MCQ Pediatric 1

"A 10-year-old girl has had a "cold" for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39°C 102.2°F, purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis? A. Brain abscess B. Maxillary sinusitis C. Streptococcal throat infection D. Sphenoid sinusitis E. Middle-ear infection"

B

"An afebrile, obese 14-year-old boy has developed pain at the right knee and a limp. For case above, select the most likely diagnosis. A. legg-Calvé-Perthes disease B. Slipped capital femoral epiphysis C. Osteomyelitis D. septic arthritis of the hip E. Transient synovitis"

B

"A previously healthy, active, 18-month-old African American child presents with unilateral nasal obstruction and foul-smelling discharge. The child's examination is otherwise unremarkable. Which of the following is the most likely diagnosis? A. Foreign body B. Nasal polyps C. Frontal sinusitis D. Deviated septum E. Choanal atresia"

A

"A 6-year-old child is hospitalized for observation because of a short period of unconsciousness after a fall from a playground swing. He has developed unilateral pupillary dilatation, focal seizures, recurrence of depressed consciousness, and hemiplegia. Which of the following is the most appropriate management at this time? A. Spinal tap B. CT scan C. Rapid fluid hydration D. Naloxone E. Gastric decontamination with charcoal"

B

"A routine prenatal ultrasound reveals a male fetus with meningomyelocele. The 24-year-old primigravid mother is told the infant will require surgery shortly after birth. You counsel her about the etiology of this defect and the risk of further pregnancies being similarly affected, and state which of the following? A. The hereditary pattern for this condition is autosomal recessive. B. The prenatal diagnosis can be made by the detection of very low levels of alpha7 fetoprotein in the amniotic fluid. C. Subsequent pregnancies are not at increased risk compared to the general population. D. Supplementation of maternal diet with folate leads to a decrease in incidence of this condition. E. Neither environmental nor social factors have been shown to influence the incidence."

A

"After being delivered following a benign gestation, a newborn infant is noted to have a platelet count of 35,000/μL, decreased fibrinogen, and elevated fibrin spilt products. On examination you note a large cutaneous hemangioma on the abdomen that is purple and firm. Which of the following anomalies might also be expected in this infant? A. Kaposiform hemangioendothelioma B. Nevus simplex C. Nevus flammeus D. PHACES. syndrome E. Infantile fibrosarcoma"

A

"A 10-year-old boy has been having "bellyaches" for about 2 years. They occur at night as well as during the day. Occasionally, he vomits after the onset of pain. Occult blood has been found in his stool. His father also gets frequent, nonspecific stomachaches. Which of the following is the most likely diagnosis? A. Peptic ulcer B. Appendicitis C. Meckel diverticulum D. Functional abdominal pain E. Pinworm infestation"

A

"A 12-year-old boy comes to the emergency department at midnight with a complaint of severe scrotal pain since 7 PM. There is no history of trauma. Which of the following is the most appropriate first step in management? A. Order a surgical consult immediately. B. Order a radioisotope scan as an emergency. C. Order a urinalysis and Gram stain for bacteria. D. Arrange for an ultrasound examination. E. Order a Doppler examination."

A

"A 14-month-old infant suddenly develops a fever of 40.2°C 104.4°F. Physical examination shows an alert, active infant who drinks milk eagerly. No physical abnormalities are noted. The WBC count is 22,000/μL with 78% polymorphonuclear leukocytes, 18% of which are band forms. Which of the following is the most likely diagnosis? A. Pneumococcal bacteremia B. Roseola C. Streptococcosis D. Typhoid fever E. Diphtheria"

A

"A 14-year-old child has headache, hypertension, edema, and a change in urine output and color.Match above clinical condition with the most likely cause A. Glomerulonephritis B. severe anemia C. Heart block D. ventricular septal defect VSD. E. Arteriovenous malformation"

A

"A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. During the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the following is the most likely diagnosis? A. Rubella B. Rubeola C. Roseola D. Erythema infectiosum E. Erythema multiforme"

A

"A 4-year-old boy, whose past medical history is positive for three urinary tract infections, presents with a blood pressure of 135/90 mm Hg. He is likely to exhibit which of the following symptoms or signs? A. Multiple cranial nerve palsy B. Headache C. Hyporeflexia D. Increased urine output E. Right ventricular hypertrophy"

B

"A 15-month-old is seen in your office for the 4th time this month with unexplained intermittent episodes of fever of 39°C. The mother has used children's ibuprofen to treat the fever and has been able to bring the temperature down to 38°C. However, the mother is now frustrated because thisis her 4th visit to the office and nobody knows why her child is continuing to have these fevers. The child is not in day care and has no history of any serious illnesses, travel, or sick contacts. The child has had no symptoms of an upper respiratory infection. On examination, the child is actively playing with his toys. He does not look ill. His rectal temperature is 39°C. The head, neck, lungs, cardiovascular, abdominal, neurologic, and musculoskeletal examination are all normal.Your clinical judgment is that the child looks well and has no serious illness. What is your diagnosis at this time? A. recurrent viral infection B. fever without a focus C. infantile febrile response D. fever of unknown origin E. periodic fever, aphthous ulcers, pharyngitis, and adenopathy PFAFA syndrome"

