PANCE questions

What percentage of sudden unexpected infant death (SUID) deaths is later discovered to have died of child abuse

<5%`

What is the appropriate pediatric dosing for intravenous fluid boluses in hypotensive pediatric patients?

20mL/kg

What is a kline line in relation to SCFE

A line drawn along the superior border of the femoral neck that should intersect the femoral head. If it does not, suspect SCFE.

What are the classic findings in transverse myelitis

A transverse level of sensory impairment, paraplegia, and sphincter disturbance

What is the most common identified source of Rocky Mountain spotted fever in the United States?

American dog tick (Dermacentor variabilis) is the most commonly identified source of transmission.

A 4-week-old boy presents with a 2-week history of increasing dyspnea, cough, and poor feeding. On examination you note conjunctivitis, and a chest examination reveals tachypnea and rales. A chest X-ray shows hyperinflation and diffuse interstitial infiltrates. Which of the following is the most likely etiologic agent? A Chlamydia trachomatis B Parainfluenza virus C Respiratory syncytial virus D Staphylococcus species

C. trachomatis

What is the treatment for Milaria rubra?

Cooling baths and avoidance of overheating

What disease is characterized by the absence of UGT activity?

Crigler Najjar type 1

Which of the following is true regarding Meckel's diverticulum? A Commonly seen at five years of age B Diagnosed by abdominal ultrasound C Diagnosed by Meckel's scan using Tc99m pertechnetate D Presents with bilious vomiting

Diagnosed by Meckel's scan using Tc99m pertechnetate

A 13-year-old boy on chemotherapy for acute lymphoblastic leukemia presents with progressive lower back pain for 2 weeks. Per mom, he has had subjective fevers and a "bulge in his lower back" that is warm to touch. He is currently afebrile and has no focal neurologic deficits. An MRI is obtained as seen in the image above. Which of the following regarding this patient's condition is true? A An appropriate antibiotic regimen is cefepime and metronidazole B Direct extension of skin and soft tissue infections is the most common cause C Erythrocyte sedimentation rate is a sensitive screening tool D Most patients present with back pain, fever, and a focal neurologic deficit

Erythrocyte sedimentation rate is a sensitive screening tool

A Fomepizole B Hydroxocobalamin C Naloxone D Physostigmine

Fomepizole

besides canned goods, how do infants acquire botulism?

From ingestion of honey, home grown vegetables, or soil.

what genetic process results in prader willi

Genetic imprinting

A five-year-old boy is brought into the emergency department in mild respiratory distress. His mother states that he has had a fever and sore throat since yesterday. Physical exam reveals drooling and inspiratory stridor. A soft tissue lateral X-ray of the neck is performed and shows thickened aryepiglottic folds and the "thumb" sign. Which of the following is the most likely causative pathogen? A Adenovirus B Group A streptococcus C Parainfluenza virus D Staph aureus

Group A strep (if not vaccinated, Hib)

What is the most common causative organism of meningitis in a 1-week-old child? A Group B Streptococci B Haemophilus influenzae C Listeria monocytogenes D Staphylococcus aureus

Group B strep

What is the most common cause of lower intestinal obstruction in neonates?

Hirschsprung

what is a common complication of Meckel's diverticulum

Intestinal obstruction caused by intussusceptions or volvulus

What is the enanthem of measles infection

Koplik spots- red spots w blue/white center on buccal mucosa

What is the most concerning differential dx for a febrile seizure

Meningitis. greatest risk: under 18 mos, focal or prolonged seizure, seizure in the ED, or saw a physician within last 48 hrs

What lung problems are CF pts at risk for?

PNA, spontaneous PTX

What is the treatment of choice for children with developmental dysplasia of the hip whom are older than 6 months of age?

closed reduction

What finding on wet mount is diagnostic of bacterial vaginosis?

clue cells- epithelial cells surrounded by bacteria

At a 4-week well-child check, a mother raises concern for a rash on her infant's scalp. For the last two weeks, the scalp has been shedding greasy scales, and now the area anterior to the ears has begun to scale, too. No family members have the rash. The family has a dog and cat at home. Which of the following is the most likely diagnosis? A Atopic dermatitis B Langerhans cell histocytosis C Seborrheic dermatitis D Tinea capitis

Seborrheic dermatitis

A 13-year-old boy presents because his mother noticed a progressive left-sided limp over the previous three weeks. The patient states that he has pain in his knee. On exam, you elicit pain on internal rotation of the hip. Which of the following is the most likely diagnosis? A Legg-Calvé-Perthes disease B Osteosarcoma C Septic arthritis D Slipped capital femoral epiphysis

Slipped capital femoral epiphysis

An obese 11-year-old Cherokee boy presents with symmetrical, hyperpigmented, velvety plaques in the intertriginous areas of the axilla, groin, and posterior neck. There are a few acrochordons scattered in the plaques. The plaques are painless, and do not itch. What is the most likely diagnosis? A Acanthosis nigricans B Addison's disease C Dowling-Degos disease D Pellagra

acanthosis nigricans

What is th age distribution of osteosarcoma?

bimodal- peaks in adolescence & adults >65

What is the initial treatment for prolonged bleeding in patients with von Willebrand disease?

desmopressin

Which of the following treatments decreases the need for repeat medical visits for children with croup? A Codeine B Cool mist therapy C Glucocorticoids D Nebulized racemic epinephrine

glucocorticoids

An 8-month-old boy has a painless swelling on the right side of his scrotum since birth that gets worse with crying. Transillumination of this side of the scrotum reveals increased fluid and the child does not cry on palpation of the testicle which lies in its normal position. Based on these findings, which of the following is the most likely diagnosis? A Epididymitis B Hydrocele C Testicular torsion D Varicocele

hydrocele

What is seen on electron microscopy of the glomerulus in patients with poststreptococcal glomerulonephritis?

immune deposits in the subepithelial space

Within the first several years of diagnosis, what are the most common causes of death in patients with systemic lupus erythematosus (SLE)?

infections, complications of glomerulonephritis, neuropsychiatric disease

What condition should be considered in individuals diagnosed with a right sided varicocele?

