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A 4-Year-Old Boy Is Brought to the Emergency Department for Evaluation

question 371

Multiple Choice

A 4-year-old boy is brought to the emergency department for evaluation of persistent fevers. About 6 weeks ago, the patient developed rhinorrhea, cough, and body aches after returning from a family trip to Costa Rica. Although the other symptoms resolved, he still has intermittent fevers and aches. The fevers tend to spike in the evenings and are accompanied by a pink, nonpruritic rash. Both features completely resolve by morning. The patient has continued to attend preschool because he feels well during the day. However, he has had a fever and rash every evening for the last 5 days. The patient takes no medications. Temperature is 39.1 C (102.4 F) . He appears tired. The oropharynx and bilateral tympanic membranes are normal. Cardiac examination shows tachycardia without murmurs. There are several pink macules at the waist and bilateral axillae. The spleen is palpable 3 cm below the costal margin. There is swelling of both knees and tenderness with deep palpation. Laboratory results are as follows: Which of the following is the most likely diagnosis in this patient?

Definitions:

Political Organization

The way power, as the capacity to do something, is accumulated, arranged, executed, and structurally embedded in society; the means through which a society creates and maintains social order and reduces social disorder.

Uncentralized Political System

A form of governance where power or legal authority is dispersed among various levels of government or organizations rather than being centralized in a single authority.

Large Population

A significant number of individuals belonging to a particular species living within a specified area, which can impact its ecosystem and resources.

Formal Political Power

The officially sanctioned ability to influence or control the actions of others, typically vested in government or organizational leaders.