A

"A 16-day-old infant presents with fever, irritability, poor feeding, and a bulging fontanelle. Spinal fluid demonstrates gram-positive cocci. Which of the following is the most likely diagnosis? A. Listeria monocytogenes B. Group A streptococci C. Group B streptococci D. Streptococcus pneumoniae E. Staphylococcus aureus"

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-year-old refuses to walk, has fever, has significant pain with external rotation of the right leg, and has an elevated WBC count. For case above, select the most likely diagnosis. A. legg-Calvé-Perthes disease B. Slipped capital femoral epiphysis C. Osteomyelitis D. septic arthritis of the hip E. Transient synovitis"

A

"A 20-month-old child is brought to the ED because of fever and irritability and refusal to move his right lower extremity. Physical examination reveals a swollen and tender right knee that resists passive motion. Which of the following is the most likely to yield the diagnosis in this patient? A. Examination of joint fluid B. X-ray of the knee C. Erythrocyte sedimentation rate ESR. D. CBC and differential E. blood culture"

A

"A 2950-g 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 3.3 kg infant delivered at 396 weeks arrives in the OPD of a pediatric hospital with normal vital signs and a respiratory rate of 80 breaths/ minute. The labor and subsequent delivery were precipitous according to the labor and delivery midwife. Which of the following is manifest during the first hours after delivery? A. transient tachypnea of the newborn B. meconium aspiration syndrome C. sepsis D. asthma E. a and b"

A

"A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a "cold" and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which immunization should be given to this childnow, according to the national EPIrecommendations? A. BCG, hepatitis B, diphtheria-tetanus-pertussis DTaP., poliomyelitis vaccine OPV. B. hepatitis B, DTaP, OPV, rotavirus, Measles vaccine Rouvax. C. DTaP, OPV, hepatitis B D. hepatitis B, pneumococcal polysaccharide vaccine PPV., OPV E. hepatitis B, DTaP, PPV, IPV, Hib, rotavirus"

A

"A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a "cold" and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements regarding vaccination against poliomyelitis is true? A. oral polio vaccine OPV. is a an inactivated killed vaccine B. Injectable polio vaccine IPV. is live, attenuated vaccine C. OPV and IPV are both recommended by the national EPI program in Cambodia D. OPV is associated with a small risk of vaccine-associated paralytic poliomyelitis E. Answers a and b are correct"

A

"A 5-year-old girl without past history of UTI is in the hospital on antibiotics for Escherichia coli pyelonephritis. She is still febrile after 4 days of appropriate antibiotics. A renal ultrasound revealed no abscess, but a focal enlargement of one of the lobes of the right kidney. CT of the abdomen reveals a wedgeshaped area in the right kidney distinct from the normal tissue with minimal contrast enhancement. Appropriate management of this patient includes which of the following interventions? A. Prolonged antibiotic therapy B. Routine treatment with 10 to 14 days of antibiotics for pyelonephritis C. Surgical consultation D. Dimercaptosuccinic acid DMSA. scan E. renal biopsy"

A

"A 6-year-old boy has developed a limp and has limited mobility of the hip, but denies pain and fever. For case above, select the most likely diagnosis. A. legg-Calvé-Perthes disease B. Slipped capital femoral epiphysis C. Osteomyelitis D. septic arthritis of the hip E. Transient synovitis"

A

"After two more visits, the mother decides to bottle-feed. She returns when the child is 3 months old, complaining that the infant is constipated. After a careful history, you find that the infant has one hard stool a day but otherwise has no symptoms. On examination, the infant is well hydrated and has had adequate weight gain. The physical exam, including the anal sphincter tone, is normal. You advise which of the following? A. explain to the mother that formula-fed babies generally have fewer stools than breast-fed babies. If the infant is having a stool every 1 to 3 days and has no symptoms, no treatment is needed B. add 2 teaspoons of bran to the bottle to increase bulk C. use glycerine suppositories twice a day D. change to another formula E. give mineral oil and water as needed"

A

"An 8-year-old is accidentally hit in the abdomen by a baseball bat. After several minutes of discomfort, he seems to be fine. Over the ensuing 24 hours, however, he develops a fever, abdominal pain radiating to the back, and persistent vomiting. On examination, the child appears quite uncomfortable. The abdomen is tender, with decreased bowel sounds throughout, but especially painful in the midepigastric region with guarding. Which of the following tests is most likely to confirm the diagnosis? A. serum amylase levels B. CBC with differential and platelets C. serum total and direct bilirubin levels D. Abdominal radiograph E. Electrolyte panel"

A

"As part of your anticipatory guidance to new parents of a healthy new-born, you suggest putting the child in which of the following positions for sleep? A. Supine position B. Prone position C. seated position D. Trendelenburg position E. A hammock"

A

"At 43 weeks' gestation, a long, thin infant is delivered. The infant is apneic, limp, pale, and covered with "pea soup" amniotic fluid. Which of the following is the best first step in the resuscitation of this infant at delivery? A. Intubation and suction of the trachea; provision of oxygen B. Artificial ventilation with bag and mask C. Chest compressions D. Administration of 100% oxygen by mask E. Catheterization of the umbilical vein"