inferior vena cava thrombosis

A 3-year-old boy is brought to the pediatric emergency department by his mother. She tells you he has had a fever and cough for the past 2 days. The boy appears to be agitated and is in respiratory distress. His temperature is 38.6°C (101.5°F) and his respiratory rate is 35/min. Physical examination shows subcostal retractions. Auscultation of the lungs reveals inspiratory stridor with a prolonged inspiratory phase. Chest X-ray shows subglottic narrowing. Which of the following is the most likely diagnosis? A Acute epiglottitis B Foreign body aspiration C Laryngotracheitis D Respiratory syncytial virus

laryngotracheitis

A 3-week-old male has a skin eruption on his face. The lesions consist of inflammatory papules and pustules primarily noted on the cheeks. No significant erythema is seen. Which of the following is the most likely diagnosis? A Erythema toxicum neonatorum B Herpes simplex C Milia D Neonatal cephalic pustulosis

neonatal cephalic pustulosis

A 13-month-old girl presents with her mother who says that her daughter has been sick for 10 days. The girl had an initial period of head-cold symptoms and is now coughing constantly. She is a well-nourished infant who demonstrates a rapid, consecutive cough with a high-pitched inspiratory whoop. Records show that the family declined vaccinations. Which of the following interventions is most indicated in managing this patients illness? A Humidification of inspired air B Nebulized albuterol C Oral amoxicillin D Oral clarithromycin

oral clarithromycin

A 16-year-old female competitive runner complains of pain and tenderness over her shins when she runs. On physical exam you notice point tenderness over her left tibia. X-rays are normal but MRI reveals a hairline fracture in the tibia. She has suffered multiple stress fractures of this bone before. A prompt workup should be initiated for which of the following disorders? A Hyperthyroidism B Hypoparathyroidism C Osteoporosis D Vitamin D deficiency

osteoporosis

A 14-year-old girl is in your clinic with her mother because of leg pain. She fell from her bike last month and hit her left leg. Since then, she has complained of pain on her left leg that waxes and wanes. On physical examination, you could palpate a soft tissue mass that is tender. Laboratory findings show elevated alkaline phosphatase and elevated lactate dehydrogenase. Radiograph reveals destruction of the normal trabecular bone pattern and a soft tissue mass that is ossified in a radial or sunburst pattern. Which of the following is the most likely diagnosis? A Chondroblastoma B Ewing sarcoma C Osteomyelitis D Osteosarcoma

osteosarcoma

Which of the following is true regarding sudden unexpected infant death (SUID)? A Most cases occur in infants younger than two months old B Normal-term infants have a higher incidence of Sudden Unexplained Death of Infancy (SUDI) than preterm infants C Peak incidence is between two and four months of age D The diagnosis is usually made in the emergency department

peak incidence between 2-4 mos

A 7-year-old boy presents complaining of occasional intermittent lower abdominal pain over the last several weeks associated with a decline in the frequency of bowel movements to one every third day. When he does defecate, stools are hard to pass and sometimes painful. There is no blood in the stools. He has no chronic medical problems, has never had surgery, and takes no medications. Review of systems are negative and physical exam is normal. What is the most appropriate initial intervention for this child? A Bisacodyl B Phosphate enema C Polyethylene glycol D Referral to gastroenterologist E Soap suds enema

polyethylene glycol

What is the most important first step in treating a patient with epiglottitis?

protect the airway

What vaccine protects from a common cause of severe watery diarrhea in children

rotavirus vaccine

what organisms cause SBI in neonates

those found in the vaginal canal: Group B Streptococcus, Escherichia coli, and Listeria monocytogenes

In patients with testicular torsion, how soon should orchiopexy be performed after symptom onset?

within 6 hrs

expected serum osmolality

2 x [Na+] + [BUN] / 2.8 + [glucose] / 18 + [ethanol] / 4.6

when is urticaria considered chronic?

> 6 wks

Which of the following infants is at highest risk for developmental dysplasia of the hip? A A female infant born in the breech position B A first-born male with a birth weight of 3200 grams C A male infant born in the breech position D A second-born male born at 37-week gestation

A female infant born in the breech position

A 15-year-old boy presents to the emergency department with lower back pain. He reports heavy lifting three weeks ago, with gradual onset of pain and no relief with symptomatic care. The pain is localized to the paraspinal muscles over his lumbar back. He reports normal urine output. Baseline laboratory tests are notable for a sodium of 140, potassium of 5.2, chloride of 110, bicarbonate of 25, BUN of 20, and creatinine of 2.3. A urinalysis shows hyaline casts, 5 white blood cells, and 1 protein. Which of the following is the most likely pathophysiology of his laboratory findings? A Acute interstitial nephritis B Acute tubular necrosis C Hypovolemia D Obstructive nephropathy

AIN

what is the major complication of nephrotic syndrome

infection

A two-year-old child is seen in the emergency room with recent onset of cough and progressive stridor. Respiratory cultures are taken, and you are concerned for bacterial tracheitis. What is the most common organism isolated on respiratory cultures in bacterial tracheitis? A Haemophilus influenzae type B B Staphylococcus aureus C Streptococcus pneumoniae D Streptococcus pyogenes

staph aureus

A 3-year-old boy presents with severe vomiting and diarrhea. The exam reveals sunken eyes, skin tenting, and a capillary refill of three seconds. At his last well visit he weighed 15 kg, but weighs just 13 kg today. Using the Holliday-Segar method, what is his maintenance fluid rate per hour? A 260.0 ml/hr B 39.0 ml/hr C 47.9 ml/hr D 83.3 ml/h

47.9 (holliday segar method) -100 for the 1st 10kg, 50 for the next 10, 20 for each additional kg. -total divided by 24 hrs (100 x 10) + (50 x 3) = 1150/24 = 47.9ml/hr

Which one of the following children should undergo testing for streptococcal pharyngitis? A A 16-year-old with pharyngitis, rhinorrhea, and voice hoarseness B A 2-year-old with fever and cough C A 5-year-old with fever, cough, and tender anterior cervical lymphadenopathy D A 9-year-old asymptomatic household contact whose brother was recently diagnosed with acute streptococcal pharyngitis

A 5-year-old with fever, cough, and tender anterior cervical lymphadenopathy

Which of these children with hematuria needs admission to the hospital? A A 10-year-old boy with recent sore throat treated with amoxicillin, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests are normal B A 12-year-old girl with lower abdominal pain, dysuria, urgency, frequency, and pink urine; UA shows microscopic hematuria, > 50 WBCs/hpf, + leukocyte esterase, + nitrites; urine pregnancy test is negative C A 6-year-old boy with nausea, vomiting, bloody diarrhea, and decreased urine output; UA shows microscopic hematuria and hyaline casts; blood tests show a high WBC count, low hemoglobin, and low platelets D An 8-year-old girl with diffuse mild edema, tea-colored urine, and normal urine output; UA shows microscopic hematuria and proteinuria; blood tests show a normal WBC count, hemoglobin, and platelets but low protein

A 6-year-old boy with nausea, vomiting, bloody diarrhea, and decreased urine output; UA shows microscopic hematuria and hyaline casts; blood tests show a high WBC count, low hemoglobin, and low platelets

A 6-year-old boy is brought in by his mother because his teachers noticed that he frequently tends to stare off while doing his schoolwork and will not respond to their questions. His mother states that she has seen him stare off during dinnertime but assumed that he was just ignoring her. What is your next step in the evaluation of this child? A Order a MRI B Order an EEG C Reassure the mother and tell her it is likely nothing D Send him to the ED for urgent treatment

EEG

Which disease is characterized by intrinsic acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia?

