543 Pediatric ?s
What causes hyaline membrane disease? (multiple) a. decrease surfactant production b. surfactant inactivation c. increase in surfactant production d. over activation of surfactant
a. decrease surfactant production b. surfactant inactivation
Which of the following must be met to consider that epilepsy has resolved? (multiple) a. remain seizure free for 10 yrs b. must not need to be on any seizure meds for last 5 yrs c. remain seizure free for 5 yrs d. must not need to be on any seizure meds for last 10 yrs
a. remain seizure free for 10 yrs b. must not need to be on any seizure meds for last 5 yrs
What is the MC presenting sign of necrotizing enterocolitis? a. vomiting b. abdominal distention c. presentation of abdominal contents outside abdomen d. bulging fontenells
abdominal distention
5 yo boy is brought to your office due to pallor and frequent ecchymosis. His mom noted that her son always has bruises on his body and will deny any episode of trauma. He was also noted to be pale which she attributes to having decreased appetite. 3 weeks ago, he had an episode of acute viral infection and had not yet fully recovered. CBC shows evidence of anemia & thrombocytopenia. Peripheral smear shows presence of blast cells. What is the most likely dx?
acute lymphoblastic leukemia (ALL)
A 17 yo girl was brought to the urgent care clinic with concerns of fever & chills for 4 days, N/V and back pain. She denies chest pain, cough or urinary sx. She had 2 episodes of diarrhea yesterday & vague abdominal discomfort. She has no other significant PMHx and doesn't take any meds. On exam, she has a fever of 102.4F, HR 110, BP 110/60. Lungs are clear and heart sounds are normal. There is mild left flank tenderness and tenderness in the left costovertebral angle. CXR & EKG are normal. UA shows increased WBC, + RBCs and no casts. What is the most likely dx?
acute pyelonephritis
An 18 yo woman comes to the clinic because she has yet to begin her period. Medical hx shows a heart murmur from when she was an infant. Family hx is significant for menarche at the age of 13 in bother her mother and sister. PE shows a mostly flat chest with minimal breast tissue, sparse pubic hair and normal external female genitalia. An US shows a normal appearing uterus. A serum FSH concentration is 58 mIU/mL (elevated). What is going on with this pt?
Turner's syndrome
Which of the following dx techniques is most useful in newborns to dx hip dysplasia? a. x-ray b. CT c. US d. MRI
US
A 3 month-old female is brought by her mom for a routine PE. The pt's mom has no complaints. On exam, you note a well-developed, well-nourished infant in no apparent distress. There is no cyanosis noted. Heart exam reveals a normal S1 with a physiologically split S2. There is a grade 3/4 high-pitched, harsh, pansystolic murmur heard best at the 3rd & 4th left intercostal spaces with radiation across the precordium. What is the dx? What is the initial dx study of choice in this pt?
VSD echocardiogram
What is the MC tx for indirect hyperbilirubinemia?
phototherapy
A 3 hr old female infant becomes cyanotic and tachypneic after her 1st feeding. Temp 98.6F, HR 110, RR 65, BP 80/50mmHg, O2 80% RA. PE shows central cyanosis but is otherwise normal. Arterial blood gas analysis on RA shows Po2 30mmHg (low). Her airway is stable and an echo was obtained. What is the dx? What is the most appropriate 1st step in the management of this pt's condition?
transposition of the great vessels
An 8 month old male is brought to the ED because of fever, irritability and decreased feeding for 3 days. He has also had 2 episodes of vomiting. UA tests + for nitrates and leukocyte esterase. The pt is started on abx and a voiding cystourethrogram is obtained the following week, which shows grade 2 vesicoureteral reflux. What is the next step in management?
treat infection and surveillance
What dx study is necessary to confirm the dx of osteosarcoma? a. tissue sampling b. x-ray c. CT scan d. gross tumor pathology
tissue sampling
Annual BP determinations should be obtained beginning at the age of a. 3 yrs b. 5 yrs c. 12 yrs d. 18 yrs
3 yrs
How many weeks post-conception can be considered chronic lung disease in a newborn? a. 30 b. 32 c. 34 d. 36
36
Pinworm infection can resolve on its own if there is no host auto-infection. How long does the infection take to resolve if not given medication?
