MCQ Pediatric 3

"A 1-day-old boy is evaluated in the nursery for minimal right arm movement. He was born at 41 weeks gestation to a woman with poorly controlled type 1 diabetes mellitus. Attempted vaginal delivery was complicated by shoulder dystocia and became a cesarean section delivery. Family history is positive for obesity in the boy's father and osteoporosis in both grandmothers. Birth weight was 4.5 kg. Examination shows crepitus and irregularity over the right clavicle. Moro reflex is absent on the right. Bilateral biceps and grasp reflexes are intact and symmetric. The infant is plethoric and has excessive fat accumulation in the abdominal and scapular regions. The remainder of the examination is normal. Which of the following is the most significant risk factor for this patient's condition? A. Brachial plexus injury B. Family history of osteoporosis C. In utero cerebrovascular accident D. Maternal history of diabetes E. Osteogenesis imperfecta "

D

"A 1-day-old infant appears dusky in the newborn nursery during feeding. Oxygen is immediately administered by nasal cannula. Shortly afterward, she develops tachypnea. On physical examination, her blood pressure from the right upper arm is 50/30 mm Hg, her pulse is 180/min, and her respirations are 60/min. An echocardiogram is consistent with hypoplastic left heart syndrome. Which of the following would likely be found on auscultation? A. Continuous ductal murmur, bounding pulses B. Continuous ductal murmur, poor peripheral pulses C. Holosystolic murmur, poor peripheral pulses, quiet second heart sound D. No murmur, precordial hyperactivity, loud second heart sound E. No murmur, precordial hyperactivity, quiet second heart sound "

D

"A 1-week-old female infant is brought to the office by her 30-year-old mother because she has been ""crying a lot."" She was born at term. Her mother was diagnosed with gestational diabetes mellitus GDM at 24 weeks gestation and had been on insulin injections since. During labor, there was a prolonged second stage due to difficulty in delivering the shoulders. Her Apgar scores were 8 and 10 at 1 and 5 minutes, respectively. Her birth weight is 3.8 kg 8.5 Ib. On examination, the infant is active. On sudden extension of the head, there is extension of all the extremities, except for the left upper extremity. There is crepitus over the left clavicular bone. Which of the following statements is true for this baby? A. This infant has clavicular fracture and should be treated with a figure of eight bandage B. This is a clavicular fracture and the infant should be evaluated for child abuse C. This is Erb Duchenne palsy due to difficult shoulder delivery D. This is a common outcome with large babies and related to gestational diabetes E. This infant has clavicular fracture and should be treated with a surgery "

D

"A 10-year-old boy is brought to the office for the evaluation of worsening fatigue for the past few weeks. He has sickle cell anemia, and has had several hospitalizations for painful crises. His vital signs are stable. He appears pale. He has a hemoglobin level of 7.7 g/dl and hematocrit of 22.5%. Which is the most likely type of anemia of this patient? A. Iron deficiency anemia B. Anemia of chronic disease C. Megaloblastic anemia D. Hemolytic anemia E. Sideroblastic anemia "

D

"A 10-year-old male fell while riding his scooter down a steep hill. In the Emergency Department, his injuries included a fractured wrist and a lacerated spleen, which required surgical removal. Two years later he is diagnosed with bacterial pneumonia. Which of the following bacterial agents is the most likely pathogen for this patient's pneumonia? A . Escherichia coli B . Klebsiella pneumoniae C . Neisseria meningitidis D . Streptococcus pneumoniae E . Staphylococcus aureus "

D

"A 10-year-old presents with 2 months history of heavy menstrual-like bleeding. Menarche occurred 6 months ago and this first menses consisted of spotting for 3-4 days without cramps. Subsequent periods were light in flow but lasted 6 to 8 days. Which of the following is the most likely cause of her bleeding? A . Von Willebrand disease B . Ovarian tumor C . thyroid disease D . Dysfunctional uterine bleeding E . Pregnancy "

D

"A 12-year-old girl is brought to the clinic due to a 2-month history of headaches. Her headaches last 1-2 hours and have no fixed time of occurrence. She denies nausea, vomiting, chills or fevers. She has no other medical problems and takes no medication. Her family history is significant for hypertension and diabetes. Her blood pressure is 156/90 mm Hg, pulse is 80/min, and respirations are 14/min. Examination shows an alert child in no distress. There is a soft to-and-fro bruit heard at the right costovertebral angle. Which of the following is the most likely cause of her hypertension? A. Coarctation of aorta B. renal artery atherosclerosis C. Pheochromocytoma D. Fibromuscular dysplasia E. Conn's syndrome "

D

"A 2-year-old child is admitted to your hospital team. The child's primary care doctor has been following the child for several days and has noted her to have had high fever, peeling skin, abdominal pain, and a bright red throat. You are concerned because two common pediatric problems that could explain this child's condition have overlapping presenting signs and symptoms. Which of the following statements comparing these two diseases in your differential is true? A. Neither has cardiac complications B. serologic tests are helpful in diagnosing both C. Only one of the diseases has mucocutaneous and lymph node involvement D. Pharyngeal culture aids in the diagnosis of one of the conditions E. A specific antibiotic therapy is recommended for one of the conditions, but only supportive care is recommended for the other"

D

"A 2-year-old girl is brought to the clinic due to fever, irritability and lethargy for the past two weeks. Over the past two months, she has complained of intermittent abdominal discomfort and has lost weight. Abdominal palpation reveals a firm nodular mass in the right flank. No bruits are heard. Abdominal x-ray reveals multiple calcifications in the renal area. Urine examination reveals increased levels of homovanillic acid and vanillylmandelic acid. Which embryonic structure has this mass most likely arisen from? A. Metanephros B. Mesonephron C. Paramesonephron D. Neural crest cells E. Lymphoid stem cells "

D

"A 3-month-old girl is brought to the pediatrician for a scheduled visit. She has been meeting all development milestones but has been vomiting after each feeding. The infant weighed 3 kg 6 lb 10 oz. at birth and now weighs 6 kg 13 lb 3 oz. She does not have diarrhea and is afebrile. The remainder of the physical examination is unremarkable. Which of the following is the most likely cause of this patient's vomiting? A. Adrenogenital syndrome B. Child abuse C. Inborn error of metabolism D. Overfeeding E. Pyloric stenosis "