HUS- hemolytic uremic syndrome

Which elbow ossification center is the first to fuse in children?

capitellum

acquired cholesteatoma

-pt will have a hx of chronic ear infxns or tympanostomy tubes -c/o painless otorrhea -Physical exam: yellow or white mass behind TM -TX: typanomastoid sx

A 32-year-old woman has just delivered a term infant in the hospital parking lot. The infant is crying and moving her arms and legs. She coughs occasionally. Her face and trunk are pink, but her hands and feet are cyanotic. Her heart rate is 130 beats/minute. What is her APGAR score? 10 6 8 9

9

Which of the following is most consistent with an acute simple febrile seizure? A A 2-month old infant with a rectal temperature of 39.5°C who presents after having two generalized tonic-clonic seizures B A 4-year old child with an oral temperature of 37.8°C who presents after having a generalized tonic-clonic seizure C An 8-month old infant with a rectal temperature of 39°C who presents after having a generalized tonic-clonic seizure lasting 5 minutes D An 8-year old child with an oral temperature of 38.8 °C who experienced 10 minutes of right upper extremity and facial twitching followed by brief confusion

An 8-month old infant with a rectal temperature of 39°C who presents after having a generalized tonic-clonic seizure lasting 5 minutes

which of the following is the initial imaging study in a pt w suspected epidural hematoma? A. CT angiography B. CT of head C. MRI of head D. Transcranial doppler sonogram

CT of head

A 2-year-old boy is being evaluated for dysphagia and difficulty breathing. His mother tells you his symptoms suddenly began about 3-hours ago. His immunizations are up to date. He appears restless, irritable, and is drooling. His temperature is 40.0°C (104°F). Physical examination shows suprasternal and subcostal retractions. Auscultation of the lungs reveals inspiratory stridor. Blood cultures are pending. Which of the following is the most appropriate treatment for this patient's condition? A Albuterol B Ampicillin C Ceftriaxone + vancomycin D Prednisone

CXT + vanco

key physical exam findings in clubfoot

Medial or posterior crease, curved lateral border, calf atrophy, cavus (abnormally high arch), equinus (plantar flexed foot), forefoot adduction and supination.

What nerve distributions are affected by a Nevus of Ito?

Posterior supraclavicular and lateral brachiocutaneous nerves

What viruses commonly cause AOM?

RSV, influenza virus, rhinovirus, and enterovirus

side effects of amphotericin

Renal injury, anaphylaxis, hypotension, fever, and headaches.

An 18-month-old girl presents to the Emergency Department with a rash. Mom reports that she has had a high fever for the last three days. Today, the fever broke, but she developed a maculopapular rash on her trunk as seen in the picture above. What is the likely diagnosis? A Erythema infectiosum B Roseola C Rubeola D Scarlet fever

Roseola

A 15-year-old boy who runs on his high school cross-country team presents to your office complaining of pain just below his right knee. He states that the pain started 3 months ago and is worse at night. He denies any recent injuries or trauma. You order an X-ray and obtain the image below. Which of the following is the most likely diagnosis? A Ewing sarcoma B Osgood-Schlatter disease C Osteosarcoma D Patellar tendonitis

osteosarcome

What is the MCC of croup

parainfluenza virus

A 12-year-old uncircumcised boy presents to the emergency department with a complaint of inability to return his foreskin to its normal position. While he was showering, he retracted his foreskin to clean his penis. He called his mother for help when he could not get his foreskin back into place. Which of the following is the most likely diagnosis? A Balanitis B Paraphimosis C Phimosis Your Answer D Priapism

paraphimosis

A 12-year-old girl presents to the office with anal itching that seems to be worse at night. She has no issues with constipation or any other changes in her bowel habits. On physical exam you see some excoriations around the anus but no tear or palpable hemorrhoid. This first occurred a few days after returning home from a summer camp in northern Michigan, where she was in a cabin with 15 other girls for one month. Which of the following is the most likely diagnosis? A Internal hemorrhoid B Lyme disease C Pinworms D Scabies

pinworms

What rescue med is used for upper airway obstruction

racemic epi

A full-term neonate is brought to the ED for constant crying for the last three hours. In the ED, he sleeps quietly in his mother's arms. He cries when you examine him but is immediately consoled when he is swaddled and held. His exam is normal. What is the next most appropriate step in his management? A CT scan of the head to rule out intracranial hemorrhage B Lumbar puncture to rule out serious bacterial infection C Reassurance D Skeletal survey for abuse

reassurance

A 15-year-old boy is sent to you by the athletic trainer of the local football team after suffering his 3rd concussion of the season. Based on current guidelines, your advice pertaining to this patient returning to play should be which of the following? A He may return to play if asymptomatic after 2 weeks B He may return to play if asymptomatic after 30 days C He may return to play if exam results are normal after 48 hours of physical rest D He should terminate play for the season

He should terminate play for the season

A 3-year-old girl presents to the ED with 1 hour of a barking cough and inspiratory stridor at rest. On exam, she has mild retractions but is not hypoxic. Which of the following interventions has been shown to reduce hospital length of stay in moderate to severe croup? A Dexamethasone B Heliox C Humidified air D Racemic epinephrine

dexamethasone

A 2-year-old boy is brought in by his mother with concerns for right ear pain, fever, and rhinorrhea. His immunizations are up-to-date. The external ear exam is unremarkable, including no posterior auricular tenderness or swelling and no pain with movement of the tragus. The external ear canal is unremarkable, and the tympanic membrane is erythematous and bulging. Pneumatic otoscopy reveals decreased movement of the tympanic membrane. What is the most likely diagnosis? A Acute otitis media B Mastoiditis C Perichondritis D Serous otitis media

AOM

A 9-year-old boy is brought in by his mom for bizarre behavior. She states that he has had intermittent fevers for the past week and is now complaining of joint pain and swelling. Most concerning for Mom is the writhing, purposeless, and uncontrollable movements of her son's hands that she observed this morning. On exam, a diastolic murmur is noted at the right upper sternal border. Which of the following tests is most likely to confirm the diagnosis? A Antistreptolysin O titer (ASO) B CBC C ECG D Echocardiogram E Myocardial biopsy

ASO

An 18-month-old boy is brought in by his parents for shortness of breath. The parents woke to him coughing a low-pitched cough. They also noted other noises when he was breathing in that resolved upon walking outside. The patient is frequently coughing but has no abnormal sounds on auscultation of the neck or lungs. What is the most appropriate treatment? A Albuterol B Dexamethasone C Racemic epinephrine D Ribavirin

dexamethasone

A 15-year-old girl presents to urgent care with a nonproductive cough and low-grade fever that developed insidiously over the previous week. Physical exam reveals diffuse rales on pulmonary auscultation, and chest X-ray shows diffuse non-focal infiltrates. Which of the following is the most accurate statement regarding this patient's condition? A Extrapulmonary manifestations may include hemolysis and CNS involvement B Mycoplasma pneumoniae is the most common etiology in all age groups C Penicillin is the most appropriate treatment D The formation of cold agglutinins is a positive confirmatory test