4-6 weeks
Which of the following is the recommended age range for the 1st or initial MMR vaccination? a. 2-4 months b. 12-15 months c. 4-6 years d. 11-12 months
12-15 months
What is the incubation period of varicella?
14-16 days
How many HAs does a child have to have in a month to be considered chronic?
15
A newborn weights 8 lbs at birth. On average, what should the infant weigh at 1 yr of age? a. 16 lbs b. 20 lbs c. 24 lbs d. 28 lbs
24 lbs
A 2 yo female presents with purulent nasal discharge bilaterally with fever and cough for 4 days. Her mom had taken her out of daycare for a similar occurrence 1 month ago that was treated with amoxicillin. Exam further reveals halitosis and edema over sinuses. What is the best tx for this child?
Augmentin dx = bacterial sinus infection
Detecting Brushfield's spots in the irises strongly suggests which of the following? a. blindness b. Down syndrome c. Gaucher disease d. Klinefelter's syndrome
Down syndrome
You are working in an OB/GYN office and review an ultrasound that shows increased nuchal thickness of the fetus. You notify the mother to be and ask her to come in for an alpha-fetoprotein test. What condition do you suspect?
Down syndrome
Every child with new onset of unprovoked seizures should be evaluated with which of the following? (multiple) a. EEG b. MRI c. CT d. US
EEG & MRI
In examination of a male child who you suspect of having an autistic spectrum disorder, you note a long face and prominent ears. Which inherited disorder would you want to rule out?
Fragile X syndrome
What test/sign suggests that there is developmental dysplasia in the hip?
Galeazzi test
An 18 yo male presents to your office for a screening PE for college lacrosse team. He reports no medical issues and doesn't take any meds. PE is unremarkable. His immunizations are up to date and he denies substance abuse and sexual activity. Review of routine labs reveals an elevation in unconjugated bilirubin. Liver enzymes, serum electrolytes and CBC are within normal limits. Conjugated bilirubin is within normal limits as well. What is the most likely dx?
Gilbert Syndrome
Name the sign that is a classic PE finding in muscular dystrophy and results from weakness in the child's proximal hip muscles.
Gower sign
The mom of a 1 week old child comes to clinic concerned. She reports that her baby boy seems to be constipated. The baby's diet consists solely of his mother's milk. Abdominal distention is clearly visible. Apart from this, the baby appears healthy. X-ray films of the abdomen show markedly dilated loops of small bowel & colon above and a constricted loop below. Which of the following is the most likely dx?
Hirschsprung's disease
A 2 yo male is brought to the ED due to acute abdominal pain. The child has not had a bowel movement in 2 days. The abdomen is distended and tender and bowel sounds are absent. The boy is taken to surgery. What is the dx?
Intussusception
A 2 yo boy is seen in the office with a 5-day hx of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips & cervical adenopathy. ASO titer and throat culture are negative. What is the dx? What is the most serious systemic complication associated with this disorder?
Kawaski's disease aneurysms (septo-cardiac)
16 yo male presents with decreased body hair & gynecomastia. On PE, the pt is noted to be tall & thin, with a wide arm span. Genital exam reveals a small penis & small, soft testicles. Which of the following is the most likely dx? a. trisomy 18 b. Turner's syndrome c. Fragile X syndrome d. Klinefelter's syndrome
Klinefelter's syndrome
A 15 yo boy is seen by his primary care physician for delayed sexual changes during puberty. Upon PE, the physician notes an overall normal appearance with small testes, some gynecomastia. Behaviorally the pts seems shy and reserved with occasional social outbursts. Although his is tall for his age, he is uncoordinated and inactive. A karyotype is done and found to contain an extra chromosome. What is the most probable dx for this child?
Klinefelter's syndrome
An 18 yo man comes to the university health clinic with a very sore throat and HA. He has had severe pharyngitis for about 12 days. He has felt exhausted with decreased appetite for 3-4 weeks. On palpation, his spleen is slightly tender and moderately enlarged. At this point, what is your suspected dx and what test can confirm the suspected dx?
Mononucleosis Monospot
You have been following a 4 month old infant for GERD. He was born full-term w/out any prenatal or delivery complications. He has been bottle fed since birth because the mom didn't feel she had the time to nurse the baby. He began spitting up with almost every feeding shortly after birth. The emesis is non-bilious and non-projectile and occurs within 5-10 mins after feedings. His birth weight was 75th % with height at 50th %. Currently his weight is 50th % and height 50th %. Labs are normal and newborn screening tests were negative. An upper GI series was done & was normal. What tx is most appropriate?
