Test and Assessment Qs - Attempt #1

Name common symptoms of infections from each organism below: A) Adenovirus B) E. coli C) G. lamblia D) S. aureus

-Adenovirus is found on hard surfaces and usually affects children < 3 years old in daycare settings. -Undercooked ground beef and leafy greens contaminated with E. coli cause bloody diarrhea. -Giardia is generally contracted from contaminated water, for example, lakes and streams. -S. aureus causes vomiting and diarrhea, but there is no bleeding.

The expected hemoglobin range for sickle cell anemia is: A) 6.5-9.5 g/dL. B) 13.5-16.5 g/dL. C) 8.5-12.5 g/dL. D) 9.5-13.5 g/dL.

A) 6.5-9.5 g/dL. Higher hemoglobins are associated with sickle cell C or sickle thalassemia; those with sickle cell trait have normal hemoglobins.

Asplenic children are at increased risk for which of the following? A) Bacterial infections B) Fungal infections C) Viral infections D) Parasites

A) Bacterial infections Bacterial infections, particularly those with encapsulated organisms, can be life-threatening in asplenic children.

Pain perception first develops in which of the following? A) Fetal life B) Newborn C) Toddler D) Adolescence

A) Fetal life Pain perception develops in fetal life by the end of the second week of gestation.

A foul-smelling vaginal discharge that emits a fishy odor when combined with 10% potassium hydroxide is most likely due to: A) G. vaginalis. B) C. albicans. C) C. trachomatis. D) N. gonorrhoeae.

A) G. vaginalis. BV, often caused by an overgrowth of G. vaginalis, is suspected on the basis of a malodorous vaginal discharge and positive "whiff" test when the discharge is mixed with potassium hydroxide.

Septicemia in the newborn period is most likely caused by which organism? A) L. monocytogenes B) H. influenzae C) N.meningitidis D) Streptococcus pneumonia

A) L. monocytogenes (Listeria)

A 2-year-old is seen 1 week after beginning treatment for a right OM. The toddler was initially improving but now complains of right ear pain and has a fever of 101°F. The most likely diagnosis would be: A) mastoiditis. B) viral illness. C) recurrent OM. D) steatoma.

A) mastoiditis. Classic sign and symptom of mastoiditis is worsening symptoms, such as pain and fever, after initial improvement of an otitis media. Viral illness is possible but less likely to be a cause in this scenario. Recurrent OM is not likely due to demonstrating initial improvement and therefore antibiotic susceptibility and treatment success. A steatoma is painless.

Although relatively rare in the United States, diphtheria can occur among underimmunized children. Which of the following clusters of signs, symptoms, and physical findings would suggest diphtheria in a child presenting with upper respiratory complaints? A) Low-grade fever, sore throat, nasal discharge, and grayish-white pseudomembrane in his or her throat B) Abrupt onset of high fever, severe sore throat, nasal discharge, and grayish-white pseudomembrane in his or her throat space C) Low-grade fever and abrupt onset of severe sore throat, with difficulty swallowing and drooling D) Abrupt onset of high fever, severe sore throat, with difficulty swallowing and drooling

A) Low-grade fever, sore throat, nasal discharge, and grayish-white pseudomembrane in his or her throat

Which of the following is true for idiopathic scoliosis, which occurs primarily in adolescents? A) Mild curves occur equally between the sexes. B) Generally, there is no family history. C) Back pain is usually associated with curves of 35 degrees or greater. D) Bracing is indicated for thoracic curves of 10-25 degrees.

A) Mild curves occur equally between the sexes. The female-to-male ratio increases with increasing curve magnitude. Small curves are equivalent between females and males.

A macular, salmon- to red-colored rash with irregular borders and central clearing is typical of which of the following? A) Systemic juvenile arthritis B) Lyme disease C) SLE D) Rheumatic fever

A) Systemic juvenile arthritis This is the characteristic rash associated with systemic juvenile arthritis that occurs in 25-50% of children. Lyme disease rash is characteristic of erythema at the site of the tick bite with central clearing like a bull's eye. SLE typically has a "butterfly rash" that is most often seen over the cheeks and bridge of the nose and gets worse in sunlight. Rheumatic fever often is associated with erythema marginatum, a nonpruritic, light pink macular rash that is usually on the trunk.

What is the important aspect of the MACRA of 2015? A) The MACRA shifts the fee-for-service reimbursement payment model to a value-based payment plan for Medicare part B providers. B) The MACRA eliminates incident-to billing for APRNs for Medicare Part A. C) The MACRA allows 100% reimbursement of the physician fee schedule for all Medicare Part B providers. D) The MACRA reduces reimbursement to 85% of the usual physician fee schedule for all Medicare Part B providers.

A) The MACRA shifts the fee-for-service reimbursement payment model to a value-based payment plan for Medicare part B providers.

Which of the following is not true with regard to hypospadias? A) The meatus is formed along the dorsum of the penis. B) It is one of the most common penile abnormalities. C) Circumcision should be deferred. D) A referral for an endocrine evaluation may be indicated.

A) The meatus is formed along the dorsum of the penis. The incidence of hypospadias has increased over the past 15 years in Western culture. The meatus of the penis forms ventrally.

A 10-year-old has marked ear pain, not wanting anyone to touch his ear. The canal is edematous, and exudate is present. TM is normal. How should this be managed? A) Topical fluoroquinolone B) Oral steroids and topical neomycin C) Oral amoxicillin and topical anesthetic D) Oral amoxicillin and topical steroid

A) Topical fluoroquinolone This patient has an otitis externa (OE) by the description of the canal (edematous with exudate). One of the most common organisms is Pseudomonas, which is susceptible to the fluoroquinolones. Because the antibiotic needs to be in contact with the canal, topical antibiotics are used. Oral antibiotics, which may be indicated in the treatment of acute bacterial otitis media, are not effective in the treatment of OE. Oral steroids are not indicated for OE. However, topical steroids can be indicated for excessive edema when the canal is blocked and the blockage prevents the instillation of the topical antibiotic.