Extrapulmonary manifestations may include hemolysis and CNS involvement

You examine a two-day-old boy in the neonatal intensive care unit. He was born to a 26-year-old G2, P2 mother via normal spontaneous vaginal delivery. The mother had limited prenatal care. The nurse notes that the infant has a poor suck. On examination, you note that the neonate is small for gestational age, with microcephaly, enlarged liver, and petechiae. On complete blood count, you note thrombocytopenia. You suspect congenital cytomegalovirus infection. Which of the following is the most appropriate therapy? A Acyclovir B Cidofovir C Foscarnet D Ganciclovir

Ganciclovir

A 30-month-old male who was recently adopted from China presents to the Emergency Center after the rapid onset of difficulty breathing. His temperatures is 103°F. He preferentially sits leaning on his arms, which are outstretched in front of him, and he is drooling. What is the most likely etiology of his respiratory distress? A Haemophilus influenzae type B B Parainfluenza virus C Respiratory syncytial virus D Staphylococcus aureus

Hib

A three-year-old girl refuses to use her left arm after her mother tugged on her arm to help her cross a street. She does not appear distressed but is holding her arm in pronation with the elbow slightly flexed. Which of the following is the most appropriate next step? A Hyperpronate the forearm while applying pressure to the radial head B Obtain radiographs of the forearm and elbow C Perform an arthrocentesis and send synovial fluid for analysis D Place the patient in a splint

Hyperpronate the forearm while applying pressure to the radial head

A 14-year-old girl presents with right thigh pain that has been going on for the last month. She recalls being kicked in the leg during soccer practice before her symptoms started. She was last seen in the ED two weeks ago and was diagnosed with a muscle contusion. On exam there is a mass palpable over the anterior distal thigh. X-ray of the femur shows a distal femoral diaphyseal lesion with cortical destruction and periosteal reaction with high suspicion for osteosarcoma. Which of the following is true regarding this disease? A Blunt trauma is associated with the pathogenesis of osteosarcoma B Ionizing radiation for childhood cancer is a risk factor for osteosarcoma C Osteosarcoma most often involves the axial skeleton followed by the long bones D Pathologic fracture is a common presenting sign

Ionizing radiation for childhood cancer is a risk factor for osteosarcoma

what lab abnormalities are associated w osteosarcoma?

Labs not useful, but the MC abnormalities are elevated alk phos, lactate dehydrogenase, ESR

You examine a four-year-old boy for a limp. The parents note that the boy was gradually refusing to run, and later, there was the presence of a limp with walking that is especially prominent at the end of the day. Parents deny fever or rash. On exam, the boy appears well with an antalgic gait and limited hip rotation. Plain radiographs obtained were normal. Bone scan shows decreased perfusion at the left femoral head. Which of the following is the most likely diagnosis? A Legg-Calvé-Perthes disease B Osteomyelitis C Slipped epiphysis D Transient synovitis

Legg-Calvé-Perthes disease

A 14-year-old boy presents to the emergency room with an excruciating painful right knee. The patient denies any history of trauma, medication use or recent illnesses. He is sexually active. The pain started this morning and has gotten worse over the past couple of hours. The patient is unable to bear weight on the knee. On physical exam, the knee is swollen, warm and tender on palpation with no overlying erythema. Which of the following organisms is most likely the cause of this infection? A Neisseria gonorrhoeae B Pseudomonas aeruginosa C Salmonella species D Staphylococcus aureus

N Gonorrhea

Can staph scalded skin syndrome be spread to other body parts by rupture of the bullae?

No, fluid inside the bullae is sterile. The toxin is produced at a remote site and delivered to the skin via the bloodstream

which racial group has the highest SIDS rate

Non-Hispanic African American and American Indian/Alaska Native infants

A 16-year-old African American boy presents with a scalp rash. On examination, it is a 5 x 5 cm boggy and thickened area of the right parietal cap with an overlying scaly and crusty plaque and hair loss. The lesion appears yellowish-green under a Wood's lamp. What is the treatment of choice for this lesion? A Clotrimazole ointment B Ketoconazole shampoo C Oral amphotericin B D Oral griseofulvin

PO griseofulvin

An 7-year-old boy with a history of cystic fibrosis presents with increased cough and fever. He has been doing well and has not been hospitalized for pneumonia in the last seven months. His X-ray demonstrates pneumonia and he requires supplemental oxygen. Which of the following antibiotic regimens is most appropriate? Ceftriaxone and azithromycin Ceftriaxone and doxycycline Moxifloxacin Piperacillin/tazobactam

Piperacillin/Tazobactam

A 5-year-old girl presents to the ED with a rash that started on her face and spread to her neck, axillae, and groin. Mom states that the patient had an upper respiratory infection one week prior. On examination, the patient's rash is tender to the touch. Which of the following statements regarding the diagnosis of this patient's condition is correct? A Deep layers of the dermis are involved B It often leaves the patient disfigured from scarring C Mucous membrane involvement is common D The disease is caused by an exotoxin-producing bacterium

The disease is caused by an exotoxin-producing bacterium

A 9-year-old boy presents to the ED with bilateral knee pain, low-grade fever, nausea, vomiting, and diarrhea for the past 4 days. His vital signs are blood pressure of 116/80 mm Hg, heart rate of 98 beats per minute, respiratory rate of 14 breaths per minute, and a temperature of 38.1°C. On examination, you note the rash seen above. Urinalysis is positive for hematuria. Which of the following statements is the most accurate? A Despite plasma exchange, most patients progress to chronic renal impairment B Long-term prednisone therapy improves 5-year survival to greater than 50% C The disease is self-limited; most cases resolve within 6-8 weeks D Without treatment, the disease carries a mortality rate of 80% at one year

The disease is self-limited; most cases resolve within 6-8 weeks (HSP)

MC sequelae of congenital CMV

Sensorineural hearing loss

A 5-day-old baby girl presents to clinic with the foot deformity (kreeled over on lateral foot). Which of the following is the most appropriate initial treatment for this deformity? Observation Passive stretching exercises performed by the parents at home Serial manipulation and casting Soft tissue release and tendon lengthening

Serial manipulation and casting

A 4-day-old, former 38 week gestation newborn presents to clinic for follow up. She was born without complications and was discharged with her mother yesterday. The mother's pregnancy and prenatal labs were unremarkable. The mother is concerned that the whites of the newborn's eyes have begun to appear yellow and her face now also appears yellow. She has been breastfeeding without difficulty, has been awake and alert, and has had five wet diapers and four yellow-green stools today. Which of the following is most likely to be contributing to this newborn's jaundice? A Abnormal RBC shape B Absence of bilirubin glucuronidation C Intestinal obstruction D Shortened red blood cell lifespan

Shortened red blood cell lifespan

A 14-year old obese boy presents with right knee pain. The physical exam reveals a tendency for the right hip to externally rotate. Which of the following is the most likely diagnosis? A Legg-Calve-Perthes B Medial meniscus tear C Osgood-Schlater's disease D Slipped capital femoral epiphysis