D

"A 3-month-old male infant is brought to the emergency department by his mother because of difficulty in breathing. His mother was admitted in the hospital ten days ago due to a urinary tract infection, and he was cared for by his grandmother during that period. His mother had just been discharged from the hospital yesterday, and noticed that he was constipated and having difficulty with breastfeeding. On examination, he is afebrile. His pulse rate is 110/min, respirations are 36/min with shallow breathing efforts, and blood pressure is 90/50mm Hg. His weight is at the 35th percentile. Examination shows ptosis, dilated pupils with sluggish reaction to light, diminished deep tendon reflexes and decreased muscle tone. What is the most likely mechanism of his illness? A. Bacterial infection of the meninges B. Autoimmune disease against acetylcholine receptors C. Clostridium difficile toxin in the intestinal tract D. Clostridium botulinum in the intestinal tract E. Clostridium botulinum toxin intake "

D

"A 3-week-old African American boy is brought to the Emergency Department because of a generalized seizure 2 hours ago. The infant is highly irritable with incessant high pitched crying. The infant's weight is 2.5 kg 250 gm below birth weight, blood pressure is 70 /40 mm Hg, pulse is 145/min and respirations are 50/min. Laboratory results show: blood glucose 120 mg/dL, Urea nitrogen 50 mg/dL, serum sodium 170 mEq/L, serum calcium 8.5 mg/dL, serum magnesium 1.5 mg/dL. Which of the following is the most likely cause of this infant's seizure? A . Hypocalcemia B . Hypoglycemia C . Hypomagnesemia D . Intracranial hemorrhage E . Meningitis "

D

"A 4-month-old baby is in for a well-child check and routine immunizations. The baby had a fever of 39°C the day he received his 2-month immunizations. The parents have read about the vaccine on the Internet and express their concerns. Which of the following is an absolute contraindication to giving the diphtheria and tetanus toxoids and acellular pertussis DTaP? A. history of fever >38C after previous vaccination B. history of local reaction after previous vaccination redness, soreness, swelling. C. family history of seizures D. encephalopathy within 7 days of administration of previous dose of vaccine E. current antibiotic therapy "

D

"A 4-year-old boy, who has a ventriculoperitoneal shunt for congenital hydrocephalus, develops fever, headache, irritability, lethargy, photophobia, and vomiting. His temperature is 39.6 C 103.2 F.. He is noted to have nuchal rigidity, with the presence of both Kernig's and Brudzinski's signs. The shunt tract is erythematous on the surface. A lumbar puncture is performed and shows a WBC of 40,000/mm3 with 85% neutrophils, a glucose concentration of 48 mg/dL, and a protein concentration of 169 mg/dL. Which of the following is the most likely pathogen? A . Haemophilus influenzae B . Neisseria meningitidis C . Pseudomonas aeruginosa D . Staphylococcus epidermidis E . Streptococcus pneumoniae "

D

"A neonate is noted to have an abnormally shaped face with a very small jaw. several hours after birth, the baby develops convulsions and tetany. serum chemistries show the following: Sodium 1 40 mEq/L, Potassium 4 mEq/L, Chloride 100 mEq/L, Bicarbonate 24 mEq/L, Magnesium 2 mEq/L, Calcium 5 mg/dL, Glucose 100 mg/dL. This child's disorder is associated with aplasia or hypoplasia of which of the following organs? A. Ovaries B. Pancreas C. Pituitary D. Thymus E. thyroid "

D

"A patient with Cushing syndrome might present with any of the following EXCEPT: A. Obesity B. A buffalo hump C. Moon face D. Bronze or hyperpigmented skin E. Glucose intolerance"

D

"An 8-moth old infant was admitted with history of excessive crying and pain abdomen. The child is pale and having recurrent pain. An hour before hospitalization, the child was passing blood and mucous likely diagnosis is: A. Acute amoebic colitis B. Acute Crohn's disease C. Acute bacillary dysentery D. Acute intussusception"

D

"The fever of malaria: A. Can be tertian occurring every 48 hours.. B. Can be quartan occurring every 72 hours.. C. Occur with no pattern at all. D. A, B& C E. B &C"

D

"The pathogenesis of malaria can affect which of the following organ systems: A. Liver and brain B. Lungs and kidneys C. Spleen and GI tract D. A, B& C E. B &C"

D

"What is most the endemic form of encephalitis in Cambodia? A. HSV. B. Enterovirus.. C. Rabies virus. D. Japanese encephalitis virus. E. All of the above"

D

"What physical exam sign/symptom is most suggestive of foreign body aspiration? A. Fever B. Polyphonic wheezing C. Cough D. Stridor E. Monophonic wheezing"

D

"Which microorganism is a common ethiology in endotoxic shock? A. Staphylococcus aureus B. Streptococcus pyogenes C. Streptococcus pneumoniae D. Escherichia coli E. All of the above"

D

"respiratory Problems in premature infants may be secondary to choose one.: A. Surfactant deficiency B. Increased chest wall compliance C. Incomplete alveolar development D. A, B & C E. B &C"

D

"A 1-year-old boy is brought to the physician by his parents for evaluation of bruising and blood in his stool. The child has had multiple episodes of otitis media and has been hospitalized twice with pneumonia, but has never had bleeding or easy bruising in the past. He has been eating and drinking well with no vomiting or diarrhea. He is afebrile with a heart rate of 150/min and a blood pressure of 80/40 mmHg. On examination, he is well-developed, well-nourished, and has a fair complexion. There are dry, scaly patches on his cheeks and lower extremities. He also has bruising and purpura on his lower extremities. His diaper contains a small amount of occult blood positive stool, but no fissures are seen on rectal examination. The remainder of the physical examination is unremarkable. Laboratory studies show: Complete blood count: Hemoglobin 11 .5 g/dL, Platelet count 20,000/mm3, leukocyte count 6,500/mm3, Neutrophils 76%, Eosinophils 1%, Lymphocytes 13%, Monocytes 10%. A peripheral smear reveals a low number of platelets, and the platelets that are seen are small. Which of the following is the most likely cause of his bleeding? A. Bone marrow infiltration B. Platelet antibodies C. Nutritional deficiency D. Platelet activation and consumption E. Impaired platelet production "

E

"A 1-year-old boy presents with the complaint from his parents of "not developing normally." He was the product of an uneventful term pregnancy and delivery, and reportedly was normal at birth. His previous health-care provider noted his developmental delay, and also noted that the child seemed to have an enlarged spleen and liver. On your examination, you confirm the developmental delay and the hepatosplenomegaly, and also notice that the child has short stature, macrocephaly, hirsutism, a coarse facies, and decreased joint mobility. Which of the following is the most likely etiology of his condition? A. Beckwith-Wiedemann syndrome B. Crouzon syndrome C. Trisomy 18 Edwards syndrome. D. Jeune syndrome E. Hurler syndrome "