Which statement is correct about true and incomplete precocious puberty? A) True GnRH-dependent precocious puberty occurs because of hormonal stimulation from the pituitary or hypothalamus and results in gonadal maturation and fertility. B) Incomplete precocious puberty does not involve the development of secondary sexual characteristics. C) GnRH-independent precocious puberty is caused by adrenal or gonadal tumors or dysfunction and results in increased linear growth but no development of secondary sexual characteristics. D) Incomplete precocity leads to testicular enlargement and ovulation.

A) True GnRH-dependent precocious puberty occurs because of hormonal stimulation from the pituitary or hypothalamus and results in gonadal maturation and fertility. True GnRH-dependent precocious puberty happens when the pituitary gland releases gonadotropins, stimulating early development of ovaries in girls and testes in boys and resulting in the production of the female sex hormone estrogen in girls and the male sex hormone testosterone in boys. In GnRH-independent precocious puberty, the development of secondary sexual characteristics is caused by estrogen or testosterone from either the adrenal gland or the gonad, independent of the hypothalamic-pituitary portion of the pubertal axis. Incomplete precocity is usually considered a normal variant that includes premature thelarche and premature adrenarche without advanced linear growth or development of other secondary sexual characteristics. In incomplete precocious puberty, the ovaries or testes do not mature.

A 14-year-old diagnosed with JIA is not up to date on his immunizations and is currently on methotrexate. Which of the following vaccinations would be cautioned in this case? A) Varicella B) Influenza C) Hepatitis B D) Tdap

A) Varicella There is risk of developing serious complications of varicella-zoster infection (VZI) in patients with JIA receiving DMARDs, including methotrexate and biologic agents. Varicella-zoster (VZ) immune status should therefore be checked in all children before starting such therapy. Seronegative children mostly receive varicella zoster vaccine (VZV).

Diagnostic findings inconsistent with β-thalassemia would be: A) hemoglobin—normal. B) reticulocytes—increased. C) Hgb A2 , 3.6. D) hypochromia, microcytosis

A) hemoglobin—normal. Hemoglobin is generally decreased in patients with this condition.

Medicare Part A covers: A) hospital, SNF, and hospice care. B) all medically necessary services. C) SNF care only. D) hospice care only.

A) hospital, SNF, and hospice care.

A 3-year-old has an edematous, mildly erythematous right upper eyelid for 1 day with a fever of 103°F. An important eye assessment would be: A) ocular mobility. B) conjunctival inflammation. C) pupillary reaction. D) optic disc papilledema.

A) ocular mobility. The description given is of an early orbital or periorbital cellulitis. These two disease entities have similarities but are very different with respect to complications and treatment, and early diagnosis is important to prevent morbidity. With orbital cellulitis, ocular mobility is absent or significantly decreased; this is not affected in periorbital cellulitis. This symptom is one of the discriminating factors in determining the diagnosis. None of the other three assessment points would be helpful with diagnosing these two disorders.

A 9-year-old girl complains that she does not like to wear shorts because her knees look funny. Upon examination, you note a genu valgum angle of greater than 15 degrees. You should: A) reevaluate in 1 year if still present. B) consult with an orthopedic specialist. C) instruct her to avoid the "W" sitting position. D) encourage exercise to strengthen the quadriceps.

A) reevaluate in 1 year if still present. Valgus up to 15 degrees is common up through the age of 8-9 years, but persistence beyond that may lead to problems and degenerative changes and warrants referral.

The most common trigger for an acute asthma episode in the very young child is: A) respiratory infections. B) exercise. C) tobacco smoke. D) outdoor allergens.

A) respiratory infections. Although respiratory infections, exercise, tobacco smoke, and outdoor allergens are potential triggers, viral respiratory infections are the most common trigger in the very young child.

Fifth disease is usually: A) seen in children ages 5-14 years old. B) transmitted via the deer tick. C) treated with oral erythromycin. D) characterized by prolonged coughing episodes.

A) seen in children ages 5-14 years old. Fifth disease, or EI, is typically seen in older children, and caregivers need reassurance of the benign nature of the disease.

Describe absence seizures

Absence seizures appear as altered awareness and blank stare, usually appear between the ages of 4 and 8 years, and the cause is predominantly genetic.

Which type of infection is not associated with humoral immunodeficiencies, such as common variable immunodeficiencies? A) Sinusitis B) Pneumonia C) Urinary tract infection D) Cellulitis

C) Urinary tract infection UTIs are not generally problematic for these patients; the most frequent infections are sinopulmonary infections as well as cellulitis and abscesses.

Providing reassurance of "normalcy" during the course of an examination would be most important for which age group?

Adolescents- d/t heightened concerns regarding body image

How to prevent swimmer's ear/OE

Alcohol and white vinegar drops (equal parts) are used to prevent swimmer's ear, instilled at the end of each swimming day to help evaporate any remaining water droplets. These types of drops are not effective in treating otitis externa.

Which of the following are most often associated with hemoglobin C? A) Growth retardation B) Hepatosplenomegaly C) Usually asymptomatic D) Frontal bossing

C) Usually asymptomatic This is considered a minor hemoglobinopathy that is usually picked up as an incidental finding on hemoglobin electrophoresis.

You notice 10 tan macular lesions of varying sizes on D. D. and refer him for a medical evaluation to rule out neurofibromatosis or Albright syndrome. What kind of lesion does D. D. have? A) Malignant melanoma B) Café au lait spots C) Mongolian spots D) Viral illness.

