ROSH Review - Pediatrics Exam
A 4-year-old boy presents to your office with his mother to discuss concerning symptoms of shortness of breath, facial swelling, cough, and development of urticaria after eating peanut butter for the first time. The patient is referred to an allergy specialist and both skin prick and immunoglobulin E antibody testing results are positive for peanut allergy. Which of the following is the first priority in caring for this patient? A. Access to injectable epinephrine B. Avoid all nuts, seeds, and legumes C. Oral desensitization to peanuts D. Physician-supervised oral food challenge
Access to injectable epinephrine
An 8-year-old boy is diagnosed with attention-deficit hyperactivity disorder. Which of the following is first-line initial treatment for this patient? A. Amphetamine-dextroamphetamine and atomoxetine B. Amphetamine-dextroamphetamine and behavioral therapy C. Behavioral therapy D. Guanfacine and behavioral therapy
Amphetamine-dextroamphetamine and behavioral therapy
A 5-year-old boy presents to the office for the second time this month for a nosebleed that has lasted for more than 15 minutes at home despite applying direct pressure to the nostrils. His mother states that he is constantly picking his nose. Physical examination reveals blood coming from the left nostril, but the bleeding site is not visualized. Which of the following is the best next step in treatment for his condition? A. Application of a topical decongestant B. Cautery with silver nitrate C. Nasal packing D. Refer to an otolaryngologist
Application of a topical decongestant
An 8-year-old boy in Thailand presents to a clinic with abdominal discomfort, decreased appetite, nausea, and vomiting. Stool microscopy is done and shows ova characteristic of roundworm infection. Which of the following is the most likely diagnosis? A. Ancylostomiasis B. Ascariasis C. Enterobiasis D. Necatoriasis
Ascariasis
A 7-year-old boy presents to the pediatrician with his mother who is complaining of the boy having academic problems at school. She states that he has a reduced ability to focus in school and often appears to be daydreaming. He makes careless mistakes, cannot pay attention for prolonged periods, fails to follow through with chores, frequently loses things at home, and prefers to avoid tasks that require mental attention, such as homework. Which of the following is the most likely diagnosis? A. Absence seizures B. Attention-deficit hyperactivity disorder predominantly hyperactive-impulsive subtype C. Attention-deficit hyperactivity disorder predominantly inattentive subtype D. Developmental variation
Attention-deficit hyperactivity disorder predominantly inattentive subtype
A 4-year-old boy is brought to the pediatrician by his father for concerns about his behavior. The patient just started preschool and teachers have reported that he prefers to play alone, particularly with toys that spin, and reacts aggressively when other children try to participate in play. During his evaluation, the patient fails to respond to his name being called and avoids eye contact with both his father and the clinician. Which of the following is the best diagnosis? A. Attention deficit hyperactivity disorder B. Autism spectrum disorder C. Conduct disorder D. Oppositional defiant disorder
Autism spectrum disorder
A 5-year-old boy repetitively flicks his fingers, and his mother notes that he mindlessly repeats every word people say. He is preoccupied with train schedules and can rehearse them by heart. While in the office, he received a flu shot but never showed any emotion. At home, he likes to play by himself with his trains. Which of the following is the most likely explanation for these findings? A. Antisocial personality disorder B. Attention-deficit hyperactivity disorder C. Autism spectrum disorder D. Conduct disorder
Autism spectrum disorder
A 17-year-old, otherwise healthy, young woman presents to your office with a six-week history of muscle cramps, tingling in her fingers and toes, and numbness around her mouth. On physical examination, she has increased deep tendon reflexes, a positive Chvostek sign and a positive Trousseau sign . Laboratory tests reveal a serum calcium of 7.2 milligrams per deciliter, a low parathyroid hormone level, and a normal 25-hydroxy-vitamin D level. Which of the following is the most likely diagnosis? A. Autoimmune hypoparathyroidism B. Dietary calcium deficiency C. Pseudohypoparathyroidism D. Renal disease
Autoimmune hypoparathyroidism