PPI
A 7 yo pt presents with an abrupt onset of fever, chills, malaise, muscular aching, HA & nasal stuffiness. The pt is taking 2 baby aspirin every 6 hrs for fever, muscle aches and HA. Which of the following complications is the pt most at risk for?
Reyes syndrome
A 1 yo boy is brought to your clinic by his mom. She is worried because he had a fever for the past 2 days of 102F. He has not had a fever today but developed a rash. On exam, the child's temp is 98F and there is a diffuse maculopapular rash on the chest, abdomen and thighs. The rash spares the face, palms & soles. The child doesn't have an cough, congestion or a runny nose. PE is otherwise normal. What should you tell the mom about the dx and prognosis. What further testing, if any, is needed?
Roseola Infantum (6th dx) excellent prognosis that resolves spontaneously w/out complications dx made clinically
What is the 1st line management of mild chronic asthma in a child?
SABA
At what age should the 1st hepatitis B vaccine be administered? a. birth b. 1 month c. 4 months d. 6 months
birth
A 3 yo girl presents with progressive abdominal enlargement associated with abdominal pain & occasional vomiting. PE shows a palpable mass over RUQ extending to right flank. She looks pale and her BP is slightly elevated. UA shows microscopic hematuria. What is the most likely dx?
Wilms tumor
You should never give child <1 yo honey as id could cause what?
botulism
Following an uncomplicated PG, a 34 yo female gives birth to 2nd child, a healthy boy. 2 days after birth, the mom develops a low-grade fever and vesicular lesions on her face & abdomen. Hx reveals an outbreak of chickenpox in her 2 yo daughter's daycare facility. The mom is dx with chickenpox. What is the best management of the newborn?
acyclovir
Which of the following are signs of meconium aspiration? (multiple) a. greenish coloring of skin b. bluish coloring of skin c. respiratory distress d. dark green streaks in amniotic fluid
all of the above
Which of the following is key in treating hyaline membrane disease? (multiple) a. oxygen administration b. early intubation c. surfactant replacement d. CPAP
all of the above
Which of the following may be seen with brachial plexus injury? (multiple) a. shoulder dystocia b. horner syndrome c. erb palsy d. klumpke palsy
all of the above
A 2 yr boy is brought to the office by his mother because of complaints of fever & ear pain. He began tugging on his ear and complaining of pain 3 days ago. The mom reports a temp of 100F this morning with decreased appetite. Current temp is 101.4F. ENT exam shows erythema and decreased mobility of the right TM. What is the most appropriate pharmacological management?
amoxicillin
A 16 yo boy is brought to the ED with sudden abdominal pain that started at school. He vomited 3x in the past 3 hrs. The pain is initially in the central abdomen around the umbilicus w/out radiation and then becomes more vaguely centered in the RLQ of the abdomen. Vitals show temp 101F, BP 110/72, HR 106. Chest exam is normal. Abdominal exam is + for RLQ tenderness with rebound and hypoactive bowel sounds. Abdominal x-ray shows non-specific bowel dilatation. What is the most likely dx?
appendicitis
Which of the following is the tx of choice for Kawaski's disease? a. methotrexate b. prednisone c. penicillin d. aspirin
aspirin
A 4 yo pt presents with episodic wheezing and a non-productive cough for the last 4 weeks. His sx are worse at nigh. PMH reveals a hx of atopic dermatitis. PE at this time is unremarkable. Which of the following is the most likely dx?