Slipped capital femoral epiphysis

A previously healthy 14-year-old boy presents to clinic with intermittent yellowing of the eyes. His mother is concerned because she notices this each time he has returned home from football practice this summer and wonders if he should quit the team. The boy experiences no symptoms during the episodes and was unaware of the yellowing of his eyes until his mother mentioned it. His exam is currently unremarkable. A liver panel is significant for an unconjugated bilirubin of 3 mg/dL. A CBC, peripheral smear, and reticulocyte count are unrevealing. The remainder of the panel is normal. What is the next best step in management? A Obtain a hepatitis antibody panel B Referral to hematology clinic C Supportive care and reassurance D Suspension from the football team until gastroenterology referral is completed

Supportive care and reassurance

A mother brings her 22-month-old child to the ED after noticing bloody bowel movements. The child has a normal birth history. Mom denies any pain associated with these episodes, but she states that the child has become increasingly pale with decreased energy. His vital signs include a blood pressure of 95/60 mm Hg, heart rate of 140 beats per minute, respiratory rate of 24 breaths per minute, and oxygen saturation of 98% on room air. Abdominal examination is unremarkable, but his stool is guaiac positive. Which of the following is most likely to confirm the diagnosis? A Abdominal ultrasound B Air contrast enema C Technetium-99m pertechnetate scintiscan D Upper GI series via nasogastric tube

Technetium-99m pertechnetate scintiscan

A 4-year-old boy presents with a laceration to his distal forearm. You are considering using a topical tissue adhesive to close the wound. Which of the following is true of tissue adhesive use in lacerations? A In wounds that require deep suture closure, the superficial layer should not be closed with skin adhesive B Tissue adhesives have the equivalent strength of 4-0 nylon sutures C Tissue adhesives should be avoided on areas of cosmetic importance D Tissue adhesives should be used only for lacerations < 2 cm in length

Tissue adhesives have the equivalent strength of 4-0 nylon sutures

A six-month-old girl is brought to the clinic for routine health supervision visit. She interacts well with her parents. She can babble and roll over. She has also started eating solid food. The family is going on a vacation to Philippines for two weeks. The parents express concern that there is currently a measles outbreak in Manila. Which of the following is the best statement regarding measles transmission? A Attack rate of measles in a susceptible individual exposed to measles is 50 percent B Contagiousness is estimated to be from three days before the appearance of rash to three days afterward C Measles is not transmitted in public spaces D Transmission occurs via person-to-person contact as well as airborne spread

Transmission occurs via person-to-person contact as well as airborne spread

Which of the following statements is true regarding febrile seizures? A Administering acetaminophen and ibuprofen during a febrile illness have been shown to decrease the likelihood of seizure recurrence B Children who have had a simple febrile seizure have the same rate of epilepsy as those who have not had a febrile seizure C Older children with a febrile seizure are more likely to have a recurrence than younger children with a febrile seizure are D Treatment with long-term anticonvulsants does not lower the long-term risk of developing epilepsy

Treatment with long-term anticonvulsants does not lower the long-term risk of developing epilepsy

A six-year-old girl presents with dark urine and pedal edema and is found to have an elevated blood pressure. She was treated for strep pharyngitis two weeks ago. Which of the following is the next best step? A Obtain a blood count B Obtain a urinalysis C Obtain antistreptolysin titers D Obtain serum complement level

UA

A 6-year-old boy is brought to the emergency room by his mother because he has been complaining of severe abdominal pain that started yesterday. He has refused to eat for the past couple of days and has vomited once since arrival to the emergency room. He has not had a bowel movement for the past 3 days. On physical exam he appears to be in moderate distress. His abdomen is soft but is exquisitely tender in the right lower quadrant on palpation. Rebound tenderness is absent. Rectal exam reveals stool in the rectal vault. Vital signs are T 101.3°F, HR 119, BP 100/68, and oxygen sat 98% on room air. Which of the following is the most appropriate diagnostic study? A Abdominal computed tomography scan with contrast B Abdominal computed tomography scan without contrast C Abdominal radiograph D Abdominal ultrasound

US

A four-year-old boy presents to the emergency department for inability to walk. He has had two days of leg pain and has been irritable for the past day. The morning of presentation, he refused to get out of bed or bear weight. On his initial examination, he has 1/5 strength in his lower extremities, and 4/5 strength in his upper extremities. Patellar reflexes cannot be elicited. Which of the following is the most likely CSF finding? A WBC 120, Glucose 20, Protein 80 B WBC 120, Glucose 65, Protein 80 C WBC 2, Glucose 65, Protein 135 D WBC 2, Glucose 65, Protein 40

WBC 2, Glucose 65, Protein 135

A 13-year-old boy presents with the acute onset of right testicular pain and swelling. An emergent testicular ultrasound is performed and shows altered blood flow to the right testicle and a twisting of the spermatic cord. Which of the following findings is consistent with the diagnosis? A Absent cremasteric reflex B An oblong, non-tender scrotal mass C Pyuria D Relief of pain with scrotal elevation

absent cremasteric reflex

An 8-year-old boy presents to the emergency department with a 10-hour history of nausea, vomiting, abdominal pain, and general malaise. His abdominal pain was initially periumbilical, but is now localized to the right lower quadrant for the past hour and he rates it 5/10. His vital signs are BP 110/75, HR 105, RR 16, and T 38.6°C. On exam there is significant rebound tenderness of the right lower quadrant and a positive Obturator sign. Lab results are significant for a WBC of 15,000. Which of the following is the most likely cause of his abdominal pain? A Acute appendicitis B Cholecystitis C Constipation D Urinary tract infectio

acute appendicitis

A 3-year-old girl is brought to the urgent care clinic for a 4-hour history of dysphagia, fever, drooling, and difficulty breathing. She is in acute distress, restless, and irritable. Her immunizations are up to date. Her temperature is 40.0°C (104°F). Auscultation of the lungs reveals inspiratory stridor. Which of the following is the most likely diagnosis? A Acute epiglottitis B Anaphylaxis C Croup D Diphtheri

acute epiglotittis

A father brings his 2-week-old newborn to the ED after a gagging episode at home where the infant "turned blue." The newborn was sleeping in his father's arms when he started choking, turned blue, and went limp. The father turned the baby over, did 5 back blows, and performed CPR for 5 minutes until the newborn started crying. On exam, the newborn appears sleepy but is easily arousable. Vital signs are HR 160, RR 30, T 37.6°C, and pulse ox is 99% on room air. Which of the following is the next best step in management? A Admit to hospital for further workup B Endotracheal intubation C Epinephrine (1:10 000) IV D Send home with reassurance