E

"A 12-year-old boy is brought to the clinic by his parents because ""he cannot walk anymore."" Yesterday, he became irritable, uneasy, and complained of tingling and weakness in both his legs. This morning, he couldn't stand up or move his legs, and complained of pain in his leg and thigh muscles. He denies any headaches, nausea or vomiting. He had an episode of febrile diarrhea 10 days ago. His family history is unremarkable. Physical examination reveals symmetric flaccid paralysis of both legs, absent deep tendon reflexes, and decreased superficial touch and vibratory sense. There is no nuchal rigidity. What structure is most likely affected in this patient's condition? A. Cerebral cortex B. Medial lemniscus C. Corticospinal tract D. Gracile fasciculus E. Peripheral nerves "

E

"A 2-week-old infant presents with hepatosplenomegaly and a thick, purulent, bloody nasal discharge. Coppery, oval, maculopapular skin lesions are present in an acral distribution. The neurologic examination is normal, including head circumference. Which of the following is the most likely cause of this congenital infection? A. cytomegalovirus CMV B. HSV C. GBS D. T. gondii E. T. pallidum "

E

"A 2-year-old boy is brought to the office by his parents due to severe diarrhea since yesterday. He has had approximately 20 episodes of non-bloody, non-mucoid stool passage in the last twenty hours, and one episode of bilious vomiting. He is also feeding less than usual. He is febrile, tachycardic and moderately dehydrated. What is the most likely cause of his presentation? A. Norwalk virus B. E.coli C. Campylobacter jejuni D. Shigella E. Rotavirus "

E

"A 2-year-old boy is brought to the pediatrician for a routine well-child visit. He has been growing and developing normally. He is starting to put words together into 2-word phrases. The boy eats a variety of foods including meats, vegetables, and fruits, and drinks 24-28 ounces 700ml. of whole milk each day. Past medical history is unremarkable. His mother has no concerns at today's visit. His physical examination is within normal limits. Laboratory results are as follows: Complete blood count: Hemoglobin 9.4 g/dl, Hematocrit 28%, Mean corpuscular volume 64 fl, red cell distribution width 14% normal 11.5%-16.0%., reticulocytes 3.0%, Platelets 240,000/µL, leukocytes 7,500/µL, blood, plasma, and serum, Ferritin 100 ng/ml 7-140 ng/ml., Iron-binding capacity 300 µg/dl 240-450 µg/dl.. Which of the following is the most likely cause for this child's anemia? A. Abnormal utilization of iron B. Cobalamin deficiency C. Iron deficiency D. red blood cell membrane instability E . reduced production of globin chains "

E

"A 2-year-old boy is rushed to the emergency department by his 21 -year-old white mother because he had a sudden-onset nosebleed which has now subsided. He never had any previous episodes. He is ""sickly"" and suffers from a productive cough and diarrhea that ""refuses to go."" His stools are greasy and foul-smelling. His appetite is normal, although his diet consists mainly of milk. His mother's boyfriend lives with them and is a chronic alcoholic. He was delivered vaginally without any complications. His weight is at the 25th percentile for his age. Physical examination reveals dry skin and dried blood at the nasal turbinates. What is the most likely cause of this child's failure to thrive? A. Lactose intolerance B. Parental neglect C. Chronic parasitic infection D. Constitutional growth delay E. Deficiency of pancreatic enzymes "

E

"A 2-year-old girl has severe dental caries of the upper and lower incisors. Her teeth are brushed twice daily with a small amount of fluoride-containing toothpaste. What is the feeding practice most likely to result in this pattern of dental caries? A. drinking juice from a cup at snack time B. drinking juice from a bottle at snack time C. drinking milk from a bottle at meal time D. prolonged breast-feeding beyond the first year E. drinking a bottle of juice in bed "

E

"A 3-month-old infant is taken to the emergency department with constipation and behavioral changes. Physical examination demonstrates ptosis and an absence of facial expression. The child appears conscious but has trouble following a toy with her gaze. The crying is very weak, and saliva is pooling in her mouth. She is also developing a generalized hypotonia, and breathing is becoming more shallow. This child's condition is most likely related to ingestion of which of the following food products? A. Canned carrots B. Canned green beans C. Canned peaches D. Formula E. Honey "

E

"A 3-month-old infant without significant past history was brought to the emergency center by her mother with a generalized tonic-clonic seizure. She is found to have glucose of 5 mg/dL. After correction of her hypoglycemia, she is admitted to your service for further evaluation. several hours later, her nurse calls to tell you that her bedside glucose check was now 10 mg/dL. You order laboratory work suggested by the pediatric endocrinology team and again correct the infant's hypoglycemia. The results of the laboratory tests you drew include an elevated serum insulin level of 50 µU/mL, and a low IGFBP-1 plasma insulin-like growth factor binding protein-1. C-peptide levels are not detectable. Which of the following is the likely cause of this child's recurrent hypoglycemia? A. Nesidioblastosis B. Pancreatitis C. Beckwith-Wiedemann syndrome D. Galactosemia E. Factitious hypoglycemia "

E

"A 4-month-old infant boy has gained only 10 ounces since birth. He has failed to gain weight with multiple formula preparations. His stools have been loose and fatty. An older sister had similar symptoms and has been repeatedly hospitalized for failure to thrive and recurrent pulmonary infections. Which of the following is the most likely cause of this patient's gastrointestinal symptoms? A . Achlorhydria B . Bacterial overgrowth C . Colonic inertia D . Gastric hypersecretion E . Pancreatic exocrine insufficiency "

E

"An alert, 6 month old male has a history of vomiting and diarrhea. He appears pale and has an RR of 45 breaths per minute, HR of 180 beats per minute, and a systolic blood pressure of 85 mm Hg. His extremities are cool and mottled with a capillary refill time of 4 seconds. What would best describe his circulatory status? A. Normal circulatory status B. Early compensated. shock caused by hypovolemia C. Early compensated. shock caused by supraventricular tachycardia D. Late decompensated. shock caused by hypovolemia E. Late decompensated. shock caused by supraventricular tachycardia"

E

"The most common cause of gross hematuria is only one answer: A. Urinary tract infections B. Meatal stenosis C. Trauma D. Glomerulonephritis E. All above"

E

"Which circulatory finding is the hallmark of the diagnosis of late decompensated. shock? A. Capillary refill of 4 seconds B. Altered mental status C. Depressed anterior fontanelle D. Hypotension E. Absent distal pulses"

E

"Which of the following factors leads to neonatal hyperbilirubinemia? A. Shortened neonatal red cell life span. B. Impaired excretion of unconjugated bilirubin. C. Limited conjugation of bilirubin in the liver. D. Increased enterohepatic circulation. E. All of the above."