A

"During a regular checkup of an 8-year-old child, you note a loud first heart sound with a fixed and widely split second heart sound at the upper left sternal border that does not change with respirations. The patient is otherwise active and healthy. Which of the following heart lesions most likely explains these findings? A. Atrial septal defect ASD. B. ventricular septal defect VSD. C. Isolated tricuspid regurgitation D. tetralogy of Fallot E. Mitral valve prolapse"

A

"The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35°C 95°F. The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and anumbilical hernia. This clinical presentation is likely a result of which of the following? A. Congenital hypothyroidism B. Congenital megacolon Hirschsprung disease. C. sepsis D. Infantile botulism E. Normal development"

A

"The mother of a 6-month-old infant is concerned that her baby may be teething. You explain to her that the first teeth to erupt in most children are which of the following? A. Mandibular central incisors B. Maxillary lateral incisors C. Maxillary first molars D. Mandibular cuspids canines. E. First premolars bicuspids."

A

"The obstetrical resident on call asks you to evaluate an area of a newborn's scalp that seems to have no hair and is scaly and yellowish. Many rashes and skin lesions can be found first in the newborn period. For the descriptions​ ​​​​​​listed above, select the most likely diagnosis. A. sebaceous nevus B. Pustular melanosis C. Erythema toxicum D. seborrheic dermatitis E. Milia"

A

"You are admitting to the hospital a 3-month-old infant who has been having poor feeding, emesis, and diarrhea for 3 days. In the emergency center, her electrolytes were found to be: sodium 157 mEq/L, potassium 2.6 mEq/L, chloride 120 mEq/L, bicarbonate 14 mEq/L, creatinine 1.8 mEq/L, blood urea nitrogen BUN 68 mEq/L, and glucose 195 mEq/L. She was given a fluid bolus in the emergency center and has subsequently produced urine. Which of the following is the most appropriate next step in her management? A. Slow rehydration over 48 hours B. Continued rapid volume expansion with 1/4 normal saline C. Packed red blood cells RBCs. D. rehydration with free water E. Urinary electrolytes"

A

"You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about nausea and a funny feeling in his chest. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis? A. Preparation for endotracheal intubation B. Intramuscular injection of diphenhydramine C. Administration of oxygen D. Subcutaneous injection of 1:1000 epinephrine E. Administration of corticosteroids"

A

"A 6-week-old infant is admitted to the hospital with jaundice. Her outpatient blood work demonstrated a total bilirubin of 12 mg/dL with a direct portion of 3.5 mg/dL. Which of the following disorders is most likely to be responsible? A. ABO incompatibility B. Choledochal cyst C. Rh incompatibility D. Gilbert disease E. Crigler-Najjar syndrome"

B

"A 10-year-old boy, the star pitcher for the Salt Lake City Little league baseball team, had a sore throat about 2 weeks ago but did not tell anyone because he was afraid he would miss the playoffs. Since several children have been diagnosed with rheumatic fever in the area, his mother is worried that he may be at risk as well. You tell her that several criteria must be met to make the diagnosis but the most common finding is which of the following? A. Carditis B. Arthralgia C. Erythema marginatum D. Chorea E. Subcutaneous nodules"

B

"A 15-year-old female presents to your office with secondary amenorrhea. As part of your evaluation, you find that she is pregnant. After informing her of the pregnancy, you continue to explain that young mothers have a higher risk of several pregnancy-related complications, including which of the following? A. Twin gestation B. Low-birthweight infants C. Hypotension D. Excessive weight gain E. Infants with genetic defects"

B

"A 15-year-old vegetarian being treated for tuberculosis develops peripheral neuropathy. For presented child above, choose the one most appropriate vitamin or trace element replacement therapy to treat the described condition. A. Vitamin A B. Vitamin B6 C. Vitamin C D. Iron E. Vitamin K"

B

"A 17-year-old boy is brought to the emergency department by his parents with the complaint of coughing up blood. He is stabilized, and his hemoglobin and hematocrit levels are 11 mg/dL and 33%, respectively. During his ospitalization, he is noted to have systolic blood pressure persistently greater than 130 mm Hg and diastolic blood pressure greater than 90 mm Hg. His urinalysis is remarkable for hematuria and proteinuria. You are suspicious the patient has which of the following? A. Hemolytic-uremic syndrome B. Goodpasture syndrome C. Nephrotic syndrome D. Poststreptococcal glomerulonephritis E. renal vein thrombosis"

B

"A 2-month-old child of an HIV-positive mother is followed in your pediatric practice. Which of the following therapies should be considered for this child? A. Monthly evaluation for Kaposi sarcoma B. Prophylaxis against Pneumocystis jiroveci pneumonia Pneumocystis carinii. C. Vitamin C supplementation D. Oral polio virus vaccine E. Bone marrow transplantation"

B

"A 28-year-old primigravida develops an erythematous skin discoloration in the upper outer quadrant of the left breast. She has achy, flu-like symptoms and fever to 38.3C. You suspect bacterial mastitis. At this time, what would you do? A. stop breastfeeding and have the mother express her breast milk until the infection is cleared B. continue breastfeeding and treat the mother with hot compresses and antibiotics C. continue breastfeeding and treat both the mother and the infant with antibiotics D. discontinue breastfeeding for now and provide antibiotics to the mother E. discontinue any further breastfeeding and perform an incision and drainage immediately"