A 6-year-old girl is brought into the office by her mother with some mild hearing loss, ear ringing, and occasional sharp pain deep in the left ear. The patient had cold symptoms about two weeks ago that resolved, and her current symptoms began about one week ago. Otoscopic exam shows a normal tympanic membrane, but a tympanogram reveals a high negative pressure that suggests an eustachian tube dysfunction. Which of the following is the best initial treatment of this condition? A. Amoxicillin B. Autoinsufflation C. Oral corticosteroids D. Proton pump inhibitor
Autoinsufflation
A 2-year-old boy presents to the emergency room with one day of fever and stridor. The patient is leaning forward, drooling, and is in distress. Direct visualization of the oropharynx is not possible due to patient discomfort. Oxygen saturation is 88%, pulse is 120 beats per minute, and temperature is 101.2º F. A lateral X-ray of the neck reveals a radiolucent protrusion of the anterior hypopharynx ("thumbprint sign"). Which of the following is the most likely diagnosis? A. Acute laryngotracheitis B. Bacterial epiglottitis C. Pharyngeal foreign body D. Retropharyngeal abscess
Bacterial epiglottitis
A 10-year-old boy presents to the clinic with a papular lesion on his arm. Physical examination reveals tender epitrochlear and axillary lymphadenopathy with erythema of the overlying skin. His mom states that they have multiple cats that sometimes scratch him. What is the etiologic agent of the most likely diagnosis? A. Bartonella henselae B. Pasteurella multocida C. Staphylococcus aureus D. Streptococcus pyogenes
Bartonella henselae
A 7-month-old infant presents to his pediatrician with irritability and abdominal swelling. His hemoglobin is 3.5 grams per deciliter, mean corpuscular volume is 70 femtoliters per cell, and iron studies reveal iron overload. Which of the following is the most likely cause of this infants anemia? A. Anemia of chronic disease B. Beta-thalassemia major C. Iron deficiency anemia D. Vitamin B12 deficiency
Beta-thalassemia major
A 3-month-old male presents to his pediatrician with white spots in his mouth and decreased oral intake for the last two days. He is breastfed and takes some bottle feeds of expressed milk. His mother also complains of increased pain with breastfeeding. On exam, white plaques are noted on the tongue and buccal surfaces of the infant, and these plaques can be scraped off with a tongue depressor. Medication is prescribed to treat thrush. Which of the following is most important to educate the family about in regards to this problem? A. Boil pacifiers and bottle nipples before reuse B. Discontinue breastfeeding C. Systemic therapy is best for infants who cannot swish the medicine D. Use the same medicine for both mom and baby
Boil pacifiers and bottle nipples before reuse
An unvaccinated 7-year-old boy presents to the pediatrician with a cough for the past three weeks. Which of the following organisms causes an illness that classically manifests as paroxysms of coughing, inspiratory whoop, and posttussive vomiting? A. Bordetella pertussis B. Clostridium tetani C. Corynebacterium diphtheria D. Streptococcus pneumoniae
Bordetella pertussis
A 2-year-old boy presents to his pediatrician. He has frequent follow-ups as he has a history of seizure and only began walking two months ago. His mother states his legs look deformed and believes they have worsened since he started walking. On physical exam, frontal bossing is noted as well as bilateral genu varum with low muscle mass of the lower extremities. Laboratory results show elevated serum alkaline phosphatase, elevated parathyroid hormone levels, normal serum creatinine, normal liver enzymes, normal serum phosphorus, normal calcium levels, and low vitamin D levels. Which of the following is the most likely diagnosis? A. Calcipenic rickets B. Phosphopenic rickets C. Primary hypoparathyroidism D. Renal insufficiency
Calcipenic rickets
A 7-year-old boy presents to the clinic with scalp pruritus. Active lice are seen on exam, and he is diagnosed with pediculosis capitis. Which of the following is an appropriate recommendation to make to this patient's family? A. Clothes and linen used by an infected individual within the two days preceding treatment should be washed B. He should not go to school for two days C. Prophylactic treatment of all household members D. Topical pediculicides should be rinsed with hot water
Clothes and linen used by an infected individual within the two days preceding treatment should be washed