E

"Which viral infection involving the CNS is likely to present with focal neurological findings? A. HSV B. Coxsackievirus C. Enterovirus D. Rabies virus E. St. Louis virus"

E

" 6-month-old male is brought to the office due to fussiness and tugging at his right ear for the past 2 days. He has had a fever of 39.4° C 103° F. for the past 2 days. His past medical history is significant for recurrent ear and lung infections, oral candidiasis, and persistent diarrhea by rotavirus. His temperature is 39.4° C 103° F., pulse rate is 150/min, respirations are 28/min, and blood pressure is 80/60mm Hg. Physical examination reveals an erythematous, bulging right tympanic membrane with poor mobility on pneumatic otoscopy. His lymph nodes are not palpable, and his tonsils are not visualized. His B and T lymphocyte levels are markedly reduced. The chest x-ray reveals an absent thymic shadow. What is the most likely etiology of this patient's condition? A. severe combined immune deficiency B. Common variable immunodeficiency C. Bruton's agammaglobulinemia D. Wiskott-Aldrich syndrome E. Chronic granulomatous disease"

A

"A 1-week-old infant is brought to the emergency department due to vomiting and poor feeding. The prenatal and birth histories are unremarkable. The infant's pulse is 140/min, temperature is 37 C 98.7 F, and capillary refill is 2 sec. He has sunken eyes, depressed anterior fontanel, and dry mucus membranes; skin elasticity is reduced. Heart and lungs are clear. There is no abdominal mass. Genital examination shows enlarged clitoris, and fusion of the labioscrotal folds. The initial laboratory work-up reveals the following: Sodium 128 mEq/L, Potassium 5.8 mEq/L, BUN 25 mg/dl. If this patient's karyotype is 46 XX, which of the following is most likely to be increased in this patient's serum? A. 17 -alpha-hydroxyprogesterone B.18-hydroxycorticosterone C.11-deoxycorticosterone D.11-deoxycortisol E.Corticosterone "

A

"A 1-week-old male newborn is seen in the office for ""noisy breathing."" The mother says that the ""noisy breathing"" is more prominent when the infant is lying on his back, and improves when he is in a prone position with his chin up. The newborn is afebrile and has no cough, vomiting, or cyanosis. There are no inspiratory retractions or wheezes. On direct laryngoscopy, the epiglottis is rolled in from side to side. Which of the following statements is true about the child's condition? A. The child should be held in an upright position for 30 minutes after feeding and never fed while lying down B. The child requires immediate tracheostomy C. The child should be treated with intravenous ceftriaxone D. The child's condition is likely to deteriorate as the age advances E. In this condition the stridor improves when the child cries "

A

"A 10-year-old boy presents with fever, headache, photophobia, and neck discomfort in the middle of summer. He is alert and oriented, but has neck pain with flexion and extension of the head. His fundi are normal, and there are no focal neurologic findings or skin changes. A lumbar puncture reveals normal protein and glucose with a cell count of 240/mL 90% lymphocytes. Which of the following is the most likely causative organism? A. enterovirus coxsackievirus or echovirus B. Streptococcus pneumoniae C. Neisseria meningitides D. Listeria monocytogenes E. HSV-1 "

A

"A 12-year-old boy is brought to the emergency department with a temperature of 39.1 C 102.4 F at home, difficulty speaking, and odynophagia for 2 days, Physical examination reveals marked erythema of the right tonsil pillar and edema of the uvula with deviation to the left. In addition to anaerobic bacteria, which of the following organisms is most likely to be isolated from a tonsillar pillar aspirate? A. Beta-hemolytic Streptococcus B. Enterococcus C. Haemophilus influenzae type b D. Staphylococcus aureus E. Streptococcus pneumonia "

A

"A 12-year-old boy is brought to the office due to a 2-day history of high-grade fever and chills. He was apparently well before the onset of fever. He has no bone pain. He has sickle cell disease and has had 4 hospitalizations for painful crises and one episode of osteomyelitis. His blood pressure is 90/60 mm Hg, pulse is 100/min, respirations are 22/min and temperature is 38.9 C 102F. He appears drowsy. His laboratory report shows a total WBC count of 16,000/mm3 with 12% bands and Hb of 9.0 g/dl. Which of the following is the most likely cause of this patient's condition? A. Streptococcus pneumoniae B. Staphylococcus aureus C. Salmonella D. Escherichia coli E. Pseudomonas aeruginosa "

A

"A 12-year-old girl comes to the physician for an annual examination. She has been in good health for the past year and has no complaints. She began having menses this year and, after a few irregular cycles, is now having a monthly period. Past medical history is significant for multiple episodes of otitis media as a child. Past surgical history is unremarkable. She takes no medications and has no known drug allergies. Physical examination is unremarkable. If not currently immune, which of the following immunizations should this patient most likely receive? A . Hepatitis B virus immunization B . HIV immunization C . Japanese encephalitis virus immunization D . Rabies virus immunization E . Salmonella typhi immunization "

A

"A 12-year-old girl comes to the physician for chronic weight loss and fatigue. She has a history of bulky, floating, foul-smelling stools, flatulence and meteorism. She also has bone pain and easy bruising. Laboratory studies show anemia with serum iron: 25 mg/dl , ferritin: 25 mg/dl and serum total iron binding capacity 600 mg/dl normal 300-360 mg/dL; PT is 16 sec. Physical examination shows loss of subcutaneous fat, pallor, hyperkeratosis and abdominal distention; bowel sounds are increased. Which of the following is most likely associated with this patient's condition? A. Anti-endomysial antibodies B. Anti-Scl-70 antibodies C. Antinuclear antibodies D. Anticentromere antibodies E. Anti-mitochondrial antibodies "

A

"A 13-year-old comes to your office expressing concern about his height. He had first seen you a year prior for his routine checkup and a preparticipation sports physical for soccer see growth curve. Now in the eighth grade, all of his friends are taller than he is, and he is at a disadvantage on the soccer field playing against much larger boys. After obtaining height information from his parents shown here, you order a skeletal bone age radiograph. Which of the following results would allow you to assure him of an excellent prognosis for normal adult height? A. A bone age of 9 years B. A bone age of 13 years C. A bone age of 15 years D. Being at the 50th percentile for weight E. Being at the 3rd percentile for weight "

A

"A 2 -year-old child is evaluated by a neurologist because of difficulty walking. Neurological examination documents ataxia and mental retardation. The neurologist notes the presence of multiple telangiectasias involving the conjunctiva, ears, and antecubital fossae. The child also has a history of multiple respiratory tract infections. Immunoglobulin studies on the child would most likely demonstrate an absence of which of the following? A . IgA and IgE B . IgA and IgG C . IgE and IgG D . IgE and IgM E . IgM and IgG "