B) Café au lait spots Café au lait spots are light- to medium-brown pigmented macular lesions of varying sizes and shapes found anywhere on the body; they are the color of coffee with milk, from which the name is derived. If there are six or more lesions, this condition may be associated with neurofibromatosis or Albright syndrome.

Most children with DMD become wheelchair dependent by what age? A) 4-6 years of age B) 10-12 years of age C) 14-16 years of age D) Highly variable depending on response to treatment

B) 10-12 years of age Many children with DMD begin using a wheelchair sometime between ages 7 and 12 years. The transition to a wheelchair usually is a gradual process; at first, the chair may be required only to conserve the child's energy when covering long distances.

Retropharyngeal abscesses are typically seen in what age group and include which mainstay treatment? A) Neonates; hospitalization for IV antibiotics B) 2- to 6-year-olds; ICU admission and IV antibiotics C) 6- to 12-year-olds; outpatient oral antibiotics D) Adolescents; ENT drainage of abscess

B) 2- to 6-year-olds; ICU admission and IV antibiotics Retropharyngeal abscesses are usually seen in children younger than 6 years of age, with an average of 3 years of age. They are a life-threatening condition because of potential airway compromise, and the patient is always admitted to the ICU and treated with IV antibiotics. Because of changes in lymphatics, they do not usually occur after age 6 years.

Sally's vomiting and diarrhea have stopped. If she needs ORT today, what would be the appropriate amount to recommend? A) 325-350 cc over 4 hours B) 600-700 cc over 4 hours C) 600-700 cc over 12 hours D) 325-350 cc over 8 hours

B) 600-700 cc over 4 hours 100 mL/kg of ORT is given over 4 hours for moderate dehydration.

Which of the following statements is not true regarding the transmission of chickenpox? A) Susceptible individuals can contract chickenpox from patients with varicella-zoster (shingles). B) Children with chickenpox are infectious only during the period of time when skin lesions are present. C) Children with chickenpox are no longer infectious once crusting of skin lesions has occurred. D) VZIG should be administered to susceptible immunocompromised individuals who are exposed to a patient with varicella-zoster infection

B) Children with chickenpox are infectious only during the period of time when skin lesions are present. VZV incubation period is between 10 and 21 days, and infected individuals are contagious for 24-48 hours prior to outbreak of lesions until all lesions have crusted over.

Treatment of true (central) precocious puberty is best achieved with: A) synthetic FSH. B) GnRH agonists C) dexamethasone D) TH

B) GnRH agonists Central precocious puberty (CPP) is suppressed with short- or long-acting gonadotropin-releasing hormone agonists (GnRHas). FSH stimulates the ovarian follicles and is not a treatment for CPP. Dexamethasone is a long-acting glucocorticoid used to suppress excessive adrenal androgens in adults. TH replacement is the treatment for hypothyroidism.

Gynecomastia in a male typically is not a finding in which of the following? A) Normal pubertal development B) Hypothyroidism C) Steroid usage D) Testicular tumor

B) Hypothyroidism (produces less thyroxine and would not be a risk factor for increasing male estrogen levels)

Which of the following statements is true about immunizations during the treatment of childhood cancer? A) Children continue to receive immunizations as usual. B) Immunizations are not given during active chemotherapy. C) Only live vaccines are held during active chemotherapy. D) No family member should be immunized while the child is receiving chemotherapy.

B) Immunizations are not given during active chemotherapy. Cancer chemotherapy suppresses the immune response. Therefore, immunizations should be withheld during chemotherapy because they are likely to be ineffective. Non-live-virus immunizations may be resumed 6 months after therapy is completed. Live-virus immunizations may be resumed 12 months after therapy is completed.

Which of the following suggests internal tibial torsion rather than internal femoral torsion in a 2-year-old child presenting with an in-toeing gait? A) Sitting in "W" position B) Knees face forward when walking C) Generalized ligament laxity D) Limited external rotation of hip

B) Knees face forward when walking Observing the patella can be very helpful in differentiating internal tibial torsion from internal femoral torsion. The patella will rotate inward if the problem is above the knee. There is also general ligamentous laxity in other areas (fingers, elbows) associated with internal tibial torsion.

Of the following advice, which would be most helpful for the parents of a baby with GER? A) Most babies continue to vomit until they are walking, at around 1 year of age. B) Lying prone after eating will decrease the amount of vomiting. C) Increase the interval between feedings to a minimum of 4 hours. D) Medications are generally necessary to prevent further problems.

B) Lying prone after eating will decrease the amount of vomiting. Lying prone, if the infant can be observed, can decrease vomiting. Reflux usually improves around 6 months of age when the baby begins to sit up. Smaller, more frequent feeds are recommended for reflux. Medications are not indicated for uncomplicated GER.

What is the preferred treatment for syphilis? A) Erythromycin B) Penicillin C) Cefotaxime D) Zithromax

B) Penicillin

Which of the following is a chromosomal abnormality associated with short stature and amenorrhea in girls? A) Down syndrome B) Turner syndrome C) Klinefelter syndrome D) Prader-Willi syndrome

B) Turner syndrome Turner syndrome, which occurs in girls, is associated with hypergonadotropic hypogonadism and stature below the third percentile in 99% of affected cases. Down syndrome is associated with short stature and can affect both girls and boys. Klinefelter syndrome is associated with tall stature and hypogonadism in males. Prader-Willi syndrome is a genetic disorder characterized by hyperphagia and obesity, hypotonia, and reduced mental ability.