admit for further workup

A 12-year-old Hispanic girl is seen in the clinic with her parents because of painful joints. History reveals that arthralgias started six months ago which affected both knee joints and all metacarpophalangeal joints of the left hand. She has associated fatigue and occasional fever. Physical examination reveals oral mucosal ulcers, discoid rash with malar distribution, and vasculitic rash on the toes. Complete blood count showed white blood count 6.1 x 109/L, neutrophils 4 x 109/L, bands 0.9 x 109/L, lymphocytes 0.5 x 109/L, monocytes 0.4 x 109/L, eosinophils 0.3 x 109/L, and platelets 84 x 109/L. Which of the following tests is most specific for the diagnosis of the patient's condition? A Anti-ribonucleoprotein antibody B Anti-Smith antibody C Antihistone antibodies D Antinuclear antibody (ANA

anti smith

A boy aged 30 months presents with respiratory distress. He was diagnosed with croup one week ago and received a single dose of dexamethasone. His cough had nearly resolved until yesterday, when coughing worsened, and he developed nasal congestion. This evening, he developed inspiratory stridor, increased work of breathing, and a fever to 103°F. What is the most likely diagnosis? A Bacterial tracheitis B Bronchiolitis C Foreign body aspiration D Recurrent croup

bacterial tracheitis

A previously healthy 6-month-old girl presents to clinic with parental concern for fatigue and weakness. Two days ago, she began having sleepiness with drooping eyelids. Since then, she has been having trouble sucking on her bottle and has seemed too weak to eat from a spoon. Her mother has tried multiple interventions to get her to feed. She has tried adding a variety of natural sweeteners to her formula and homemade canned fruits to encourage feeding. Her mother is worried that her lack of intake has caused her entire body to become weak and floppy, and she has not had a bowel movement in five days. On examination, the infant is sleepy. The anterior fontanelle is soft but slightly sunken. Respirations are shallow. Neurological examination is significant for diffuse hypotonia, including bilateral ptosis and ophthalmoplegia. The hypotonia is more severe in the upper extremities than the trunk and lower extremities. What is the most likely etiology of the infant's hypotonia? A Botulism B Guillain-Barré syndrome C Neonatal myasthenia gravis D Prader Willi

botulism

A 5-month-old girl is transferred from an outside facility with concerns of bilateral ptosis, ophthalmoplegia, weak suck, mild diffuse hypotonia, and constipation that have developed and worsened over the past three days. A detailed history reveals that the infant was born at term via an uncomplicated home delivery. She has been previously healthy, growing, and normally developing. Her vaccine schedule has been delayed due to parental hesitancy. She has had no recent illness, sick contacts, or trauma. She has one healthy older brother who is homeschooled and she does not attend daycare. Her parents are gradually introducing her to new fruits and vegetables from their supply of home-canned goods, and she has thus far tolerated them well. Initial laboratory evaluation included unremarkable blood counts and liver panel. Serum chemistries were significant for a slightly elevated bicarbonate level. A capillary blood gas revealed a respiratory acidosis with partial metabolic compensation. A non-contrast CT of the brain was normal and subsequent cerebrospinal fluid analysis was normal. Which of the following is indicated for treatment? A Botulism immune globulin B Intravenous immunoglobulin C Vancomycin and ceftriaxone D Vitamin K administration

botulism immune globulin

a 10 yr old boy presents w c/o dizziness & progressive hearing loss in the Left ear for the past month. he does not c/o any pain. physical exam reveals intact TM w a pearly mass visible behind the membrane. Audiometry reveals mild conductive hearing loss to the affected ear. What is the most likely dx? A. AOM B. Cholesteatoma C. chronic suppurative OM D. OE

cholesteatoma

Which of the following is most characteristic of a complex febrile seizure? A Convulsions are focal in nature B Convulsions lasting 12 minutes C Second seizure occurs with second febrile illness D Single seizure that occurs at a temperature of 40°C

convulsions are focal in nature

A 3-year-old boy is brought to the urgent care clinic by his mother. She tells you he has had a fever and cough for the past 2 days. His temperature is 38.6°C (101.5°F) and his respiratory rate is 35/min. Auscultation of the lungs reveals inspiratory stridor with a prolonged inspiratory phase. A chest X-ray shows subglottic narrowing. Which of the following is most likely the best treatment for this child's condition? A Antibiotics B Anticholinergics C Bronchodilators D Corticosteroids

corticosteroids

Which medical treatment is known to be beneficial in patients with croup by decreasing edema in the laryngeal mucosa?

corticosteroids

A 6-year-old boy was well until this morning when he awoke with papulovesicular eruptions over his arms, hands, legs, and feet. He refuses to eat or drink. What is the most likely etiology of his symptoms? A Coxsackie virus B Herpes virus C Rickettsia rickettsiae D Treponema pallidum

coxsackie

A 17-month-old girl presents to the office with two days of fever, congestion, and cough. On examination, inspiratory stridor is noted when the patient becomes fussy. What is the most likely etiology of her stridor? A Bacterial tracheitis B Croup C Epiglottitis D Laryngotracheal foreign body aspiratio

croup

A 4-year-old girl is brought to the ED after 48 hours of vomiting and diarrhea. Her parents are concerned that she is becoming dehydrated. Which of the following is a sign of moderate dehydration? ADecreased urine output B-Hypotension C-Lethargy D-Mottled extremitie

decreased urine output

A family brings in their 3-month-old infant who was just adopted from Honduras. They are not aware of the infant's birth history and were told that the child was healthy and lived in an orphanage for the first three months of life. They are concerned that he has significant bruising over his back. On examination, a large blue patch is present over the sacrum. Similar patches are present over the bilateral shoulders. The remainder of the examination is benign. Which of the following is the most likely diagnosis? A Child abuse B Coagulopathy C Dermal melanosis D Nevus of Ota

dermal melanosis (Mongolian spots)

A 2-year-old boy presents to the Emergency Department with his grandmother due to concern for dehydration. He has had two wet diapers and eight watery, malodorous, green stools in the past 24 hours. He has been extremely thirsty and drinking plenty of water and juice. Serum chemistries are significant for a sodium 151 mEq/L, chloride 117 mEq/L, potassium of 3.0 mEq/L, and bicarbonate of 19 mEq/L. Urinalysis is significant for 1 ketones but is otherwise normal. What is the most likely cause of this child's hypernatremia? A Diabetes insipidus B Diarrhea C Salt poisoning D Water deprivation

diarrhea

A 6-year-old boy presents to your office with a 5-day history of fever and headache. He denies any changes in vision or nuchal rigiditiy. He denies any international travel but he does mention that he went hiking in Tennessee one week ago. Physical exam reveals a nonpruritic, small, maculopapular rash noted on the arms and wrist that began yesterday. Laboratory values are significant for thrombocytopenia and hyponatremia. Which of the following is the first-line treatment? A Amoxicillin B Chloramphenicol C Corticosteroids D Doxycycline

doxy

An 8-year-old boy presents to your office with complaints of fever, headache and rash. His mother tells you that he recently returned from visiting relatives in North Carolina. Physical exam reveals a maculopapular rash on the patient's wrists and ankles that appears to be spreading to his trunk. His temperature is 102°F (38.9°C). Which of the following is the most appropriate therapy? A Amoxicillin B Cephalexin C Doxycycline D Penicillin