A

"A 2-day-old male infant is jaundiced. He was born at term from an uncomplicated pregnancy, and was normal at birth. He otherwise appears healthy and is feeding well. Vital signs are stable. Physical examination shows jaundice. There is no organomegaly. Laboratory investigations show: Hemoglobin 17.0 g/L, MCV 88 fl, Platelets 220,000/mm3, leukocyte count 4,500/mm3, Total bilirubin 7.5 mg/dL, Indirect bilirubin 6.0 mg/dL. What is the most likely cause of this patient's jaundice? A. Physiologic jaundice B. Bacterial infection C. Breast milk jaundice D. Biliary atresia E. Erythroblastosis fetalis "

A

"A 2-month-old infant comes to the emergency center with fever for 2 days, emesis, a petechial rash, and increasing lethargy. In the ambulance he had a 3-minute generalized tonic/clonic seizure that was aborted with lorazepam. He does not respond when blood is drawn or when an IV is placed, but he continues to ooze blood from the skin puncture sites. On examination, his anterior fontanelle is open and bulging. His CBC shows a WBC of 30,000 cells/μL with 20% band forms. Which of the infant's problems listed below is a contraindication to lumbar puncture? A. Uncorrected bleeding diathesis B. Bulging fontanelle C. Dehydration D. History of recent seizure E. Significantly elevated WBC count consistent with bacteremia "

A

"A 2-week-old boy in the neonatal intensive care unit had a birth weight of 1200 g. Ultrasound of the head reveals grade II intraventricular hemorrhage and periventricular leukomalacia. An ophthalmologic examination reveals retinopathy of prematurity of both eyes. In addition, a hearing screen demonstrates bilateral hearing deficits. Which of the following is the most important determinant of this child's neurodevelopmental outcome? A. length of gestation B. Maternal Education C. Outcome of the mother's previous pregnancies D. Quality of prenatal care E. Socioeconomic status of the family "

A

"A 2-week-old neonate is brought to the office due to poor feeding and persistent vomiting. He had an episode of jerky movements of his limbs this morning. He was delivered at term with no complications and weighed 2.7kg 6 Ib at birth. He appears lethargic, irritable and jaundiced. On examination, he weighs 2.2kg 5 Ib. His liver and spleen are enlarged. Bilateral cataracts are evident. Which of the following is most consistent with these findings? A. Galactose-1-phosphate uridyl transferase deficiency B. Galactokinase deficiency C. Uridyl diphosphate galactose-4-epimerase deficiency D. This is a self-limiting condition and does not need any intervention E. Early diagnosis and treatment does not have any effect on the patient's eyesight "

A

"A 2-year-old boy is being followed for congenital cytomegalovirus CMV. infection. He is deaf and developmentally delayed. The child's mother informs you that she has just become pregnant and is concerned that the new baby will be infected and may develop serious consequences. Which of the following is true? A. The mother has antibodies to CMV that are passed to the fetus B. The mother's infection cannot become reactivated C. The likelihood that the new baby will become clinically ill is approximately 80% D. termination of pregnancy is advised E.The new infant should be isolated from the older child "

A

"A 2-year-old boy is brought to the office by his mother because he has not started to walk yet. His birth history is significant for prolonged labor, and his APGAR scores at 1 and 5 minutes were 3 and 5, respectively. His older brother is 4 years old, and has a normal developmental history. On examination, the child has hypotonia, learning disabilities and hyperactive deep tendon reflexes. What is the most likely cause for the child's delayed milestones? A. Cerebral anoxia B. Congenital infection C. Congenital muscular dystrophy D. Friedreich's ataxia E. Infantile spinal muscular atrophy "

A

"A 2-year-old girl presents with fever of 39.3 C and irritability. She has had an upper respiratory tract infection for 4 days. On examination, the right ear is bulging and has poor movement on insufflation. Which of the following organisms is most likely responsible for these findings? A. S. pneumoniae B. S. aureus C. M. pneumoniae D. E. coli E. group A Streptococcus "

A

"A 20-month-old male is brought to ER with high fever, confusion and a skin rash suggestive of measles. He has a history of recurrent respiratory infections over the last 6 months. The patient's family has recently emigrated from a rural Russian province. Which of the following forms of vitamin supplementation should be considered in this patient? A. Vitamin A B. Vitamin K C. Vitamin D D. Vitamin E E. Vitamin B 12 "

A

"A 2950-g 6.5-lb black baby boy is born at home at term. On arrival at the hospital, he appears pale, but the physical examination is otherwise normal. Laboratory studies reveal the following: mother's blood type A, Rh-positive; baby's blood type O, Rh-positive; hematocrit 38%; and reticulocyte count 5%. Which of the following is the most likely cause of the anemia? A. Fetomaternal transfusion B. ABO incompatibility C. Physiologic anemia of the newborn D. Sickle-cell anemia E. Iron-deficiency anemia "

A

"A 3-day-old infant, born at 32 weeks' gestation and weighing 1700 g 3 lb, 12 oz, has three episodes of apnea, each lasting 20 to 25 seconds and occurring after a feeding. During these episodes, the heart rate drops from 140 to 100 beats per minute, and the child remains motionless; between episodes, however, the child displays normal activity. blood sugar is 50 mg/dL and serum calcium is normal. Which of the following is most likely true regarding the child's apneic periods? A. They are due to an immature respiratory center B. They are a part of periodic breathing C. They are secondary to hypoglycemia D. They are manifestations of seizures E . They are evidence of underlying pulmonary disease "

A

"A 3-month-old Jewish infant is brought to the emergency department because of a generalized seizure 1 hour ago. He is lethargic, weighs 2.7kg 61b., and has a doll-like face with fat cheeks, relatively thin extremities, and a protuberant abdomen. His liver is felt 5cm 2in. below the right costal margin. His kidneys are enlarged. His blood sugar level is 40mg/dl. His serum uric acid, total cholesterol, triglycerides and lactic acid levels areelevated. The levels of his liver transaminases are normal. What is the most likely cause of this infant's symptoms? A. Glucose-6-phosphatase deficiency B. Acid maltase deficiency C. Deficiency of glycogen debranching enzyme activity D. Deficiency of branching enzyme activity E. Liver phosphorylase deficiency "