asthma
A 2-month old infant presents for a routine health maintenance visit. The mother has been concerned about the infant's hearing since birth. PE reveals no apparent response to a sudden loud sound. Which of the following is the most appropriate dx evaluation? a. audiometry b. tympanometry c. acoustic reflectometry d. auditory evoked potentials
auditory evoked potentials
What finding on immunohistological staining of leukemic cells indicates a dx of acute myeloblastic leukemia? a. 25% blasts in bone marrow b. auer rods c. sheets of undifferentiated cells with hyperchromatic nuclei d. striated muscle cells
auer rods
An 8 yo boy present to the office w/ his parents for an evaluation of his bedwetting. He is being teased about his bedwetting on overnight outings. He has never had a prolonged period of dryness at night. He has no wet accidents during the day and has not had difficulties w/ constipation or stool incontinence. He is on no meds and PMH is unremarkable. PE is normal. Which of the following interventions is likely to affect a long-term resolution of his bedwetting most effectively? a. fluid restriction b. bedwetting alarm c. imipramine d. desmopressin acetate
bedwetting alarm
The mother of a 14 yo girl came to the OB/GYN clinic w/ concerns because her daughter has not had her 1st menstrual period yet. She has no other health problems on hx. Her mother said that she is a little bit slow and goes to special education classes. On exam, the pt is 4ft 5in tall, her neck skin shows folds on the side as webs, her breasts are not fully developed and her nipples are widely separated. On listening to her heart, no murmurs are detected. The lower limb pulse is weaker than the upper extremities pulse. What is the most probably cause of the feeble pulse in the lower limbs? What inherited disorder does she most likely have?
coarctation (narrowing) of the aorta commonly associated with Turner's syndrome
You are seeing a 2 month old infant for his well-baby assessment. He had a normal birth hx and has been growing well. The mother nursed him for 3 weeks and then switched to formula due to nipple soreness. A week later, he became very fussy, crying nonstop for more than 3 hrs a day usually in the evening. He does this just about every day according to the mom. The crying doesn't seem to be related to the feedings and there is no V/D. He has not been sick or congested and has normal stools and wet diapers. He does seem gassier during these crying episodes and is inconsolable despite holding and rocking him. The mother is becoming frustrated and anxious and has 2 toddlers at home too. His vitals and PE are normal. What is the dx? What is the most appropriate management/recommendations?
colic supportive tx
An afebrile 2 yo female presents with a 3 day hx of foul smelling, blood-tinged, mucoid drainage from the left nostril. Which of the following is the most likely dx?
nasal foreign body
Upon inspection of a 16 yo male pt's scrotum, you note that the left side is undeveloped and a testis is not palpable. There is no scrotal tenderness, swelling or nodularity. What is the most likely dx? What does a pt with this condition have a higher risk of developing?
cryptorchidism increased risk of testicular cancer
A 12 month old child with tetralogy of Fallot is most likely to have which of the following clinical features? a. chest pain b. cyanosis c. convulsions d. palpitations
cyanosis
All intraventricular hemorrhages occur by which of the following? a. day 1 b. day 2 c. day 3 d. day 4
day 4
A 3 yo boy presents to ED in acute respiratory distress. The pt had a body temp of 104F. RR 70 & HR 130. Auscultations of lungs are unremarkable. An exam of the throat reveals an exudate in the posterior pharynx that is grey-yellow in color and membranous. Bleeding occurred when it was scraped and removed. The child has had no immunizations. A throat culture is ordered. Knowing that those results will take a few days, what is the next step in management at this point?
diphtheria antitoxin & abx
Which of the following is the most severe form of hip dysplasia? a. dislocatable hip b. dislocated hip c. subluxatable hip d. acetabular dysplasia
dislocated hip
A 10 yo boy present w/ his mother to outpatient clinic. Both parents have type-2 DM and mother is concerned about the likelihood of her son developing DM and would like to prevent it. The child's weight is 85th percentile. His last serum glucose was normal for his age. What is the next step for this child? a. weight loss program involving low-calorie, high protein diet b. encourage sports & physical activity and refer to pediatric dietician c. start an anti-obesity agent to reduce risk of diabetes d. there is nothing to do at this point since his serum glucose level was normal
encourage sports and physical activity and refer to pediatric dietician
A 5 yo male is brought to the office by his father who reports a 2 day hx of low grade fever & coryza. The child awoke this morning with bright red cheeks. PE reveals edematous confluent plaques over the malar region of the face and reticular rash over the child's extensor surfaces. What is the most likely dx?
erythema infectiosum aka 5th disease caused by parvovirus B19
A woman gives birth to an apparently healthy 8lb baby girl. During her 1st feeding attempt, choking, coughing and cyanosis occur. Historically, the mom had polyhydramnios during her PG. Which dx is the most likely explanation for the newborn's distress?