doxy

A 6-week-old infant is brought to the Emergency Room with parental concern for one week of cough and congestion. Although her cough has worsened, she remains afebrile. Chest radiography reveals bilateral interstitial infiltrates and hyperexpansion. What is the treatment of choice? A Amoxicillin B Cefotaxime C Erythromycin D Reassurance and return precautions

erythromycin

mammography can detect 90% of breast cancers that are present. true/false

false

A 2-year-old girl presents to the Emergency Department with her parents for a rash. She has lesions on her palms and on the soles of her feet, as well as in her oral cavity as shown above. Which of the following indicates that the child can safely return to daycare? A Ability to tolerate oral intake B Active skin lesion resolution C Antibiotic therapy is complete D Fever resolution

fever resolution

A six-year-old girl is brought to the clinic because of a rash. She was in school when she developed a rash about 30 minutes after eating peanuts. The lesions are pruritic. She denies difficulty of breathing, throat tightness, vomiting, or abdominal pain. On physical examination, there are multiple raised, erythematous plaques, with central pallor that are less than one centimeter to several centimeters in diameter. The lesions are scattered over her chest, abdomen, and arms. Which of the following is the most appropriate therapy? A Chlorpheniramine B Diphenhydramine C Fexofenadine D Hydroxyzine

fexefenadine

A 5-day-old former 39-week neonate is brought to clinic by her concerned mother for jaundice extending from her face down to her chest. The infant was born by cesarean section for prior maternal cesarean section. Her postnatal course has been uncomplicated, and she was discharged with her mother on the third day of life. She did not require phototherapy. She was told that she and the baby had the same blood type. She is exclusively breastfeeding on demand and mother feels that it is going well. The infant is having yellow-green stools after each feed and has a wet diaper approximately every four hours. She has lost 4% from birth weight. What is the most appropriate next step in management? A Further assessment of breastfeeding B Obtain total serum bilirubin, hematocrit, and direct antibody testing C Phototherapy D Transition to formula feeding

further assessment of breastfeeding

What GI disorder is associated with erythromycin use in neonates?

hypertrophic pyloric stenosis

A five-year-old boy presents to the emergency department with nasal bleeding lasting greater than two hours. In the emergency department, the nurse applied pressure for 20 minutes without successful resolution. The patient appears well and has a normal heart rate and blood pressure. The patient's mother reports that the child's father has a bleeding disorder for which he occasionally uses a nasal spray. The patient has never had testing, and this is his first physician encounter for bleeding. Which lab abnormality would you expect to find for the child's inherited condition? A Decreased platelet count B Increased bleeding time C Increased platelet count D Increased prothrombin time

inc bleeding time

which of the following is considered a severe sx of hypoparathyroidism? A. Laryngospasm B. muscle cramps C.paresthesia D. perioral numbness

laryngospasm

How is a positive Galeazzi test defined?

limb length discrepancy

A 7-year-old boy presents for a well child check. His mother reports that he has always been a healthy child and does well in school. On examination, he is noted to have pectus excavatum and long, tapered fingers. He is wearing glasses, and mother reports a history of upward lens subluxation. What is the most likely genetic abnormality? A Ehlers Danlos Syndrome B Homocystinuria C Marfan Syndrome D Osteogenesis Imperfecta

marfan

An otherwise healthy 16-year-old boy is seen in clinic for a routine physical examination. He is a straight-A student and does not participate in sports. On exam you note that his height is greater than the ninety-fifth-percentile for age, he has long fingers, a pectus deformity, and auscultate a mid-systolic click followed by a 3/6 late systolic murmur. Which of the following is the most likely diagnosis? Ehlers Danlos syndrome Homocystinuria Marfan syndrome Russell Silver syndrom

marfan syndrome

A four-year-old girl is brought to the clinic because of a rash. Five days prior, she developed fever, decreased appetite, eye redness, and coughing. Yesterday, the mother noted the appearance of a rash that started on the face and today has spread to the neck and trunk. The girl has not had any vaccines since the mother was opposed to it. On physical examination, temperature is 38.5ºC with erythematous, maculopapular, blanching rash on the neck, upper trunk, lower trunk, and extremities. Which of the following is the most likely diagnosis? A Drug eruption B Measles C Roseola D Varicella

measles

what are common causes of TM perforation?

middle ear infection & trauma w foreign object

which of the following clinical sxs or signs is most suggestive of breast fibroadenoma? A. bilateral cyclical tender masses B. fixated irregular mass C. fluctuant mass w surrounding erythema & edema D.mobile well defined mass

mobile well defined mass

A four-year-old child presents to the emergency room with high fever, barking cough, stridor and moderate retractions at rest. Which of the following is the most appropriate treatment for this condition? A Albuterol nebulizer B Ceftriaxone C Nebulized racemic epinephrine D Oral oseltamivir

nebulized racemic epi

A 12-year-old boy has a cognitive disability and multiple café-au-lait macules. Which additional finding is most likely on examination? A Annular, hypopigmented macules B Facial angiofibromas C Neurofibromas D Periungal fibromas

neurofibromas

Do childhood vaccines protect against coxsackie A?

no

A 3-year-old previously healthy, fully immunized boy presents after a seizure that occurred two hours prior to arrival. He has never had a seizure before. Today, he experienced a 35 second generalized tonic-clonic seizure. He had a postictal period of 20 minutes and is now at his neurologic baseline. Emergency Medical Services were called and he had a blood glucose level of 84 mg/dL on scene. He has had a cough and runny nose for the past day. Shortly before the seizure, he developed a fever to 39.3°C. On exam, he is a well appearing boy with a supple neck, no rashes, normal tympanic membranes, normal pharynx, clear lungs, and a soft abdomen. What diagnostic study should be obtained on this patient? A Electroencephalogram B Lumbar puncture C No diagnostic studies are indicated D Non-contrast computed tomography scan

none indicated

An 11-month-old previously healthy boy presents in January with a two-day history of rhinorrhea, cough, and wheezing. Physical exam is significant for bilateral wheezing and crackles heard at the lung bases. The patient's pulse oximetry is 96 percent on room air. Which of the following is the most appropriate next step in management? A Administer racemic epinephrine B Albuterol nebulizer treatment every four hours C Chest X-ray D Observation and supportive care

observation & supportive care

A 14-day-old neonate presents to clinic with bilateral eye discharge and conjunctival injection. What treatment is indicated? A Ceftriaxone intramuscular B Erythromycin ointment C Oral erythromycin D Warm compresses and lacrimal duct massage