The most common congenital heart defect in children is: A) tricuspid atresia B) VSD C) aortic stenosis D) pulmonary atresia

B) VSD VSD is the most common defect, either in isolation or in association with other defects. The incidence of VSD ranges from 1.56 to 53.2 per 1,000 live births. VSD occurs in 50% of all children with congenital heart disease and in 20% as an isolated defect. Tricuspid atresia and pulmonary atresia are fairly rare (approximately 4-6/100,000 live births), as is aortic stenosis (approximately 8 per 1,000 live births, accounting for 3-5% of all congenital heart defects).

The initial attack of acute rheumatic fever is preceded by: A) a viral illness. B) a GAS infection. C) exposure to mites. D) exposure to chickenpox.

B) a GAS infection. Rheumatic fever is considered a delayed autoimmune reaction in genetically predisposed individuals to group A beta-hemolytic streptococcal pharyngitis. No other organism has been associated with rheumatic fever.

Immunoglobulin replacement therapy is always necessary for children with: A) chronic granulomatous disease. B) agammaglobulinemia (X-linked or autosomal recessive). C) transient hypogammaglobulinemia of infancy. D) Wiskott-Aldrich syndrome.

B) agammaglobulinemia (X-linked or autosomal recessive). Children with agammaglobulinemia always require immunoglobulin to provide them with the antibodies they cannot make for themselves. They require this treatment lifelong.

Treatment of a child with glomerulonephritis would not include: A) vasoconstrictors for hypotension. B) antibiotics for persistent infection. C) increased fluids to maintain hydration. D) avoidance of diuretics.

B) antibiotics for persistent infection.

Although uncommon, potential sequelae of rubella may include: A) pneumonia and chronic otitis media B) arthritis, thrombocytopenia, and encephalitis C) oophoritis and infertility D) arthritis, carditis, and neurologic involvement

B) arthritis, thrombocytopenia, and encephalitis

Meatal stenosis, narrowing of the distal urethra, is most commonly seen following: A) orchiopexy. B) circumcision. C) epididymitis. D) hypospadias repair.

B) circumcision.

J. D. is a postterm infant with lesions of varying morphology, including wheals, vesicles, and pustules, on her trunk. You suspect J. D. has: A) cutis marmorata. B) erythema toxicum neonatorum. C) milia. D) contact dermatitis.

B) erythema toxicum neonatorum. Erythema toxicum neonatorum is a transient, benign, self-limited skin rash with lesions of varied morphology; erythematous macules; wheals, vesicles, and pustules occurring in 50-60% of all newborns. Lesions usually arise from an erythematous base, with macular erythema fading within 2-3 days. It occurs predominately on the trunk; however, it may occur anywhere on the body except the soles and palms.

A pathognomonic skin finding in children with chronic AI (Addison disease) is: A) purple striae. B) increased pigmentation in the axilla, groin, areola, and hand creases and along surgical scars. C) darkened, thickened skin. D) increased perspiration and heat intolerance.

B) increased pigmentation in the axilla, groin, areola, and hand creases and along surgical scars.

A new vibratory systolic murmur is heard at the lower-left sternal border in a healthy 4-year-old at her preschool physical. The cardiovascular exam is otherwise normal. A likely diagnosis is: A) venous hum. B) innocent or vibratory (Still's) murmur. C) transposition of the great arteries. D) rheumatic heart disease.

B) innocent or vibratory (Still's) murmur. This is a classic definition of an innocent or vibratory (Still's) murmur. A venous hum is a continuous murmur noted at the right upper sternal border. Even with septal shunts, a child born with transposition of the great arteries would not appear healthy and remain undiagnosed for 4 years, and rheumatic heart disease typically has a mitral valve murmur that is noted at the apex, radiates to the axillae, and is holosystolic.

The most appropriate management of a 5-year-old with a firm, nontender nodule in the mid-upper eyelid for 3 weeks would be: A) cool compresses. B) topical ophthalmic ointment. C) oral antibiotics. D) oral steroids.

B) topical ophthalmic ointment. The history describes a chalazion, which often resolves without treatment. However, prophylaxis with topical antibiotic ointment is an appropriate and recommended prophylactic treatment because chalazions may become infected. Warm compresses, not cool, can also be used. Oral antibiotics are only used to prevent recurrence if chalazions frequently develop. Oral steroids have no part in the treatment of chalazions. Rarely, an ophthalmologist may inject a chalazion with a steroid, but this is not done routinely and only then by an ophthalmologist.

Difference between beta thalassemia and sickle cell disease?

Beta thalassemia is caused by a defect in the beta-globin gene, controlling the production of the beta-globin chains of hemoglobin. Sickle cell disease is caused by a defect in hemoglobin itself with the presence of abnormal hemoglobin S.

You receive the results of newborn screening from a healthy, term neonate and find that the TSH done on newborn screen is 82 mIU/L. What is your best option? A) Have the child come to the clinic next week for a reevaluation. B) Rescreen the child in 1 month. C) Begin thyroid supplementation immediately and refer to pediatric endocrinology. D) Reassure the family that these are normal results.

C) Begin thyroid supplementation immediately and refer to pediatric endocrinology. Congenital hypothyroidism screening is included in the newborn screen done prior to discharge and before day 7 of life. Tests obtained (T4, TSH, or both) vary by state. If the TSH is > 40 mIU/L, the infant should be started immediately on thyroid replacement and referred to a pediatric endocrinologist. Any delay in starting thyroid replacement can lead to mental retardation and neurologic consequences.

The most common bacterial cause of an STI is: A) N. gonorrhoeae. B) T. vaginalis. C) C. trachomatis. D) herpes simplex.

C) C. trachomatis. Chlamydia is the most common bacterial cause of STIs, with over 4 million cases annually.

During the first well-baby visit of Jane, 2 weeks old, her mother says that she is concerned because her genitalia look different from his 3-year-old sister's. During the physical exam, you notice that the baby's clitoris is enlarged, and her labia are hyperpigmented. You know that a common cause of ambiguous genitalia is the newborn female is: A) idiopathic. B) congenital hypothyroidism. C) CAH D) cushing syndrome.