esophageal atresia
Which of the following is the MC seizure in children? a. generalized b. tonic clonic c. febrile d. absence
febrile
A 19 yo woman has been consuming up to 6 beers daily since she was 16. She is now PG with her 1st child, has had little prenatal care and is due to deliver in 4 weeks. What neonatal problem should you anticipate?
fetal alcohol syndrome
Which vitamin has shown to reduce the risk of spina bifida when taken prenataly?
folate
A newborn male infant with Down syndrome is born at 38 weeks gestation. His Apgar scores at 1 & 5 mins are both 8 with scores of 1 for acrocyanosis and irregular breathing. He passes meconium several hrs later. Between 24 & 48 hrs after birth, the infant has multiple episodes of vomiting despite lack of feedings and doesn't have additional bowel movements. Vomitus is bilious and non-bloody. On PE, the infant is crying he appears jaundiced and his abdomen is distended. An abdominal x-ray is performed and shows a "double bubble" sign. Which is the 1st step in the management of this pt?
gastric decompression with NG tube dx = duodunal atresia
In February of this year, an 11 month old boy presents to your clinic after 2 days of vomiting, diarrhea and fever. Temp is office is 104F. Clinically he is significantly dehydrated and you decide to admit him to your services. WBC is normal. His stool and urine are negative for WBCs. What is the most likely dx?
gastroenteritis
The mother of a 3 yo boy asks to have a blood test done on her son for lead poisoning. They moved into an older home built in 1940. She noticed some paint peeling on windowsills and doors and has seen small paint chips on the floor. They are now having the house repainted and staying with relative. His finger-stick blood lead level comes back at 13 mcg/dL (normal 0-4). Which additional management should be done at this level?
get venous confirmation testing in 1 week to 1 month & get case management involved
A 5 yo boy comes to the ED because of fever, severe abdominal pain & bloody diarrhea for 4 days. He has no allergies and isn't taking any meds. Medical hx is non-contributory. Exam shows diffusely tender abdomen and purpura covering his lower extremities. Labs show anemia, leukocytosis, thrombocytopenia and elevated creatinine. What is the most likely dx?
hemolytic uremic syndrome
A 2 yo girl is seen by her pediatrician because she has had frequent and prolonged bilateral nosebleeds. There is a family hx of a bleeding disorder. Bleeding time is increased but platelet count and clotting time are normal. Coagulation factor assays show slight decrease in factor 8 but normal factor 9 levels. What is the most likely dx for this family?
hemophilia A
Which of the following is the MC cause of respiratory distress in preterm infants? a. hyaline membrane disease b. chronic lung disease c. canal atresia d. meconium aspiration
hyaline membrane disease
If a PG woman is infected with Parvovirus B19, what complication can develop in the baby?
hydrops fetalis
An 8 yo male presents w/ pain in his legs after exercise. PE reveals radial-femoral pulse delay and BP in the lower extremities is 15mmHg lower than in the upper extremities. Which of the following lab or radiological findings would be most commonly noted in this pt? a. inferior border rib notching b. decreased hemoglobin c. left atrial enlargement d. transposed aorta and pulmonary artery
inferior border rib notching
Injury to the basal ganglia and brainstem due to high levels of bilirubin is called :
kernicterus
a 15 yo girl is referred to the cardiologist's office for workup of HTN. There is no family hx of heart disease. On PE, BP 140/70 left & right upper extremities, 90/70 left and right lower extremities, HR 85. RR 20. brachial and femoral pulses are incongruent. You note pulsations in suprasternal notch. Cardiac auscultation reveals 3/6 systolic ejection murmur. What would you expect to see on CXR? a. right ventricular hypertrophy & large pulmonary arteries b. left ventricular hypertrophy & a notch in the aorta c. prominence of the aorta, pulmonary artery & left atrium d. increased pulmonary vasculature
left ventricular hypertrophy and a notch in the aorta (coarctation of aorta)
An 8 yo male presents for further workup of a series of development delays & learning disabilities and dysmorphic features. His PMH is significant for delays in motor development, including sitting w/out support at 10 months and walking at 20 months. Academically he is currently struggling with math in school. On exam he displays a long thin face a large jaw and protruding ears. Given this pt's likely dx, what physical finding is he likely to demonstrate following puberty? a. tall stature b. microochidism c. microcephaly d. macroorchidism e. neurofibromas
macroorchidism
An 8 yo boy develops fever & URI. He is evaluated by the pediatric PA who sees blue-gray spots in his mouth near his 2nd molars. A day later, the boy develops a rash on his face. The rash consists of reddened macules & papules. Over time, the rash becomes confluent and moves downward over his body. Desquamation of the rash is not present. What is the most likely dx?