A 4-year-old-boy with a past medical history significant for premature birth at 37 weeks and asthma is diagnosed with community-acquired pneumonia. Which of the following is the greatest risk factor for this patient developing acute respiratory distress syndrome? A. Age B. Asthma C. Community-acquired pneumonia D. Premature birth
Community-acquired pneumonia
A six-week-old infant male is brought into the office by his mother for persistent drainage and tearing of the patient's left eye for the past two weeks with occasional purulent discharge when she wipes his eyes. Upon physical exam, the child is alert and active, in no acute distress. His conjunctivae are clear and extraocular muscles are intact. You note that his left eye is constantly tearing, but there is no purulent material present at this time. Which of the following is the most likely diagnosis? A. Acute bacterial conjunctivitis B. Blepharitis C. Dacryocystitis D. Hordeolum
Dacryocystitis
A 12-year-old boy with a family history of venous thromboembolisms presents to the clinic with redness and swelling in his right calf. His calf is tender to palpation. Venous ultrasound is ordered, and he is diagnosed with a venous thromboembolism. After resolution of the acute episode, he is diagnosed with antithrombin deficiency. Which of the following describes the pathophysiology? A. Decreased inhibition of thrombin and factor Xa B. Mutation of factor V C. Reduction in protein C D. Reduction in protein S
Decreased inhibition of thrombin and factor Xa
An 11-year-old boy presents to the clinic with abdominal pain, nausea, and vomiting since this morning. He also complains of urinating frequently, feeling dehydrated, and is slightly drowsy. Fruity breath is noted on exam. His plasma glucose is 400 mg/dL and other laboratory findings are still pending. Which of the following is the most likely diagnosis? A. Acute pancreatitis B. Diabetic ketoacidosis C. Hyperosmolar hyperglycemic state D. Viral gastroenteritis
Diabetic ketoacidosis
A 15-year-old boy presents to the clinic complaining of two weeks of bloody diarrhea and intestinal cramping. He states that the diarrhea began on the last day of his trip to Bolivia and has persisted despite taking seven days of ciprofloxacin 500 mg twice daily, which the travel clinic prescribed him. Which of the following physical exam findings would be most consistent with a presumptive diagnosis of amebiasis in this patient? A. Diffuse abdominal tenderness with hyperactive bowel sounds B. Fever and jaundice C. Hepatosplenomegaly D. Right lower quadrant pain with rebound tenderness
Diffuse abdominal tenderness with hyperactive bowel sounds
An unvaccinated 5-year-old boy presents to his pediatrician with a sore throat for the past three days. On oropharyngeal examination, a white-gray adherent membrane is seen. It bleeds with scraping. Rapid strep test is negative. Which of the following is the most likely diagnosis? A. Diphtheria B. Group A streptococcal pharyngitis C. Infectious mononucleosis D. Viral pharyngitis
Diphtheria
An 11-year-old boy presents to the emergency department with severe pain to his left groin. Upon physical examination, you notice that the left testicle is elevated and slightly tender to palpation, but there is no edema or erythema present. Which of the following will confirm the diagnosis? A. Doppler ultrasonography B. Magnetic resonance imaging with contrast C. Physical exam is sufficient for confirmation D. Urinalysis
Doppler ultrasonography
A 6-year-old boy is brought to the clinic for evaluation of headache, generalized malaise, and myalgia that began three days after his return from camping. Laboratory studies confirm the suspected diagnosis of Rocky Mountain spotted fever. Which of the following is the appropriate treatment? A. Amoxicillin B. Clarithromycin C. Doxycycline D. Penicillin G
Doxycycline
An 11-month-old female presents to your office with parental concerns about weight loss, diarrhea, and flatulence. Her mother says they have recently changed the patient's diet to avoid gluten, and her symptoms have improved. How would you confirm the diagnosis of celiac disease? A. Complete blood count B. Duodenal biopsy C. Serum immunoglobulin A anti-tissue transglutaminase antibody D. Symptom resolution with a gluten-free diet
Duodenal biopsy
An infant is born with a heart rate of 96 beats per minute. He has a regular respiratory rate and active motor movements. His skin is mostly pink, but his hands and feet are blue. He cries in response to irritable stimuli. Which of the following is the correct Apgar score? A. Eight B. Nine C. Seven D. Six
Eight