B

"A 3-year-old child presents to your office for an evaluation of constipation. The mother notes that since birth, and despite frequent use of stool softeners, the child has only about one stool per week. He does not have fecal soiling or diarrhea. He was born at term and without pregnancy complications. The child stayed an extra day in the hospital at birth because he did not pass stool for 48 hours, but has not been in the hospital since. Initial evaluation of this child should include which of the following? A. A child psychiatry evaluation for stool retention and parenting assistance B. A barium enema and rectal manometry C. Plain films of the abdomen D. Dietary log and observation E. Beginning oral antispasmodic medication"

B

"A 3.3 kg infant delivered at 396 weeks arrives in the OPD of a pediatric hospital with normal vital signs and a respiratory rate of 80 breaths/ minute. The labor and subsequent delivery were precipitous according to the labor and delivery midwife.Which of the following statements is true? A. symptoms of respiratory distress in newborns include poor feeding, intercostal retraction, and nasal flaring B. normal respiratory rate in a newborn is less than 60 breaths/minute C. transient tachypnea of the newborn is the most common cause of neonatal respiratory distress D. cesarean section is not a risk factor for transient tachypnea of the newborn. E. a, b, and c"

B

"A 7-year-old boy has cramping abdominal pain and a rash mainly on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and microhematuria. You diagnose Henoch-Schönlein, or anaphylactoid, purpura. In addition to his rash and abdominal pain, what other finding is he likely to have? A. Chronic renal failure B. Arthritis or arthralgia C. seizures D. Unilateral lymphadenopathy E. Bulbar nonpurulent conjunctivitis"

B

"A mother comes to your office with her 6 weeks of age infantwhohas been "spitting up"all of her formula "since birth." She is afraid the infant is malnourished. The baby weighs 5 kg. Her birth weight was 3.5 kg. At this time, you should advise the mother to do which of the following? A. return home and relax; the child will grow out of it B. increase the time spent burping the infant and keep the infant semiupright after feedings C. investigate the child for pyloric stenosis D. suggest the use of a GI tract motility modifier such as metoclopramide E. immediately refer the child to a pediatric gastroenterologist"

B

"A nurse calls you to evaluate an African American newborn whom she thinks has a bacterial skin infection. The areas in question have many scattered pustules full of a milky fluid. Upon examining pustules, they easily wipe away, revealing a small hyperpigmented macule. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis. A. sebaceous nevus B. Pustular melanosis C Erythema toxicum D. seborrheic dermatitis E. Milia"

B

"An 18-year-old friend of the family returns from spring break from a coastal town in Central America. He has an intensely pruritic lesion on his foot. The lesion is raised, red, serpiginous, and has a few associated bullae. Match the common skin condition with the most appropriate therapy A. Mild cleansing cream, topical moisturizers, and topical steroids B. Ivermectin C. reassurance only D. Topical steroids or a selenium sulfide-containing product E. Topical antifungal agents"

B

"Aunt Mary is helping her family move to a new apartment. During the confusion, 3-year-old Jimmy is noted to become lethargic. The contents of Aunt Mary's purse are strewn about on the floor. In the ER, the lethargic Jimmy is found to have miosis, bradycardia, and hypotension. He develops apnea, respiratory depression, and has to be intubated. His condition would most likely benefit from which of the following therapies? A. Deferoxamine B. Pediatric intensive care unit PICU. support and trial of naloxone C. N-acetylcysteine Mucomyst. D. Atropine E. Dimercaptosuccinic acid DMSA, succimer."

B

"Examination of the cerebrospinal fluid CSF. of an 8-year-old, mildly febrile child with nuchal rigidity and intermittent stupor shows the following: WBCs 85/μL all lymphocytes., negative Gram stain, protein 150 mg/dL, and glucose 15 mg/dL. A computed tomographic CT. scan with contrast shows enhancement of the basal cisterns by the contrast material. Which of the following is the most likely diagnosis? A. Tuberous sclerosis B. Tuberculous meningitis C. Stroke D. Acute bacterial meningitis E. Pseudotumor cerebri"

B

"On a routine-screening CBC, a 1-year-old is noted to have a microcytic anemia. A follow-up hemoglobin electrophoresis demonstrates an increased concentration of hemoglobin A2. The child is most likely to have which of the following? A. Iron deficiency B. β-Thalassemia trait C. Sickle-cell anemia D. Chronic systemic illness E. lead poisoning"

B

"The 7-year-old boy now in your office was last seen 2 weeks ago with a mild viral upper respiratory tract infection. Today, however, he presents with fever, ataxia, weakness, headache, and emesis. In the office he has a 3 minute left-sided tonic-clonic seizure. You send him to the hospital and order a magnetic resonance imaging MRI. of the brain, the results of which show disseminated multifocal white matter lesions that enhance with contrast. This boy's likely diagnosis is which of the following? A. Multiple sclerosis B. Acute disseminated encephalomyelitis C. Malignant astrocytoma D. Bacterial meningitis E. Neurocysticercosis"

B

"The parents of a 2-year-old bring her to the emergency center after she had a seizure. Although the parents report she was in a good state of health, the vital signs in the emergency center reveal a temperature of 39°C 102.2°F. She is now running around the room. Which part of the story would suggest the best outcome in this condition? A. A CSF white count of 100/μL. B. Otitis media on examination. C. The seizure lasted 30 minutes. D. The child was born prematurely with an intraventricular hemorrhage. E. The family reports the child to have had right-sided tonic-clonic activity only."

