Rosh Pediatrics Practice Exam

What is the likely diagnosis in a child with persistent symptoms of a rash associated with fatigue and feeding difficulties?

1. Ventricular septal defect

2. Acute rheumatic fever

3. Hemophilia

4. Iron-deficiency anemia

The correct answer is: Ventricular septal defect

The symptoms described—persistent rash, fatigue, and feeding difficulties—suggest a condition that can be linked to systemic issues rather than localized or acute problems. Ventricular septal defect is a congenital heart defect that can lead to heart failure and poor perfusion. This can manifest with symptoms such as difficulty feeding in infants due to fatigue, and the inadequate circulation can contribute to a poor nutritional state, leading to rashes associated with malnutrition or underlying systemic inflammation. In contrast, acute rheumatic fever primarily affects the heart and can present with joint pain and fever, but it is less likely to produce a persistent rash and would not typically be associated with feeding difficulties specifically in a child. Hemophilia, while it can lead to easy bruising and bleeding, generally does not cause rash-like symptoms or feeding issues. Iron-deficiency anemia may lead to fatigue but would not normally be associated with a rash unless there were other coinciding conditions influencing the child’s overall health. Thus, the combination of fatigue, feeding difficulties, and a persistent rash aligns best with the potential systemic impact of a congenital heart problem like ventricular septal defect, making it a plausible diagnosis.