measles
Koplik spots are pathognomonic for which condition?
measles
A 16 yo boy comes to the office because of redness in both eyes and facial swelling for the past 4 days. He has also been experiencing fever and myalgia. He states that he has never had his vaccinations as a young child. PE shows bilateral conjunctival hyperemia, tender parotid glands and swelling and tenderness of his left testicle. Visual acuity exam shows no abnormalities. What is the most likely dx?
mumps
Parotitis occurs in ~70% of symptomatic pts with which infectious disease?
mumps
Which of the following is the MC acquired GI emergency in a newborn? a. necrotizing enterocollitis (NEC) b. omphaocele c. intussusception d. bowel obstruction
necrotizing enterocollitis (NEC)
3 week old male infant presents with recurrent regurgitation after feeding that has progressed to projectile vomiting in the last few days. The mom states that the child appears hungry all the time. She denies any diarrhea in the child. What finding upon palpation of the abdomen can help confirm the suspected dx? a. bile stained vomitus b. hemoccult positive stool c. olive-shaped mass d. sausage shaped mass in upper abdomen
olive-shaped mass
At what point is Hand, Foot and Mouth no longer considered contagious?
once lesions crust over
An infant presents to your office for his 2 week PE. The only abnormal finding on exam is white plaques on the buccal mucosa and palate. When you try to remove the plaques, there are small punctate areas of bleeding. What is the most likely dx?
oral candidasis
3 yo presents w/ profuse watery diarrhea for the past 3 days. The child vomited twice yesterday, but not today. On exam, the child is febrile with HR of 110, RR 18 & BP 60/40mmHg. On exam, the child is alert & responsive with no focal findings. Which of the following is the most appropriate intervention? a. abx therapy b. remove gluten from diet c. IV fluids d. oral rehydration w/ reassurance
oral rehydration w/ reassurance dx = gastroenteritis
A 5 week old boy is seen at the pediatrics department after experiencing multiple long bone fractures. The parents explain the pt has been seen by multiple pediatric orthopedics after 3 fractures in the past week. Child abuse is ruled out & PE is otherwise normal, but a hearing test reveals significant hearing loss. What is the most likely dx in this pt?
osteogenesis imperfecta
PE findings in a 4 yo that included blue sclerae & recurrent fractures indicates which of the following? a. Down syndrome b. Marfan syndrome c. Osteogenesis imperfecta d. Klinefelter syndrome
osteogenesis imperfecta
A month-old infant is brought to the office by her parents because of concerns about poor feeding and little weight gain since birth. She was born at 35 weeks via spontaneous vaginal delivery to a healthy mother following an uncomplicated PG. She appears comfortable with no signs of cyanosis. Her temp is 98.6F, HR 150, RR 45 & BP 105/40mmHg. O2 96% RA. PE shows morphologically normal infant with a soft & flat anterior fontanel. Cardiac exam shows a machinery murmur heard throughout systole and diastole at the left 2nd intercostal space at the sternal border on auscultation. The extremities are well perfused with strong peripheral pulses. What is the most likely dx?
patent ductus arteriosus
An 8 yo boy returned from summer camp 1 week ago and his mom is concerned because he always seems very itchy. She noticed form red dots on his arms and legs today and brings him in for evaluation. PE shows burrow marks on his hands and axilla. What is the best tx?
permethrin dx : scabies
A mother brings her 3-week old infant to the pediatrician's office because he was not back to birth weight at the baby's initial visit or 2-week weight check and she is concerned he is not feeding well. Temp 98F, HR 120, RR 60, BP 90/50mmHg. PE shows the infant is tachypneic, diaphoretic & lethargic. He also has a cleft palate and cyanosis. Based on this info, what is the most likely cause of the pt's presentation?
persistent truncus arteriosus
What is the MC cause of glomerulonephritis in children?
post-strep infection
Which of the following is the best initial tx of choice for a child with nephrotic syndrome? a. prednisone b. ceftriaxone c. dialysis d. hydrochlorothiazide
prednisone
A newborn infant begins vomiting 4 weeks after birth. The mom states that her baby nurses well but forcibly vomits after feeding. He has begun to lose weight. This is her 1st child and she is concerned. On exam, you notice a 2cm palpable firm mass in the abdomen. What is the most likely dx?