B

"The parents of a 3-year-old patient followed in your clinic recently took their child on quickly planned 5-day trip to Africa to visit an ill grand-parent. Everyone did well on the trip, but since their return about 10 days ago the boy has been having intermittent, spiking fevers associated with headache, sweating, and nausea. The parents had not been too concerned since he was relatively well, except for being tired, between the fevers. Today, however, they feel that he looks a bit pale and his eyes appear "yellow." Which of the following is likely to reveal the source of his problem? A. Hepatitis A IgG and IgM titers B. Complete blood count CBC. with smear C. Hemoglobin electrophoresis D. Tuberculosis skin test E. Hepatitis B IgG and IgM titers"

B

"Your 6-year-old son awakens at 1:00 AM screaming. You note that he is hyperventilating, is tachycardic, and has dilated pupils. He cannot be consoled, does not respond, and is unaware of his environment. After a few minutes, he returns to normal sleep. He recalls nothing the following morning. Which of the following is the most likely diagnosis? A. seizure disorder B. Night terrors C. Drug ingestion D. Psychiatric disorder E. Migraine headache"

B

"blood samples of a 3-day-old full-term infant are sent for screening to identify diseases that would have serious, permanent consequences without prompt and appropriate treatment. select the most appropriate treatment for Hypothyroidism A. Special infant formula B. Hormone therapy C. Vitamin therapy D. Antibiotic prophylaxis E. Sunlight"

B

"A 1-week-old child's mother complains that the child has a transient rash that has splotchy areas of erythema with a central clear pustule. Your microscopic examination of the liquid in the pustule reveals eosinophils. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis. A. sebaceous nevus B. Pustular melanosis C. Erythema toxicum D. seborrheic dermatitis E. Milia"

C

"A 10-month-old baby boy, recently adopted from Guyana, has a 5-hour history of crying, with intermittent drawing up of his knees to his chest. On the way to the emergency room he passes a loose, bloody stool. He has had no vomiting and has refused his bottle since the crying began. Physical examination is noteworthy for an irritable infant whose abdomen is very difficult to examine because of constant crying. His temperature is 38.8°C 101.8°F. The rectal ampulla is empty, but there is some gross blood on the examining finger. Which of the following studies would be most helpful in the immediate management of this patient? A. Stool culture B. Examination of the stool for ova and parasites C. Air contrast enema D. Examination of the blood smear E. Coagulation studies"

C

"A 14-year-old girl has a 9-month history of diarrhea, abdominal pain usually periumbilical and postprandial, fever, and weight loss. She has had several episodes of blood in her stools. Which of the following is the most likely diagnosis? A. Chronic appendicitis B. Chronic pancreatitis C. Crohn disease D. Bulimia E. Gallstones"

C

"A 17-year-old adolescent female is 6 weeks postpartum. She presents to the emergency room with the complaints of increased jaundice, abdominal pain, nausea, vomiting, and fever. Her examination is remarkable for jaundice, pain of the right upper quadrant with guarding, and a clear chest. Chest radiographs appear normal. Which of the following tests is most likely to reveal the cause of this pain? A. serum chemistries B. Complete blood count CBC with platelets and differential C. Ultrasound of the right upper quadrant D. Upper GI series E. Hepatitis panel"

C

"A 3-day-old infant was born to a mother with active systemic lupus erythematosus Sle.. Match above clinical condition with the most likely cause A. Glomerulonephritis B. severe anemia C. Heart block D. ventricular septal defect VSD. E. Arteriovenous malformation"

C

"A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a "cold" and could not receive his immunizations.The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements regarding future immunizations for the child is true? A. never give an immunization with a low-grade fever B. never give an immunization if a child is malnourished C. give an immunization even if the child has a low-grade fever or a runny nose D. postpone an immunization if a child has a mild ARI E. answers a and b are correct"

C

"A 4-month-old infant is brought to your clinic by his mother. The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a "cold" and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements regarding immunization against measlesis true? A. measles vaccine is available in combination with diphtheria-tetanus-pertussisDTaP. vaccine B. measles vaccine should be given before age 3 months C. measles vaccine should be given at age 9 months D. answers a and b are correct E. answers a and c are correct"

C

"A 5-year-old boy is brought into the ER immediately after an unfortunate altercation with a neighbor's immunized Chihuahua that occurred while the child was attempting to dress the dog as a superhero. The fully immunized child has a small, irregular, superficial laceration on his right forearm that has stopped bleeding. His neuromuscular examination is completely normal, and his perfusion is intact. Management should include which of the following? A. Irrigation and antimicrobial prophylaxis B. tetanus booster immunization and tetanus toxoid in the wound C. Copious irrigation D. Primary rabies vaccination for the child E. Destruction of the dog and examination of brain tissue for rabies"

C

"A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine output for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9-month checkup. You note her heart rate and blood pressure to be normal. She is lethargic, and her skin is noted to be "doughy." After confirming that her respiratory status is stable, you send electrolytes, which you expect to be abnormal. You start an IV. Which of the following is the best solution for an initial IV bolus? A. One-fourth normal saline 38.5 mEq sodium/L B. D10 water 100 g glucose/L C. Normal saline 154 mEq sodium/L D. 3% saline 513 mEq sodium/L E. Fresh-frozen plasma"