A

"A 3-week-old female is brought into the emergency department with a fever and irritability. She was born after a normal pregnancy and delivery. Her mother had routine prenatal care and has no history of sexually transmitted infections. The infant's mother is 14 years old and the father is 17 years old. They are not married, and the father is not involved in the care of the infant. The infant lives with her mother and maternal grandparents at the maternal grandparents' home. You are concerned about meningitis and decide to do a lumbar puncture. The mother and maternal grandparents are present in the emergency department. Informed consent should be obtained from which of the following individuals? A. Mother B. Maternal grandparents since the mother is a minor C. Mother and father must both provide consent D. Mother and grandparents since the mother is a minor E. Informed consent is not necessary because the mother is a minor "

A

"A 3-year-old boy is brought to the office by his 27-year-old white mother for the evaluation of recurrent bone fractures. His first fracture was that of the femur, and occured when he was 6 months old. He had a fracture of the wrist 4 months ago. His mother also has a history of multiple fractures since childhood. She lost all her teeth at a very early age and is complaining of deafness. Her husband has a history of severe alcohol abuse. On examination, both mother and son have blue sclerae. What is the most likely involved disease process? A. Mutations in type 1 collagen B. Mutations in fibrillin 1 gene C. Child abuse D. Vitamin-D deficiency E. Congenital syphilis "

A

"A 3-year-old boy is brought to the office by his parents for the evaluation of dry eyes and photophobia. He has some difficulty in adapting to darkness. He is a very poor eater, and his diet consists mainly of canned foods, and very rarely, fresh vegetables or milk. Examination reveals dry, scaly skin, follicular hyperkeratosis in the extensor surfaces of the extremities, and dry, silver-gray plaques on the bulbar conjunctiva. What is the most likely diagnosis of this patient? A. Vitamin A deficiency B. Thiamine deficiency C. Ariboflavinosis D. Scurvy E. Hypervitaminosis A "

A

"A 3-year-old male is brought to the emergency department for evaluation of right neck swelling. His parents noticed a lump on his right neck yesterday, which has since increased in size and is now erythematous and tender. He has been previously healthy except for mild upper respiratory tract symptoms last week. His temperature is 38C 100.4F., pulse is 90/min, and respiratory rate is 25/min. On examination, he is nontoxic appearing. A 5-cm anterior cervical lymph node is palpated on the right side. It is poorly mobile, warm, erythematous, and tender to palpation. There is no fluctuance or induration. What is the most likely organism causing these symptoms? A. Staphylococcus aureus B. Francisella tularensis C. Peptostreptococcus D. Nontuberculous mycobacteria E. Epstein-Barr virus "

A

"A 3.8 kg baby of a diabetic mother developed seizures at 16 hours of birth. Most probable cause is: A. Hypoglycemia B. Hypocalcemia C. Birth asphyxia D. Intra ventricular hemorrhage"

A

"A female infant is normal at birth but develops a severe hemolytic anemia after age 6 months. Peripheral blood smear shows a microcytic, hypochromic anemia with numerous target cells and increased reticulocytes. Hemoglobin electrophoresis at 9 months of age demonstrates hemoglobin F of 90%, increased hemoglobin A2, and decreased hemoglobin. Which of the following is the most likely diagnosis? A. Alpha-thalassemia trait B. Beta-thalassemia major C. Beta-thalassemia minor D. Hb H disease E. Hydrops fetalis"

A

"An 18-month-old child is brought to the emergency department by his mother due to a one-day history of lethargy and anorexia. He had a fever the whole day yesterday, which responded to Tylenol Acetaminophen. He then developed a petechial rash over his entire body, which worsened in the last few hours. He is up-to-date with his immunizations, and is an otherwise healthy baby. On examination, he is drowsy and lethargic. He has neck stiffness and appears septic. He flexes his hips when his neck is flexed. What is the most likely organism responsible for the patient's symptoms? A. Meningococcus B. Haemophilus influenza C. Cytomegalo virus D. Borrelia burgdorferi E. Listeria monocytogenes"

A

"Encephalitis is usually the result of which of the following: A. Viral B. bacterial C. protozoa D. autoimmune E. fungal"

A

"The most common organism in patients with empyema purulent pleurisy is: A. Staphylococcus aureus B. Group A Streptococcus C. E. coli D. Streptococcus pneumoniae"

A

"The species of malaria associated with adherence to endothelial walls, cerebral malaria, and a high mortality rate is: A. P. falciparum B. P. vivax C. P. malariae D. P. ovale E. All of the above"

A

" A 1-year-old child with ALL in remission for 3 months is in the office for a health maintenance visit. He is due for multiple vaccinations including hepatitis B vaccine, inactivated polio vaccine IPV, varicella vaccine H. influenzae B vaccine Hib, and pneumococcal vaccine PCV. You remember that some of these vaccines are live attenuated viruses and are contraindicated in immunocompromised patients. Which vaccine will you not give to this patient? A. PCV B. Varicella vaccine C. Hepatitis B vaccine D. Hib E. IPV "

B

"A 10-year-old girl has bullous target lesions and mucosal erythema, which developed after her third dose of trimethoprim-sulfamethoxazole for a urinary tract infection. Which of the following is a likely associated clinical finding? A. diarrhea B. Fever C. Lymphadenopathy D. Vomiting E. nausea "

B

"A 12-month-old patient has allergies to multiple foods. The child's mother has eliminated the foods from the diet and wants to know if these allergies will be lifelong. You tell her that some allergies do get better if the food is eliminated for 1-2 years. In which of the following is the allergy most likely to resolve, with elimination of the food from the diet? A. peanuts B. milk C. nuts D. fish E. shellfish "

B

"A 12-year-old girl comes to the physician because of a 2-day history of periorbital edema and abdominal distention. She has no other complaints. She has never been diagnosed with hypertension. Her father died at the age of 40, with renal failure. Her temperature is 37.1°C 98.9°F, blood pressure is 125/75 mm Hg, pulse is 80/min, and respirations are 14/min. Examination shows facial puffiness, shifting dullness, and 1+ bilateral pitting pedal edema. Urinalysis shows 3+ proteinuria and lipid laden casts. 24-hour urinary protein excretion is 5 g/day, total serum protein is 4.5 g/dl and serum albumin is 2.3 g/dl. Which of the following is this patient at increased risk of developing? A . Macrocytic normochromic anemia B . Accelerated atherogenesis C . Hypergammaglobulinemia D . Hypercalcemia E . Hypoparathyroidism "

B

"A 2-year-old boy presents with fever, loss of appetite, sore throat, with red, blister-like lesions on the tongue, gums and inside of the cheeks and a red rash, without itching on the palms, soles and the buttocks. Which of the following disease, you think the most probably. A. Rubella B. Hand-foot-mouth disease C. Varicella D. Measles E. HSV"