pyloric stenosis
A 2 week old infant is admitted to the hospital w/ complaints of abdominal distention, poor feeding and constipation since birth. The mom mentioned that her child passed meconium a few days ago. Rectal exam of child revealed an empty anal canal & rectum. Which of the following would be used to make a definitive dx? a. abdominal x-ray b. barium enema c. manometry d. rectal biopsy
rectal biopsy
A 6 month old infant presents to the clinic because his concerned father noticed "white eyes" in family photos. Ophthalmologic exam shows unilateral white-eye reflexes. The father informs you that as a child, he had a have his left eye enucleated but he is unsure as to the exact reason why. The infant has no other siblings and is otherwise healthy. What is the likely dx? Based on these findings, what type of cancer would this infant be most at risk of developing?
retinoblastoma increased risk of osteosarcoma
A 10 yo male is brought to your office complaining of severe throat pain, fever & chills. This is the 4th day of illness. His body temp is 103.6 F & exam of his throat reveals an intensely red inflamed throat with patchy spots. A rapid strep test is +. ASO titer is significantly elevated. The pt also has lesions on his back and trunk that are evanescent and raised. What is the dx? What is the name of the rash?
rheumatic fever erythema marginatum
Which of the following is definitive tx for coanal atresia? a. placement of nasal tube b. placement of stent c. surgery d. no definitive tx
surgery
A 2 yo boy is brought to the pediatrician because of weakness and recurrent rectal bleeding. According to his mom, he has been passing 3-4 fluid, maroon and red stools per day and has become progressively more apathetic and withdrawn but never showed signs of abdominal pain, fever, vomiting, diarrhea, jaundice or bleeding from other sources. He has reached all developmental landmarks for his age. Vitals are WNL and PE is normal except for pallor of skin & apathy. CBC shows mild anemia. A small-bowel x-ray shows diverticulum near terminal ileum. What test is used to make a definitive dx?
surgical removal with histopathological confirmation dx = Meckel's diverticulum
A 4 yo male is brought to the ED by his parents because he lost consciousness for a couple of seconds after he cried. His parents tell you that for the last 3 months, they noticed their son turned blue when running and that he usually adopts a position of his chest on his knees to relieve his SOB and recover his normal coloration. PE reveals short stature for his age and clubbing of his fingers & toes. On cardiac auscultation, there is a single component on the 2nd heart sound and a harsh systolic murmur on upper left sternal border. ECG shows RAD. Blood analysis shows elevated hemoglobin and hematocrit. On CXR the heart has a normal size although the apex is elevated from the diaphragm (boot shaped). The lung fields are cellar and pulmonary vascularity is diminished. Which of the following is the most likely dx?
tetralogy of Fallot
A 4 yo presents with a hx of having failed 2 courses of abx therapy for acute otitis media. Initially she was on high-dose amoxicillin for 10 days followed by augmentin. Mother has been complaint with administering the med. Which of the following is the next most appropriate intervention?
tympanocentesis
A 2-day-old is in the neonatal ICU because she was born w/ an abnormal body habitus. She has a short neck, widely spaced nipples and a broad chest. Her height is in the 4th percentile. Which of the following other PE findings is most likely to be present in this child? a. ambiguous genitalia b. cleft palate c. diastolic murmur d. upper extremity HTN
upper extremity HTN
5 month old baby is brought to the clinic by her mother. The baby was born full-term and sent home 2 days after normal vaginal delivery with her mother. The mother is concerned because the baby has increased sweating and fatigue during breastfeeding. As a result of the poor feeding, the mother feels that the baby is not gaining sufficient weight. On exam, a pansystolic (holosystolic) murmur is heard at the lower left sternal boarder. What dx do you suspect?
ventricular septal defect
Which of the following describes a loop in the intestine that twists around itself and the surrounding mesentery and causes an obstruction? a. volvulus b. malrotation c. hirschsprung d. pyloric stenosis
volvulus
Which of the following is a milestone usually achieved by a 15-month old infant? a. walks alone b. puts 3 words together c. feeds self well with spoon d. builds tower of 7 cubes
walks alone