C) CAH (congenital adrenal hyperplasia) CAH, most commonly detected on newborn screen, is a common cause of virilization in the newborn female. Males may appear normal. Ambiguous genitalia necessitates immediate evaluation and is rarely idiopathic, and it is not seen in congenital hypothyroidism. Cushing syndrome is characterized by glucocorticoid excess and is rarely seen in infancy.

A newborn presents with lymphadenopathy, a decrease in the ability to move the left leg, Coombs-negative hemolytic anemia, hepatomegaly, and snuffles. What is the most likely diagnosis? A) Congenital herpes infections B) Congenital CMV infection C) Congenital syphilis D) Congenital gonococcal infection

C) Congenital syphilis Congenital syphilis presents with snuffles, lymphadenopathy, Coombs-negative hemolytic anemia, and pseudoparalysis of Parrot. CMV is usually an asymptomatic infection, and when it is symptomatic in the newborn, the presentation would include IUGR, developmental delay, jaundice, hepatosplenomegaly, purpura, generalized petechiae, thrombocytopenia, and bone abnormalities. Congenital gonococcal infection would usually present with severe conjunctivitis as the presenting complaint.

Infant immunization for hepatitis B often raises many parental questions about the disease. Which of the following is not true about HBV? A) It can survive for more than 1 week on fomites. B) It is the most common form of hepatitis in the world. C) Contaminated water and shellfish are the major sources. D) Perinatally infected infants are likely to become carriers.

C) Contaminated water and shellfish are the major sources. Contaminated shellfish and water are the major sources of hepatitis A.

Muscle spasms associated with tetanus are aggravated by which of the following? A) Fever B) Tetanus immunoglobulin C) External stimuli D) Nonsteroidal anti-inflammatory drugs (NSAIDs

C) External stimuli

Which of the complications of strep pharyngitis cannot be prevented with antibiotics? A) Peritonsillar abscess B) Cervical adenitis C) Glomerulonephritis D) Acute rheumatic fever

C) Glomerulonephritis Even with prompt and adequate treatment with antibiotics, acute glomerulonephritis (AGN) cannot be prevented. However, not all strains of strep are nephrogenic. The other potential complications of strep (peritonsillar abscess, cervical adenitis, and acute rheumatic fever) can be prevented with antibiotics.

Which of the following is NOT true about the use of imipramine for the treatment of enuresis? A) It is not generally recommended for this nonfatal disorder due to the potentially lethal side effects. B) The lasting cure rate is approximately 17%. C) Imipramine should only be given to children who have had a baseline electroencephalogram (EEG). D) The most appropriate imipramine treatment group is adolescent boys with both attention deficit hyperactivity disorder (ADHD) and persistent nocturnal enuresis.

C) Imipramine should only be given to children who have had a baseline electroencephalogram (EEG). While imipramine therapy is helpful in approximately 50% of children, care should be taken to stay within the recommended 25-50 mg po qHS. A baseline EEG is not necessary.

Mrs. J. brings her 6-year-old son in because of "hives" that she describes as a red, raised rash. Which finding would support a diagnosis of erythema multiforme rather than urticaria? A) Lesions that blanch with pressure B) Eyelid edema C) Lesions that are present for more than 24 hours D) Intense pruritus

C) Lesions that are present for more than 24 hours Urticarial lesions tend to be pruritic and blanch with pressure but generally fade within a few hours. Due to the large number of mast cells present in the eyelids, edema is common with urticaria. The lesions of erythema multiforme are fixed and present for up to 2-3 weeks

"Incident-to" billing is specific only to: A) Medicare and Medicaid. B) Medicaid. C) Medicare. D) private insurance companies.

C) Medicare.

Which of the following would be the most appropriate initial management of a newborn diagnosed with DDH? A) Observation and reexamination at 2-week wellchild visit B) Triple diapering in nursery C) Pavlik harness D) Surgical reduction

C) Pavlik harness The treatment of choice for subluxation and reducible dislocations identified in the early phase is a Pavlik harness. The harness is applied with hips having greater than 90 degrees of flexion and with adduction of the hip limited to a neutral position.

A 1-day-old male child is evaluated in the newborn nursery for a fever. A CBC reveals a WBC of 18 K/cu mm with a differential of 84% polymorphonuclear (PMN) cells, 2% lymphocytes, 9% monocytes, 3% eosinophils, and 2% bands. Which of the following would be highest on your list of differential diagnoses? A) Necrotizing enterocolitis (NEC) B) Maternally transmitted bacterial infection (e.g., group B strep) C) SCID D) TORCH infection

C) SCID While all conditions are possible, this child's profound lymphopenia gives him a diagnosis of SCID until unproven; immediate lymphocyte subset evaluation should be undertaken. He should be treated as though he has SCID until it is proven that he does not.

A 2-year-old girl presents with symptoms of painful urination, frequency, and occasional incontinence over the past week. When seen in your office, she has a temperature of 101.6°F. Which of the following would be your approach in establishing a definitive diagnosis? A) Clean-catch midstream collection of specimen for U/A B) Clean-catch midstream collection of specimen for urine culture C) Straight catheterization collection of specimen for urine culture D) VCUG

C) Straight catheterization collection of specimen for urine culture In a non-toilet-trained child, the most accurate method for nonemergent urine collection is a sterile straight catheterization for urine culture.

Paul has four superficial lesions on his anterior lower abdomen of 1 week's duration. The lesions are 4 cm in diameter, scaly, irregular-shaped plaques with skin-colored centers and erythematous borders. The affected areas are slightly pruritic. What condition do you suspect Paul has? A) Psoriasis B) Eczema C) Tinea corporis D) Pityriasis rosea

C) Tinea corporis Tinea corporis lesions are characterized as scaly plaques of varying sizes from less than 5 mm to more than 3 cm, with mild erythematous active borders. Lesions spread peripherally as they heal centrally and may be singular or several; numerous lesions are uncommon.