C

"A cyanotic newborn is suspected of having congenital heart disease. He has an increased left ventricular impulse and a holosystolic murmur along the left sternal border. The ECG shows left-axis deviation and left ventricular hypertrophy LVH. Which of the following is the most likely diagnosis? A. Transposition of the great arteries B. Truncus arteriosus C. Tricuspid atresia D. tetralogy of Fallot E. Persistent fetal circulation"

C

"An 8-month-old infant arrives to the emergency department ED. with a 2-day history of diarrhea and poor fluid intake. Your quick examination reveals a lethargic child; his heart rate is 180 beats per minute, his respiratory rate is 30 breaths per minute, and his blood pressure is low for age. He has poor skin turgor, 5-second capillary refill, and cool extremities. Which of the following fluids is most appropriate management for his condition? A. Dextrose 5% in 1/4 normal saline D5 1/4 NS. B. Dextrose 5% in 1/2 normal saline D5 1/2 NS. C. Normal saline D. Whole blood E. Dextrose 10% in water D10W."

C

"An awake, alert infant with a 2-day history of diarrhea presents with a depressed fontanelle, tachycardia, sunken eyes, and the loss of skin elasticity. Which of the following is the correct percentage of dehydration? A. less than 1% B. 1% to 5% C. 5% to 9% D. 10% to 15% E. More than 20%"

C

"The mother of a 2-year-old male child states that she has noticed white, cheeselike materialarising from his foreskin and also that he cannot fully retract the foreskin behind the glans penis. Which of the following is the correct advice for this parent? A. The child has phimosis and requires a circumcision. B. The child has paraphimosis, and in addition to a circumcision, likely has an infection requiring topical antibiotics. C. The child is normal. D. The child likely has a previously undiagnosed hypospadias. E. Ultrasound of kidneys, bladder, and ureters is indicated to check for unidentified associated defects."

C

"Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood cell WBC. count and differential. The platelet count is 15,000/μL. Which of the following is the most likely diagnosis? A. Von Willebrand disease vWD B. Acute leukemia C. Idiopathic immune thrombocytopenic purpura ITP D. Aplastic anemia E. Thrombotic thrombocytopenic purpura"

C

"You are called to a delivery of a woman with no prenatal care; she is in active labor but has no history of amniotic rupture. The biophysical profile done in the emergency center revealed severe oligohydramnios. When you get this infant to the nursery, you should carefully evaluate him for which of the following? A. Anencephaly B. Trisomy 18 C. renal agenesis D. Duodenal atresia E. Tracheoesophageal fistula"

C

"A 12-month-old girl has been spitting up her meals since 1 month of age. Her growth is at the 95th percentile, and she is otherwise asymptomatic and without findings on physical examination. Which of the following is the most likely diagnosis? A. Pyloric stenosis B. Partial duodenal atresia C. Hypothyroidism D. Gastroesophageal reflux E. Tracheoesophageal fistula"

D

"A 15-year-old is participating in high school football practice in August in texas. He had complained of headache and nausea earlier in practice, but kept playing after a cup of water. He is now confused and combative. He is dizzy and sweating profusely. His temperature is 41°C 105.8°F.​Therapy should consist of which of the following? A. Provide oral rehydration solutions B. Administer acetaminophen rectally C. Order to rest on the bench until symptoms resolve D. Initiate whole body cold water immersion E. tell him to go take a shower and rest until the next day's practice"

D

"A 2-year-old arrives in the emergency center after having swallowed a button battery from one of her toys. She is breathing comfortably, without stridor. Radiographs show the battery to be lodged in the esophagus. Which of the following is the correct next step? A. Induce emesis with syrup of ipecac. B. Admit for observation, and obtain serial radiographs to document movement of the battery. C. Discharge home with instructions to monitor the stool for the battery. D. Immediate removal of the battery via endoscopy. E. Encourage oral intake to assist in passage of the battery."

D

"A 2-year-old presents to the emergency center with several days of rectal bleeding. The mother first noticed reddish-colored stools 2 days prior to arrival and has since changed several diapers with just blood. The child is afebrile, alert, and playful, and is eating well without emesis. He is slightly tachycardic, and his abdominal examination is normal. Which of the following is the best diagnostic study to order to confirm the diagnosis? A. Exploratory laparotomy B. Barium enema C. Ultrasound of the abdomen D. Radionucleotide scan E. Stool culture"

D

"A 3.3 kg infant delivered at 396 weeks arrives in the OPD of a pediatric hospital with normal vital signs and a respiratory rate of 80 breaths/ minute. The labor and subsequent delivery were precipitous according to the labor and delivery midwife. Which of the follow is not a common pathogen found in neonatal sepsis? A. group B streptococcus B. Staphylococcus aureus C. Streptococcus pneumonia D. Bacteroidesfragilis E. none of the above"