A 13-year-old boy reports to the pediatrician with his mother. His complaints include fever, sore throat, and excessive fatigue that have worsened since onset last week. Physical exam reveals symmetric posterior cervical lymphadenopathy, splenomegaly, pharyngeal erythema with white tonsillar exudates, palatal petechiae, and fever of 102.1°F. Which of the following is the most likely diagnosis? A. Adenovirus infection B. Epstein-Barr virus infection C. Influenza virus infection D. Streptococcus pyogenes infection
Epstein-Barr virus infection
An 8-year-old boy presents to the office with an erythematous maculopapular rash that is in a lacy pattern on his trunk and arms that is nonpruritic. His cheeks are noticeably red, but he is afebrile. He had a fever one week ago, but it resolved within two days without any other symptoms until now. Which of the following is the most likely diagnosis? A. Erythema infectiosum B. Hand, foot, and mouth disease C. Roseola D. Rubella
Erythema infectiosum
A 12-year-old boy presents to his pediatrician with a migratory arthritis and heart murmur three weeks after a streptococcal pharyngitis infection. Which of the following is one of the major Jones criteria for acute rheumatic fever? A. Elevated acute phase reactants B. Erythema marginatum C. Fever D. Prolonged PR interval on electrocardiogram
Erythema marginatum
A 6-year-old boy is diagnosed with absence seizures after multiple episodes of staring with lack of response to verbal stimuli. Electroencephalogram confirmed the diagnosis. Which of the following would be the correct pharmacologic treatment option for this patients seizures? A. Carbamazepine B. Ethosuximide C. Phenobarbital D. Topiramate
Ethosuximide
A 16-year-old boy is brought into the emergency department by his parents following an injury during a wrestling match that day resulting in right ear pain. On exam, a tender fluctuant area of blood 6 cm in diameter is noted along the pinna. Which of the following is the correct treatment plan for an auricular hematoma? A. Aspiration of hematoma using fine needle B. Cold compress to affected area over next 48 hours C. Evacuation of hematoma through incision and drainage D. Referral to plastic surgery
Evacuation of hematoma through incision and drainage
A 2-year-old boy presents to the hematology clinic with easy bruising and recurrent hemarthrosis. He has severe hemophilia A. Which of the following is the best treatment? A. Desmopressin B. Factor IX replacement C. Factor VIII replacement D. Platelet transfusions
Factor VIII replacement
A 16-year-old boy of Mediterranean descent presents to the office for a routine check-up. He is found to have mild anemia and further workup reveals an elevated reticulocyte count and elevated indirect bilirubin level. A peripheral smear shows the presence of Heinz bodies. Which of the following is the most likely diagnosis? A. Beta thalassemia minor B. Glucose-6-phosphate dehydrogenase deficiency C. Hereditary spherocytosis D. Sickle cell anemia
Glucose-6-phosphate dehydrogenase deficiency
A 3-year-old boy is brought to the emergency department for acute onset of multiple episodes of diarrhea. His mother reports that he has not urinated in the past eight hours and that he had a seizure about one hour ago. Laboratory results reveal an elevated blood urea nitrogen, mild thrombocytopenia, and mild anemia. A peripheral smear reveals schistocytes and urinalysis reveals red blood cell casts. Which of the following is the most likely diagnosis? A. Disseminated intravascular coagulation B. Hemolytic uremic syndrome C. Henoch-Schonlein purpura D. Thrombotic thrombocytopenic purpura
Hemolytic uremic syndrome
A 15-year-old boy presents to the clinic with fever, posterior cervical lymphadenopathy, sore throat, and splenomegaly. Which of the following is the best test to confirm the most likely diagnosis? A. Epstein-Barr virus-specific antibodies B. Heterophile antibody test C. Rapid antigen detection test D. Throat culture
Heterophile antibody test
A 4-year-old boy is brought to the office by his mother for a painless lump on his left testicle. On physical exam, the lump is about 2 centimeters in diameter, round, painless, and soft to touch. It increases in size with Valsalva maneuver. Transillumination of the scrotum shows homogenous tissue without any dark shadows. Which of the following is the most likely diagnosis? A. Hydrocele B. Spermatocele C. Testicular tumor D. Varicocele
Hydrocele
An 8-month-old girl with a history of eczema presents to her pediatrician with fever, upper respiratory congestion, and report of tugging on her ears. Her mother is concerned for ear infections. On examination, her tympanic membranes are obscured from view by cerumen, and irrigation for cerumen removal is recommended to the mother who agrees with the plan. Which of the following should be avoided during irrigation in patients with dry skin in the ear canal? A. Docusate sodium B. Hydrogen peroxide C. Mineral oil D. Saline solution