Which of the following is not characteristic of innocent heart murmurs in children? A) Systolic in timing B) Varies in loudness with positioning C) Usually transmitted to the neck D) Usually loudest at lower left sternal border or at second or third intercostal space

C) Usually transmitted to the neck (Innocent murmurs rarely transmit to other areas of the body)

Chronic granulomatous disease affects: A) B cells. B) T cells. C) WBCs D) both B and T cells.

C) WBCs CGD is caused by the lack of a pathogen-killing oxidative burst from phagocytes.

You are following an 18-month-old girl in your practice with a history of breast development that appeared 2 months ago and has not progressed. Her growth velocity is normal. All of the following are indicated except: A) careful physical exam to evaluate for other secondary sexual characteristics. B) reassurance and continued monitoring. C) laboratory evaluation of LH, FSH, and estradiol. D) plot length on growth chart at 3- to 6-month intervals.

C) laboratory evaluation of LH, FSH, and estradiol. Premature thelarche is a benign, self-limiting condition characterized by isolated, non-progressive breast development in girls. It is common in children under 2 years old and often regresses after that age. Growth should be carefully monitored along with signs of other secondary sexual characteristics. Referral or laboratory evaluation is indicated only if growth pattern is abnormal or if puberty progresses.

A 5-year-old has chronic granulomatous disease. His kindergarten class is going to a pumpkin patch for a Halloween field trip. Gavin should: A) go on the field trip with his classmates, but wear a mask. B) go on the field trip without worries. C) not go on the field trip. D) take an additional dose of his prophylactic antibiotics before going on the field trip.

C) not go on the field trip. Children with CGD need to be protected from spores found in fresh soil, mulch, and similar products. These organisms could cause life-threatening pneumonitis in someone with CGD.

In addition to home monitoring of BG and urine ketone levels, children with T1DM should have their HbA1c measured: A) once a week. B) once a month. C) once every 3 months. D) once every 6 months.

C) once every 3 months. Glycosylated hemoglobin or HbA1c is a blood test that measures the percentage of glucose that is attached to the hemoglobin cell. Once attached, the glucose remains attached for the life of the hemoglobin cell, which is approximately 3 months. Therefore, HbA1c reflects average glycemia over approximately 3 months. The normal range is between 4% and 6.5%. The target HbA1c for patients with type 1 diabetes is < 7.5%. Because the test measures glycemic control over a longer period of time, doing the HbA1c weekly or monthly is not recommended. Measuring HbA1c every 6 months may miss signs of deteriorating glycemic control, especially during periods of growth and development such as childhood and adolescence.

Uncomplicated anterior cervical adenitis can be treated with all of the following EXCEPT: A) amoxicillin-clavulanate. B) dicloxacillin. C) penicillin. D) cephalexin.

C) penicillin. All antibiotics listed can be used to treat S. pyogenes and S. aureus, the most common organisms causing cervical adenitis.

The greatest risk in a patient with a hyphema is: A) glaucoma. B) lnfection. C) rebleed. D) cataracts.

C) rebleed. The greatest imminent risk from a hyphema is a rebleed, which often leads to more eye damage (vision loss) than the initial bleed. There is an increased risk for the development of glaucoma and cataracts following various causes of eye trauma not specific to hyphemas. With hyphemas, the bleeding occurs in the anterior chamber and is not as susceptible to outside organisms like a corneal abrasion would be. Therefore, infection is not as imminent a problem as it would be with a corneal abrasion.

A hypernasal voice and snoring in a child is suggestive of:

Characteristic of hypertrophied adenoids

Describe appropriate speech for a 2.5 yo:

Children aged 2-3 years have several articulation dysfluencies, among them is the dropping of final consonants. Two- to three-word sentences are normal for the 24- to 30-month-old child.

Conjunctivitis appearing in a 2-day-old infant is likely due to:

Conjunctivitis developing on day 2 of life is most likely due to a chemical irritation from the routine prophylactic eye medication. Although this is seen less frequently with the current use of erythromycin ophthalmic ointment instead of silver nitrate, it still occurs. The other causes of conjunctivitis listed tend to occur later than day 2 of life. Ocular chlamydia is typically seen at age 2 weeks or later.

A 2-year-old child is evaluated in the emergency department for a closed head injury following a 10-foot fall from an open window. When interpreting diagnostic imaging results, you are aware that the most common and generally the least serious type of skull fracture is: A) basilar fracture. B) compound fracture. C) depressed fracture. D) linear fracture.

D) linear fracture. The linear fracture is the most common and has little serious clinical implication, unless it overlies a vascular channel or penetrates an air sinus.

The most common cause of thyroiditis is: A) subacute thyroiditis caused by a viral infection of the gland. B) acute suppurative thyroiditis caused by bacterial infection. C) exposure to radiation or trauma. D) Hashimoto's or chronic autoimmune thyroiditis.

D) Hashimoto's or chronic autoimmune thyroiditis. Hashimoto's or chronic autoimmune thyroiditis is the most common cause of goiter/hypothyroidism in childhood (incidence increases with age; females affected more than males; increased incidence with type 1 diabetes). Infections and exposure to radiation or trauma are less common in children and teens.

Mrs. Doyle is upset. Two-month-old John's frequent vomiting has her convinced that "something is seriously wrong." Which of the following is most suggestive of GER? A) He's gained 5 ounces this month. B) He has a slight wheeze today. C) He eats hungrily after vomiting. D) He drinks 7-8 ounces every 3-4 hours.

