy red welts or bumps where the larvae have attached to the skin. While the history of hiking is relevant to potential exposure to chiggers, the rash and the associated disease are distinct from the erythema migrans rash of Lyme disease. .

Choice A rationale

Nephrotic syndrome typically has a gradual onset of symptoms, developing over days to weeks, as protein loss in the urine accumulates. An abrupt onset is less characteristic.

Choice B rationale

Proteinuria, the presence of abnormally high levels of protein in the urine (normal range is less than 150 mg/24 hours), is a defining characteristic of nephrotic syndrome. Damage to the glomeruli in the kidneys leads to increased permeability and leakage of protein into the urine.

Choice C rationale

Hypoalbuminemia in the blood (normal range is 3.5 to 5.5 g/dL) is a key feature of nephrotic syndrome. The excessive loss of protein in the urine leads to a decrease in serum albumin levels.

Choice D rationale

Fever is not typically a primary symptom of nephrotic syndrome. While children with nephrotic syndrome can develop infections, fever is not a direct consequence of the underlying kidney dysfunction.

Choice E rationale

Hyperlipidemia, an elevated level of lipids (fats) in the blood (normal total cholesterol is less than 200 mg/dL), is commonly associated with nephrotic syndrome. The liver increases lipoprotein synthesis in response to the decreased serum albumin levels.

Choice F rationale

While a positive Group A beta-hemolytic streptococcal infection can lead to post-streptococcal glomerulonephritis, which can sometimes present with nephrotic features, it is not a common finding directly associated with the primary diagnosis of nephrotic syndrome itself.

Choice G rationale

Anasarca, which is severe generalized edema characterized by widespread swelling due to fluid retention, is a common finding in nephrotic syndrome. The low serum albumin levels reduce oncotic pressure in the blood vessels, leading to fluid shifting into the interstitial spaces. .