oral erythromycin

A two-month-old male infant presents in August with a copious, bubbly, tenacious mucous discharge from his nose and mouth. He also has a repetitive paroxysmal cough terminated by an inspiratory "whoop" and followed by post-tussive emesis. The infant had upper respiratory symptoms for the past two weeks. His parents report a possible seizure before taking him to the emergency room. Other infants in his day care center have been diagnosed with respiratory infections associated with a "prolonged" cough. The infant is pale and cyanotic, tachypnic and bradycardiac as well as anxious looking. Physical examination of his chest is consistent with a lobar pneumonia. What is the most likely diagnosis in this infant? A Adenovirus B Chlamydia C Pertussis D Respiratory syncytial virus

pertussis

An 8-year-old girl is being evaluated for a persistent cough. She also has malaise, weight loss, and fatigue. She says her cough is worse at night and interferes with her sleep. She had an unknown illness about 10-days ago that consisted of coryza, lacrimation, and a low-grade fever. However, the cough has persisted and is becoming more severe as she has several repetitive spasmodic bursts of 5-10 coughs occurring about 20 times a day. Which of the following is the most likely cause of this patient's condition? A- Bordetella pertussis B-Haemophilus influenza C-Influenza virus D-Parainfluenza virus

pertussis

a 70yr old woman w HIV presents to the clinic w unilateral burning pain around her trunk for the past 4 mos. she also says that she initially had a red rash in the distribution of the pain, but it resolved after a few weeks. which of the following is the most like dx? A. diabetic neuropathy B. ischemic stroke C. muscle strain D. postherpetic neuralgia

postherpetic neuralgia

A 6-year-old boy presents to the Emergency Department with periorbital swelling. His mother notes that for the past three days the periorbital swelling would appear in the morning and gradually decrease throughout the day. The boy also presents with loss of appetite, abdominal pain, and loose bowel movements. The physical examination reveals an fussy child with blood pressure of 100/70 mmHg and temperature of 37oC. He has periorbital edema, anicteric sclerae, pink palpebral conjunctiva, clear breath sounds, a nontender abdomen, no bipedal edema, and capillary return less than 2 seconds. Urinalysis is positive for 3+ proteinuria and red blood cell count of 10 cells/hpf. Serum cholesterol and triglyceride levels are elevated with serum albumin less than 2.5 g/dL. What is the initial drug of choice for the most likely diagnosis? A Cyclophosphamide B Cyclosporine C Levamisole D Prednisone

prednisone

An otherwise healthy 4-year-old boy presents with his parents for vomiting and diarrhea. Several kids at his school have had similar symptoms. He began to have nonbloody, nonbilious vomiting yesterday and this morning began to have nonbloody diarrhea. He felt warm at home, but he is currently afebrile. He is well-appearing and playful. He is able to drink water without difficulty. Which of the following is the next best step? A Administer intravenous fluids B Admit for observation C Provide reassurance and discharge home D Send stool cultures

reassurance and discharge

2-week old infant is brought to the office for a well child visit. The physical examination is completely normal except for a clunking sensation and feeling of movement when adducting the hip and applying posterior pressure. Which one of the following would be the most appropriate next step? A Plain radiograph of the pelvis B Reassurance that the problem resolves spontaneously in 90% of cases, and follow-up in 2 weeks C Referral for orthopedic consultation D Triple diapering and follow-up in 2 weeks

referral

A 13-month-old boy is brought by his anxious parents to the clinic because of a rash. For the previous three days, he has been having high-grade fever that is lysed by ibuprofen. Then today, he became afebrile, and the mother noted the appearance of a rash on the neck and trunk. On physical examination, his temperature is 37.3ºC, heart rate is 104 beats per minute, respiratory rate is 25 cycles per minute. His skin examination reveals blanching maculopapular rash on the neck and trunk that has spread to the face and extremities. Which of the following is the most likely diagnosis? A Measles B Roseola C Rubella D Scarlet fever

roseola

A mother brings her 9-month-old child to the clinic with a complaint of a rash on his torso for one day that began on his abdomen and spread to his arms and legs. He has had a fever up to 104°F for two days associated with a runny nose. On physical exam, his temperature is 99°F and you note a slightly erythematous papular rash on his trunk that extends to his extremities, but spares his face and palms. The patient is smiling and playing with toys in the exam room. He has associated clear rhinorrhea; patient is alert and active. Rapid antigen detection test for Group A streptococcus is negative. Which of the following is the most likely diagnosis? A Erythema infectiosum B Meningococcemia C Roseola infantum D Scarlet fever

roseola infantum

The athlete who suffers multiple concussions and returns to play too soon is at risk for what syndrome?

second impact syndrome

A 12-month-old girl presents with a fever and the rash (looks like skin peeling aftern sunburn), which started around her mouth and is now present on her neck, chest, and groin. Her mucous membranes are not involved. The epidermis is noted to slip away from the underlying dermis when gentle lateral pressure is applied. What is the most likely diagnosis? A Bullous impetigo B Staphylococcal scalded skin syndrome C Stevens-Johnson syndrome D Toxic epidermal necrolysis

staph scalded skin syndrome

A 3-month-old presents with three days of cough, congestion, and increasing work of breathing. On exam, respiratory rate is 60 breaths per minute with moderate subcostal retractions. Air movement is good, but there are scattered rhonchi, crackles, and expiratory wheezes. Heart rate is 145 beats per minute with a regular rate and rhythm and no murmurs. Oxygen saturation is 89% on room air. Which of the following is the next step in management? A Initiate supplemental oxygen by nasal cannula B Obtain a chest radiograph C Trial of nebulized albuterol D Trial of nebulized epinephrine

supplemental O2 by nasal cannula

Which of the following is recommended by the American Academy of Pediatrics Task Force on sudden unexpected death of infancy to reduce the risk of sudden unexpected death of infancy in the general population? A Parents should consider offering a pacifier at nap time and bedtime B Parents should place infants in the prone position for sleep C Parents should place infants to sleep on soft mattresses D Parents should use home monitoring systems

use of pacifier

A 6-month-old infant presents to the pediatrician's office with a two-day history of increased fussiness, poor feeding, low-grade fever and rash. The family returned from a trip to India last week. The rash appears on the trunk in several stages of erythematous macules, vesicular papules and pustules. Which of the following is the most likely diagnosis? A Herpes simplex B Measles C Pityriasis rosea D Varicella

varicella

A 12-month-old girl presents with recurrent urinary tract infections. The external genital examination is normal. Renal ultrasonography shows hydronephrosis. Voiding cystourethrography does not reveal any detrusor abnormality. Which of the following is the most likely diagnosis? Bladder diverticulum Cryptorchidism Epispadias Vesicoureteral reflux

vesicoureteral reflux

A 17-year-old girl is seen in clinic due to vaginal discharge. She complains of yellow-green discharge and pruritus around her vaginal area. She is sexually active since last year and has had three partners. She denies taking any medication and uses condoms occasionally. Her last menstrual period was last week. On physical exam, you note frothy discharge with vaginal erythema and cervical hemorrhages. Which of the following is the next best step? A Obtain a wet mount B Obtain Herpes simplex virus PCR C Obtain Rapid plasma Reagin (RPR) D Provide reassurance and discharge home

wet mount