D) He drinks 7-8 ounces every 3-4 hours. John is being overfed, which predisposes infants to GER. A more appropriate intake for a 2-month-old is 4-5 oz every 3-4 hours.

21. The peak incidence of osteosarcoma is: A) 4-7 years of age. B) 8-11 years of age. C) 12-14 years of age. D) 15-19 years of age.

D) 15-19 years of age. The incidence of osteosarcoma peaks during the growth spurt of adolescence, between 15 and 19 years of age, with males slightly more likely to be affected than girls.

You are evaluating a 13-year-old girl for Graves' disease. Which of the following signs would not support this diagnosis? A) An enlarged thyroid B) Exophthalmos C) A positive family history D) An elevated TSH level

D) An elevated TSH level In hyperthyroidism, the TSH level is low; the other answers are consistent with signs of Graves' disease.

If a 14-year-old girl came to you to initiate a birth control method, for which of the following birth control methods would you counsel her about possible weight gain? A) Combined hormonal OCP B) Etonogestrel implant C) Levonorgestrel IUD D) Depo-medroxyprogesterone acetate

D) Depo-medroxyprogesterone acetate Depo is the only birth control associated with weight gain (about 5 lb over 2 years).

Which is not a characteristic anatomic feature of Di-George syndrome? A) Hypertelorism B) Cleft palate C) Cardiac defects D) Frontal bossing

D) Frontal bossing Dysmorphia associated with DiGeorge syndrome includes hypertelorism & low set ears. Congenital heart disease and cleft lip/palate are associated syndromic features.

There are several skin features seen with TS (tuberous sclerosis). Which of the following is most characteristic? A) CALs B) Blue or purple striae C) Papules in a "Christmas tree" pattern D) Hypopigmented macules in an "ash leaf" shape

D) Hypopigmented macules in an "ash leaf" shape Hypopigmented macules in an elliptical shape are characteristic and are often described as "ash leaf" spots.

All are consistent with glaucoma EXCEPT: A) photophobia. B) epiphora (increased tears). C) blepharospasm. D) leukocoria (white red reflex).

D) leukocoria (white red reflex). The classic triad for glaucoma is photophobia, epiphora, and blepharospasm. The cornea may be hazy with glaucoma, but it is not associated with a leukocoria.

Malignant melanoma is a form of much-dreaded skin cancer. Which of the following is not characteristic of this condition? A) It occurs in all ethnic groups but more commonly in light-skinned individuals B) Severe sunburn or excessive exposure to sunlight before the age of 10 years predisposes developing melanoma later in childhood or in adult life. C) It spreads through the lymphatic system and invades other distant skin surfaces and organs. D) It spreads primarily by invading skin surfaces that surround the major lesion.

D) It spreads primarily by invading skin surfaces that surround the major lesion. Malignant melanoma is characterized by being more common in females from birth to 40 years of age and in light-skinned individuals. Severe sunburn or excessive exposure to the sun before the age of 10 years predisposes developing melanoma later in childhood or in adult life. Malignant melanoma is spread through the lymphatic system and invades other skin surfaces and organs. It is not spread by invading skin surfaces that surround the major lesion.

What is the appropriate treatment for genu varum in a 15-month-old child? A) Passive exercise with each diaper change B) Denis Browne splint at night C) Blount brace at night D) No treatment is warranted.

D) No treatment is warranted Genu varum, or bowed leg, is normal until approximately 18 months.

A 17-year-old female does not want to be pregnant but has not been using protection. It is now 9 weeks since her last menstrual period. Which of the following is correct about her options? A) She is too far along for medical termination. B) She must have a D&C in a hospital setting. C) She is past the gestational age for termination and must consider adoption or keeping the baby. D) She can have either a medical or surgical termination.

D) She can have either a medical or surgical termination. Terminations of pregnancy can be completed with medication up to 10 weeks (70 days) after a patient's last menstrual period.

You are evaluating F. P., age 3 years, who sustained an acute burn when she pulled a pan of boiling water onto herself within the past hour. Because burns are classified according to the depth of injury to the skin layers and the amount of area involved, how would you rate the burn if 5% of her body surface is burned and the burned area involves the epidermis and upper part of the dermis? A) She has minor first- and second-degree burns. B) She has a major second-degree burn. C) She has a major full-thickness burn D) She has major first- and second-degree burns. F. P.'s burn should appear: A) dry, with mild edema and erythema. B) as dry, whitish areas that blanch with pressure. C) as dry, whitish to brownish areas with edema. D) moist with edema, erythema, and a few vesicles.

D) She has major first- and second-degree burns. Burns are classified according to the depth of injury to skin layers. First-degree/superficial burns involve the epidermis layer only. Second-degree/partial-thickness burns involve the epidermis and part of the dermis, which may be superficial dermis or deep dermis. D) moist with edema, erythema, and a few vesicles. First- and second-degree burns are red, swollen, moist, and blistered areas with tenderness.

What type of hemorrhage would be expected with severe factor VIII deficiency? A) Severe hemorrhage following moderate to severe trauma B) Gross bleeding following mild to moderate trauma C) Gynecologic hemorrhage D) Spontaneous hemarthrosis

D) Spontaneous hemarthrosis

Which of the following statements is true regarding SCFE? A) It is more common in females who are underweight. B) It generally occurs following severe sudden trauma. C) Incidence is more common in athletes. D) The goal of treatment is to stabilize or improve the position of the femoral head.

D) The goal of treatment is to stabilize or improve the position of the femoral head. The goal of treatment in SCFE is to prevent further slippage and to stabilize the epiphysis via surgical intervention.