B

"A 2-year-old child is brought to the emergency department with sudden onset of unresponsiveness, miosis, bradycardia, and muscle fasciculations. These findings are most suggestive of poisoning with which of the following? A. Acetaminophen B. Organophosphates C. salicylates D. tricyclic antidepressants E. vitamin A"

B

"A 3-week-old boy presents to the physician's office with a 1-week history of forceful, projectile vomiting. He has been vomiting after almost every feeding. The vomitus contains mostly undigested formula and is non-bilious. On examination, his oral mucosa is dry, his anterior fontanel appears to be depressed, and his capillary refill is 3-4 seconds. An abdominal examination reveals an olive-sized mass in the epigastrium. Which of the following electrolyte findings will most likely be seen? A. Hypochloremic metabolic acidosis B . Hypochloremic metabolic alkalosis C . Normal electrolytes D . respiratory acidosis with metabolic compensation E . respiratory alkalosis "

B

"A 3-year-old boy is brought by his father to the Emergency Department with fever, headache and neck pain that developed over the past several hours. The father states he is not the birth father, and that he and his wife adopted the boy at 18 months of age after his birth mother abandoned him. Physical examination reveals a lethargic male with a temperature of 39.7 C 103.5 F. There is photophobia, and mildly injected conjunctiva are appreciated. Pupils are equal and reactive and funduscopic examination is unremarkable. The patient has neck stiffness with a positive Kernig's sign. A complete blood count reveals a leukocyte count of 24,000/mm3 with 64 segmented neutrophils and 25 bands. A lumbar puncture is performed that reveals elevated CSF pressure, decreased glucose, and elevated protein. A Gram's stain shows gram-negative pleomorphic rods. There is no growth on blood agar. Growth on chocolate agar reveals white colonies. Which of the following is the most likely pathogen? A. Haemophilus ducreyi B. Haemophilus influenzae type b C. Neisseria meningitidis D. Listeria monocytogenes E. Streptococcus pneumoniae "

B

"A 3-year-old boy is brought to the emergency department three hours after having a seizure. He has been having severe diarrhea for the last three days. His mother recently read about the importance of maintaining adequate hydration during diarrhea, so she had been giving him a lot of milk mixed with water. On examination, his vital signs are stable and mucus membranes are moist. Initial lab results are: Hb 13 g/dl, WBC 6,000/mm3, Platelets 300,000/mm3, blood Glucose 98 mg/dl, serum Na 120 mEq/L, serum K 3.4 mEq/L, Chloride 92 mEq/L, BUN 22 mg/dl, Creatinine 1.2 mg/dl. What is the most likely cause of this patient's seizure? A. SIADH B. Water intoxication C. severe dehydration D. Acute renal failure E. sepsis "

B

"A 4-week-old boy is brought to clinic by his mother because of a 1 day history of labored breathing. His birth was uneventful and immunizations have been up to date. His mother reports that the patient developed conjunctivitis on the fourth day of life. On physical examination, he is breathing rapidly at 40 breaths per minute and is afebrile. His chest reveals bilateral inspiratory crackles and a slight wheeze. On chest x-ray, bilateral pneumonia is evident. The leukocyte count is elevated at 15,000 with 40% eosinophils. Which of the following is the most likely pathogen causing the patient's symptoms? A . Ascaris lumbricoides B . Chlamydia trachomatis C . Mycoplasma pneumoniae D . Pneumocystis carinii E . Varicella zoster virus "

B

"A 4-year-old boy is sent to the emergency room because of clinical suspicion of meningitis. He has been ill for 2 days with fever and lethargy. On examination, he is febrile, the neck is stiff, and papilledema is present. There is no rash, the lungs are clear, and heart sounds normal. Which of the following is the most likely causative organism? A. Neisseria meningitidis B. Streptococcus pneumoniae C. Haemophilus influenzae D. Staphylococcus E. Listeria species "

B

"A 5-year old boy comes with overnight petechial spots 2 weeks back he had history of abdominal pain and no hepato-splenomegaly. Diagnosis is: A. Acute lymphatic leukemia B. Aplastic anemia C. Idiopathic thrombocytopenic purpura D. Acute viral infection"

B

"A positive tuberculin skin test a delayed hypersensitivity reaction. indicates that A. a humoral immune response has occurred. B. a cell-mediated immune response has occurred. C. both the T and B cell systems are functional. D. only the B cell system is functional"

B

"Hypertrophic pyloric stenosis is common in A. Females B. Males C. Both D. Malabsorption"

B

"Which of the following is NOT TRUE about breast feeding? A. recommended food for infants both term and preterm B. 50% of energy from proteins C. Contains immunological benefits i.e. IgA, active lymphocytes. D. Promotes growth of lactobacillus in GI E. Decreases incidence of allergic disorders"

B

"Which of the following is a definite indication to start antiretroviral treatment in HIV infected children? A. CD4 cell counts >1500 in a 4 year old asymptomatic child. B. Pneumocystis carinii pneumonia. C. recurrent otitis media but no other symptoms. D. Bilateral anterior cervical lymphadenopathy E. All of the above"

B

"A 1-year-old patient is in the office for a health maintenance visit and is ready for immunizations. The child has a mild upper respiratory infection and a low-grade fever. The mother does not want the child to receive vaccine because she has been told that the vaccine could make the illness worse. You tell her the only true contraindication to vaccination is which of the following? A. if the child has a skin rash B. if there is an immunosuppressed adult in the household C. if the child has hypersensitivity to a vaccine component D. if a pregnant woman is in the household E. if the mother is breast-feeding "

C

"A 10-year-old boy comes to the office with fever and chills for 5 days and myalgia. He has recently returned from a 2-week vacation to New England with his family. On physical examination he has mild splenomegaly. Which of the following is the most likely cause of his symptoms? A. Kawasaki disease B. pneumococcus C. babesiosis D. leptospirosis E. psittacosis "

C

"A 10-year-old boy was healthy until about 10 days ago when he developed 7 days of fever, chills, severe muscle pain, pharyngitis, headache, scleral injection, photophobia, and cervical adenopathy. After 7 days of symptoms he seemed to get better, but yesterday he developed fever, nausea, emesis, headache and mild nuchal rigidity. Cerebrospinal fluid CSF shows 200 white blood cells WBC per microliter all monocytes and an elevated protein. Correct statements about this infection include which of the following? A. The condition is obtained from arthropod vectors B. CNS involvement is uncommon C. Most cases are mild or subclinical D. Appropriate treatment includes intravenous IV. immune globulin IVIG and aspirin E. Hepatic and renal involvement occurs in the majority of cases "