D

"A 4-month-old infant is brought to your clinic by his mother. The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a "cold" and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements is true regarding hepatitis B vaccine in children? A. an extra dose should never be given B. it is recommended as a routine immunization, and the first dose should not be given before the age of 2 months C. it is recommended as a routine immunization, and the first dose should be given at 6 months D. it is recommended as a routine immunization, and the first dose should be given prior to discharge from the hospital after birth E. the 3rd dose may be given within 2 weeks of the 2nd dose"

D

"A 5-month-old child regularly regurgitates a large portion of her feeds. A pH probe study showed significant periods of low esophageal pH. The child has normal growth and no other significant past medical history. Which of the following is the best management at this point? A. Barium swallow and upper GI series B. Oral reflux medications C. Esophageal manometry D. Close observation only E. Surgical correction with fundoplication"

D

"A 6-week-old child arrives with a complaint of "breathing fast" and a cough. On examination you note the child to have no temperature elevation, a respiratory rate of 65 breaths per minute, and her oxygen saturation to be 94%. Physical examination also is significant for rales and rhonchi. The past medical history for the child is positive for an eye discharge at 3 weeks of age, which was treated with a topical antibiotic drug. Which of the following organisms is the most likely cause of this child's condition? A. Neisseria gonorrhoeae B. Staphylococcus aureus C. Group B streptococcus D. Chlamydia trachomatis E. Herpesvirus"

D

"A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C 104°F and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following? A. Intubation and intravenous antibiotics B. Inhaled epinephrine and oral steroids C. Inhaled steroids D. Observation in a cool mist tent E. Oral antibiotics and outpatient follow-up"

D

"A healthy 1-year-old child comes to your office for a routine checkup and for immunizations. His parents have no complaints or concerns. The next day, the CBC you performed as customary screening for anemia returns with the percentage of eosinophils on the differential to be 30%. Which of the following is the most likely explanation? A. Bacterial infections B. Chronic allergic rhinitis C. Fungal infections D. Helminth infestation E. Tuberculosis"

D

"A mentally retarded 14-year-old boy has a long face, large ears, micropenis, and large testes. Chromosome analysis is likely to demonstrate which of the following? A. Trisomy 21 B. Trisomy 18 C. Trisomy 13 D. Fragile X syndrome E. Williams syndrome"

D

"A newborn's father complains that his son has dandruff, with many waxy flakes of skin on the scalp. When he scrapes the lesions, hair often comes off with the flakes of skin. In addition, the baby has flaking of the eyebrows. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis. A. sebaceous nevus B. Pustular melanosis C. Erythema toxicum D. seborrheic dermatitis E. Milia"

D

"A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis? A. Rheumatic fever B. Kawasaki disease C. Scarlet fever D. Endocarditis E. Tuberculosis"

D

"One of your asthmatic patients arrives for a checkup. The mother reports that the child seems to need albuterol daily, especially when exercising, and she has coughing fits that awaken her from sleep about twice a week. Her grandmother had recommended a Chihuahua as a "cure" for her asthma, but her mother has seen no difference since the arrival of the pet. Appropriate treatment measures would include which of the following? A. Short-acting, inhaled β-agonists, as needed B. Daily leukotriene modifier with short-acting β-agonist C. Inhaled nedocromil with short-acting β-agonists D. Medium-dose, inhaled corticosteroids with short-acting β-agonists E. High-dose, inhaled corticosteroids with theophylline and short-acting β-agonists"

D

"The 3-year-old sister of a newborn baby develops a cough diagnosed as pertussis by nasopharyngeal culture. The mother gives a history of having been immunized as a child. Which of the following is a correct statement regarding this clinical situation? A. The mother has no risk of acquiring the disease because she was immunized. B. Hyperimmune globulin is effective in protecting the infant. C. The risk to the infant depends on the immune status of the mother. D. Erythromycin should be administered to the infant. E. The 3-year-old sister should be immediately immunized with an additional dose of pertussis vaccine."

D

"The signs and symptoms of meningitis in an infant can be different than those in an adult. Which of the following signs and symptoms of meningitis is more helpful in an adult patient than in a 4-month-old? A. lethargy B. Jaundice C. Vomiting D. Brudzinski sign E. Hypothermia"

D

"You are awakened in the night by your 2-year-old son, who has developed noisy breathing on inspiration, marked retractions of the chest wall, flaring of the nostrils, and a barking cough. He has had a mild upper respiratory infection URI. for 2 days. Which of the following therapies is indicated? A. Short-acting bronchodilators and a 5-day course of steroids B. Intubation and antibiotics C. Observation for hypoxia and dehydration alone D. Inhaled epinephrine and a dose of steroids E. Rigid bronchoscopy"

D

"A 1-year-old presents for a well-child checkup, but the parents are concerned about giving the child his immunizations. Which of the following is a true contraindication to the administration of the fourth DTaP diphtheria and tetanus toxoid and acellular pertussis. vaccine? A. Child is currently on amoxicillin for an otitis media B. Positive family history of adverse reactions to DTaP vaccine C. A past history of infantile spasms D. Child is currently febrile to 39°C 102.2°F. E. Prolonged seizures 6 days after the last DTaP vaccine"

E

"A 14-year-old high school student arrives to your clinic for well-child care. In reviewing his records you determine that his most recent immunization for tetanus was at 4 years of age. Which of the following should you recommend? A. tetanus toxoid B. Adult tetanus and diphtheria toxoid Td. C. Diphtheria toxoid, whole cell pertussis, and tetanus toxoid DPT. booster D. tetanus toxoid and tetanus immune globulin E. tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine adsorbed Tdap."