The management of scoliosis depends on the severity of the curve as well as the age of the child. Which of the following would require surgical intervention? A) Curves of 15 degrees in a child who is still growing B) Thoracic and/or lumbar curve greater than 25 degrees, even if growth is complete C) Thoracic curve greater than 30 degrees or lumbar curve greater than 40 degrees that has not progressed while in brace D) Thoracic curve greater than 50 degrees or lumbar curve greater than 40 degrees

D) Thoracic curve greater than 50 degrees or lumbar curve greater than 40 degrees Surgery may be required in children with structural problems that cause kyphosis and in adolescents with curvature of the back that exceeds 50-60 degrees. Surgery is indicated for children who have progressive spinal deformity that cannot be controlled by nonoperative means, such as bracing, and where there is significant spinal growth remaining. For Cobb angle less than 15 degrees: Observation at 6- to 12-month intervals For Cobb angle 15-20 degrees: Outpatient therapy with a combination of therapist-guided sessions and home exercise program For Cobb angle 21-25 degrees: Outpatient physiotherapy, scoliosis intensive rehabilitation (SIR) program where available; a brace may be indicated For Cobb angle greater than 25 degrees: Outpatient physical therapy, SIR program, and brace wear; rationale for surgical intervention

Which malignancy is associated with genitourinary anomalies? A) Acute lymphocytic leukemia B) Chronic myelogenous leukemia C) Osteosarcoma D) Wilms tumor

D) Wilms tumor Wilms' tumor is also known as nephroblastoma and is a cancer of the kidneys.

One of the most commonly suggested reasons for primary nocturnal enuresis is: A) certain medications, such as theophylline. B) genitourinary abnormalities. C) family disruptions and stress. D) delayed maturation of voiding inhibitory reflex and arousal response.

D) delayed maturation of voiding inhibitory reflex and arousal response. Many children who experience primary nocturnal enuresis have not yet developed a normal arousal response.

Secondary hypothyroidism results from: A) excess release of TH beyond the newborn period. B) intrauterine exposure to thyrotoxic drugs. C) autoimmune disease. D) disease or disorder of the pituitary gland compromising thyroid function.

D) disease or disorder of the pituitary gland compromising thyroid function. Excess release of TH beyond the newborn period is associated with hyperthyroidism. Autoimmune disease and intrauterine exposure to thyrotoxic drugs are associated with primary hypothyroidism. Pituitary gland disorders result in problems with TSH regulation, resulting in secondary hypothyroidism.

In the newborn period, IDMs are particularly at risk for: A) small size for gestational age. B) IUGR. C) disorders in bone development. D) hypoglycemia.

D) hypoglycemia. (and sterility often not noticed until puberty)

A 9-year-old boy has had no significant health problems by history, but his mother is very concerned because he is "wetting himself." As you begin your history and physical examination, you keep in mind that the most common type of enuresis in school-age children is: A) primary nocturnal enuresis. B) occasional daytime enuresis. C) secondary nocturnal enuresis. D) primary diurnal enuresis.

D) primary diurnal enuresis. The recurrence risk for a child to be affected by enuresis is 40% if one parent and 70% if both parents had been enuretic as children.

While examining a 4-month-old boy, you are unable to palpate one of the testes. The next most appropriate step is to: A) reassure the parents that this is a normal finding. B) refer the child to an endocrinologist. C) reexamine the baby in 2 months. D) refer the child to a urologist.

D) refer the child to a urologist. (The testes rarely descend after the first 6 months).

The most common temperamental profile is:

Easy- Approximately 40% of children are described as having an easy (rhythmic, approachable, adaptive) temperament

A child has been to multiple specialists and has had numerous procedures done over the course of the 3 years since he was born. The child appears well. The mother is very social with all the medical staff and seems to enjoy being in the hospital. Based on current terminology, what do you think the mother's behavior reveals?

Factitious disorder imposed on another (Munchausen syndrome, medical child abuse, and factitious disorder by proxy are old diagnostic terminology)

What is the normal hemoglobin range?

Male: 13-18 g/dL Female: 12-16 g/dL

During a prenatal visit, you review the mother's record for routine prenatal screening results. While educating the mother, you explain that the screening of maternal serum for alpha-fetoprotein (MSAFP) between the 15th and 21st weeks of pregnancy is done primarily to screen for:

Neural tube defects

Cholesterol screening should be done:

On children 2 years of age and older who have a parent with a total cholesterol level of 240 mg/dL or greater. It is a recommended screening test for children between 9 and 11 years of age.

A cobblestone appearance of the palpebral conjunctiva usually indicates:

Severe allergy- consistent with allergic conjunctivitis

While conducting a developmental screening test, the mother of an 18-month-old child reports to you that the toddler does not imitate activities. You decide to assess the child's development further by giving him further screening from which sector?

Social/Language (Imitating activities is considered to be a personal-social task and is also used, along with language assessment, to assess and screen for ASD)

In what Tanner stage does gynecomastia usually appear in males?

Tanner stage 3

A Grade II musical or vibratory murmur heard best at the lower left sternal border that changes with positioning is suggestive of a:

Vibratory or Still's murmur

Which of the following ocular findings would be considered an ophthalmic emergency? A) Unilateral vesicular lesions on the upper eyelid in a 3-week-old B) Presence of chemosis in a 5-year-old with bilateral upper eyelid edema C) Cobblestone-like appearance along the inner aspect of the upper eyelid in a 15-year-old D) Bilateral redness along eyelid margins with tiny ulcerated areas in a 16-year-old

Unilateral vesicular lesions would indicate a possible herpetic infection of the eye, which in a 3-week-old could spread to the CNS and potentially causing severe, permanent CNS damage and/or death. Chemosis is swelling on the conjunctiva, often associated with allergies, and is not life- or vision-threatening. This is the same with a cobblestone appearance of the inverted upper eyelid. Answer D is suggestive of blepharitis, which is not an emergency disorder.