C

"A 10year-old boy is admitted to the hospital because of bleeding. Pertinent laboratory findings include a platelet count of 50,000/µL, prothrombin time PT of 15 seconds control 11.5 seconds, activated partial thromboplastin time aPTT of 51 seconds control 36 seconds, thrombin time TT of 13.7 seconds control 10.5 seconds, and factor VIII level of 14% normal 38%-178%. Which of the following is the most likely cause of his bleeding? A. Immune thrombocytopenic purpura ITP B. Vitamin K deficiency C. Disseminated intravascular coagulation DIC D. Hemophilia A E. Hemophilia B "

C

"A 12-year-old boy is brought to the emergency department because of severe pain near his left knee. He has sickle cell disease and has been hospitalized previously for sickle cell crisis. Vital signs are notable for persistent fever. Examination of the left lower extremity reveals a normal knee joint with marked tenderness and swelling over the proximal tibia. Laboratory studies show leukocytosis and elevated ESR. Imaging studies confirm the diagnosis of osteomyelitis. Which of the following organisms is the most likely cause of his condition? A. Escherichia coli B. Pseudomonasspecies C. Salmonella species D. Streptococcus pneumoniae E. Group B streptococcus "

C

"A 12-year-old male is found to have a murmur during a routine sports physical. He has a family history of sudden death at a young age. It is a harsh crescendo-decrescendo murmur that begins after S1 and is best heard at the left lower sternal border. Valsalva maneuver intensifies the murmur. Which of the following is the most likely mitral valve abnormality in this patient? A. Dilated mitral valve annulus B. Rupture of chordae tendinae C. Abnormal mitral leaflet motion D. Mitral annulus calcifications E. Prolapse of the mitral valve "

C

"A 2-month-old male is brought to the emergency department for evaluation of cyanosis, which occurred earlier in the day while the infant was taking his bottle. Initially, he became fussy and sweaty, then his mother noticed that his lips turned blue. He became intermittently tachypneic and continued to cry. As the crying continued, the cyanosis worsened. His temperature is 37C 98.6 F., blood pressure is 80/50 mmHg, pulse is 150/min, and respiratory rate is 45/min. On examination, the child is alert, cyanotic, and tachypneic. Cardiac auscultation reveals a normal S 1 followed by a systolic ejection click. A grade 2/6 crescendo-decrescendo systolic ejection murmur is heard at the left upper sternal border. The patient is immediately placed in a knee-chest position. This maneuver will improve this patient's condition by which of the following mechanisms? A . Increased systemic venous return B . Decreased pulmonary blood flow C . Increased systemic vascular resistance D . Increased respiratory drive E . Increased right to left shunting "

C

"A 2-year-old child is brought to the emergency department because of generalized convulsions that last 15 minutes. He has had a fever for 24 hours, and his current temperature is 39.5 C 103 F. He also has a sore throat, but otherwise looks healthy. His father also had several episodes of febrile seizures in his childhood. Which of the following is the most important factor that will increase the risk of recurrence of febrile seizures? A. Age older than 18 months B. Duration of seizure longer than 5 minutes C. Family history of febrile seizures D. Fever of long duration before onset of seizure E. temperature higher than 39.0 C"

C

"A 3-year-old-boy ingests 40 of his older sister's chewable vitamin tablets, as well as 3 tablets of 250 mg of acetaminophen. The ingredients in the multivitamin tablets are as follows: Vitamin A 3000 IU, Thiamine 1 mg, Vitamin C 75 mg, Vitamin B6 1 mg, Vitamin D 400 IU, Iron 12 mg, Fluoride 1 mg. The child is brought to the emergency department in no acute distress. Which of the following complications may occur if appropriate therapy is not undertaken? A. Acute renal failure from vitamin D toxicity B. Hepatic failure from acetaminophen toxicity C. Hepatic failure from iron toxicity D. Increased intracranial pressure from vitamin A toxicity E. Intestinal ischemia from fluoride toxicity "

C

"A 4-day-old boy is brought to the physician for an outpatient follow-up visit. His mother's pregnancy and delivery were uncomplicated. The patient weighed 3.4 kg 7.5 lb. and was 48.2 cm 1'7"". long at birth. He did well in the newborn nursery and was discharged from the hospital on day 2 of life. His mother reports that he is now exclusively breastfed and nurses for 10 minutes on each breast every 3 hours. He has two wet diapers/day and has not had a bowel movement for 2 days. He weighs 2.95 kg 6.5 lb. and is 48.2 cm 1'7''. long. He appears jaundiced on the face and chest. The remainder of the physical examination shows no abnormalities. Laboratory studies reveal: Total bilirubin 15 mg/dl, direct bilirubin 1 mg/dl, Infant's blood type 0 positive, Mother's blood type A positive. Which of the following is the most likely cause of this infant's hyperbilirubinemia? A . Biliary atresia B . Breast milk jaundice C . Breastfeeding failure jaundice D . Galactosemia E . ABO incompatibility "

C

"A 4-day-old infant is brought to the physician for an outpatient follow-up visit. The mother's pregnancy and delivery were uncomplicated. The infant weighed 3.4kg 7 .5 lb. and was 19 in 48.2 cm. long at birth. He did well in the newborn nursery and was discharged from the hospital on day 2 of life. Today his mother reports that he is exclusively breastfed, and nurses for 10 minutes every 3 hours. He has 3-4 wet diapers a day, and has not had a bowel movement for two days. On examination, he weighs 2.95 kg 6.5 lb. and is 19 in 48.2 cm. long. He appears jaundiced on the face and chest. The remainder of the physical examination is unremarkable. Laboratory values are shown below. Total bilirubin 15 mg/dl, direct bilirubin 1 mg/dl, Infant's blood type O positive, Mother's blood type A positive. Which of the following is the most likely cause of this infant's hyperbilirubinemia? A . Biliary atresia B . Breast milk jaundice C . Breastfeeding jaundice D . Galactosemia E . ABO incompatibility "

C

"AIDS is caused by a human retrovirus that kills A. B lymphocytes. B. lymphocyte stem cells. C. CD4-positive T lymphocytes. D. CD8-positive T lymphocytes. E. All of the above"

C

"Failure to initiate and maintain spontaneous respiration following birth is clinically known as A. Birth asphyxia B. RDSrespiratory Distress Syndrome C. respiratory failure D. Pulmonary oedema"

C

"The following features are true for tetralogy of Fallot, EXCEPT: A. ventricular septal defect B. Right ventricular hypertrophy C. Atrial septal defect D. Pulmonary stenosis"

C