E

"A 3-day-old infant born at home is brought to the emergency center with bloody stools,hematemesis, and purpura. His circumcision is oozing blood. For presented child above, choose the one most appropriate vitamin or trace element replacement therapy to treat the described condition. A. Vitamin A B. Vitamin B6 C. Vitamin C D. Iron E. Vitamin K"

E

"A 3-year-old refuses to walk, is afebrile, had an upper respiratory tract infection a week ago, has right hip pain with movement, and has a normal WBC count. For case above, select the most likely diagnosis. A. legg-Calvé-Perthes disease B. Slipped capital femoral epiphysis C. Osteomyelitis D. septic arthritis of the hip E. Transient synovitis"

E

"A 4-year-old boy and his family have recently visited a local amusement park. several of the family members developed "gastroenteritis" with fever and diarrhea, but the 4-year-old's stool was slightly different, as it contained blood. His mother reports that in the past 24 hours he developed pallor and lethargy; she relates that his face looks swollen and that he has been urinating very little. Laboratory evaluation reveals a hematocrit of 28% and a platelet count of 2,000/μL. He has blood and protein in the urine. Which of the following diagnoses is most likely to explain these symptoms? A. Henoch-Schönlein purpura B. IgA nephropathy C. Intussusception D. Meckel diverticulum E. Hemolytic-uremic syndrome"

E

"A 4-year-old boy, recently adopted through an international adoption service, is noted to have intermittent watery diarrhea, nausea, belching, and abdominal pain. His weight is less than the fifth percentile for his age. Which of the following studies would be most helpful in making the diagnosis? A. CBC and differential B. ESR C. Abdominal ultrasound D. Liver function studies E. Stool microscopy for ova and parasites"

E

"A child can walk well holding on to furniture but is slightly wobbly when walking alone. She uses a neat pincer grasp to pick up a pellet, and she can release a cube into a cup after it has been demonstrated to her. She tries to build a tower of two cubes with variable success. She is most likely at which of the following age? A. 2 months B. 4 months C. 6 months D. 9 months E. 1 year"

E

"A mother calls you frantic because she has just been diagnosed with chicken pox. She delivered 7 days ago a term infant that appears to be eating, stooling, and urinating well. The child has been afebrile and seems to be doing well. Which of the following is the most appropriate step in management? A. Isolate the infant from the mother. B. Hospitalize the infant in the isolation ward. C. Administer acyclovir to the infant. D. Administer varicella-zoster immunoglobulin to the infant. E. Advise the mother to continue regular well-baby care for the infant."

E

"A mother comes to your office with her 8-week-old infant girl. The mother is tearful and depressed. She has been trying to breastfeed, but she tells you, "I'm obviously inadequate. I'm not producingenough milk, and the baby is fussy all of the time." On examination, the infant looks thin. Since her lastcheckup 3 weeks ago, she has gained only 90 g. The rest of the physical examination is normal. At this time, what should you not do? A. ask some very direct questions about the mother's feeding technique B. refer the mother to a lactation consultant C. encourage the mother to start pumping and include the baby's father or other family member in feeding her milk to the baby, adding formula if necessary until her milk supply is adequate for the baby's catchup growth D. schedule a reassessment within 3 days after interventions have been undertaken E. advise immediate and complete cessation of breast milk with switch to formula"

E

"A mother wishes to breast-feed her newborn infant, but is worried about medical conditions that would prohibit her from doing so. You counsel her that of her listed conditions, which of the following is a contraindication to breast-feeding? A. Upper respiratory tract infection B. Cracked and bleeding nipples C. Mastitis D. Inverted nipples E. HIV infection"

E

"A newborn's mother complains that her infant seems to have very small white dots all over his nose. The dots do not wipe off with bathing, but they are also not erythematous. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis. A. sebaceous nevus B. Pustular melanosis C. Erythema toxicum D. seborrheic dermatitis E. Milia"

E

"A previously healthy 18-month-old has been in a separate room from his family. The family notices the sudden onset of coughing, which resolves in a few minutes. Subsequently, the patient appears to be normal except for increased amounts of drooling and refusal to take foods orally. Which of the following is the most likely explanation for this toddler's condition? A. severe gastroesophageal reflux B. Foreign body in the airway C. Croup D. Epiglottitis E. Foreign body in the esophagus"

E

"An 18-month-old child presents to the emergency center having had a brief, generalized tonicclonic seizure. He is now postictal and has a temperature of 40°C 104°F. During the lumbar puncture which ultimately proves to be normal, he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient? A. Salmonella B. Enterovirus C. Rotavirus D. Campylobacter E. Shigella"

E

"An 8-year-old girl presents with well controlled, moderately persistent asthma. Her therapies consist of occasional use of short-acting β-agonists, daily inhaled steroids, and a leukotriene inhibitor. She presents with white patches on her buccal mucosa. You recommend which of the following? A. HIV testing B. Tuberculosis skin testing C. Measurement of serum immunoglobulins D. Discontinuation of all her asthma medications E. Rinse her mouth after use of her inhaled medications"

E