Hydrogen peroxide
A 9-month-old female presents to her pediatrician. Her parents are concerned that she has been refusing to eat and drink for two days and is very fussy. She has only had two wet diapers all day. She has had a low-grade fever but no other symptoms. She perks up a bit with acetaminophen but is still pushing away offers of food and drink. On exam, two ulcers are noted on her tongue and four on her buccal surfaces. The ulcers are pale and surrounded by a thin red rim. She also has a few red spots on her palms and soles. Her pulses are +2 throughout, and she has < 3 second capillary refill. Given her presentation, which of the following is the best treatment for this patient? A. Acyclovir B. Hydrocodone-acetaminophen C. Ibuprofen D. Intravenous immunoglobulin
Ibuprofen
A 5-year-old boy presents to the emergency department with penile pain and difficulty urinating. Upon physical exam, you note an enlarged glans penis with a mildly erythematous band of foreskin behind the glans. Which of the following is the most appropriate initial treatment for this condition? A. Ice the penis and do a manual reduction and compression B. Perform a circumcision C. Perform a dorsal slit procedure D. Prescribe an anti-inflammatory to reduce swelling
Ice the penis and do a manual reduction and compression
A 12-year-old boy presents with a nose bleed that started two hours ago. He was treated for a viral upper respiratory infection two weeks ago. He is otherwise healthy. Physical examination reveals lower extremity purpura and petechiae but is otherwise normal. Laboratory studies reveal thrombocytopenia, normal levels of clotting factors, and normal prothrombin time/partial thromboplastin time. The peripheral blood smear is also normal. Which of the following is the most likely diagnosis? A. Hemolytic uremic syndrome B. Hemophilia C. Idiopathic thrombocytopenic purpura D. Thrombotic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura
A previously healthy 10-year-old boy presents to the clinic with unilateral red eye and eye discharge. He denies any associated eye pain, photophobia, or changes in visual acuity. Physical examination reveals 20/20 visual acuity bilaterally. Which of the following is the most likely diagnosis? A. Angle-closure glaucoma B. Infectious conjunctivitis C. Infectious keratitis D. Iritis
Infectious conjunctivitis
A 17-year-old boy presents to the emergency department with fever, sore throat, and lymphadenopathy. He has enlarged and tender symmetric posterior cervical lymph nodes and palatal petechiae. The heterophile antibody test is positive. What is the most likely diagnosis? A. Common cold B. Cytomegalovirus C. Group A Streptococcal pharyngitis D. Infectious mononucleosis
Infectious mononucleosis
A 12-year-old girl presents with severe eye pain after being hit with a softball directly in her right eye. Physical exam reveals significant orbital edema and ecchymosis. She consents to having mild double vision and is unable to gaze upwards, but otherwise has normal visual acuity. What is the most likely diagnosis? A. Globe rupture B. Inferior orbital fracture C. Nasoethmoid fracture D. Orbital hematoma
Inferior orbital fracture
A 6-year-old boy presents to the urgent care clinic with his mother complaining of muffled hearing in his right ear, which started earlier today. Examination reveals a moving, winged insect in the external auditory canal. Perforation of the tympanic membrane cannot be excluded at this time. Which of the following is the first step in management of this foreign body? A. Aural toilet with suctioning B. Instillation of mineral oil C. Removal of insect with alligator forceps D. Saline irrigation
Instillation of mineral oil
A 13-year-old boy presents to his pediatrician with a two-week history of high fevers and a two-month history joint pain. He complains of wrist and ankle pain in the mornings and when he has fevers. Initially he just had joint pain but has now had fevers daily for two weeks, as high as 104°F. He also has a pink rash that goes away when the fever subsides. When afebrile, he behaves like his usual self; he is still attending school and engaging in sports. His fever and symptoms do respond to ibuprofen, but his mother is concerned because the fevers have been going on for so long. Which of the following is the most likely diagnosis? A. Juvenile idiopathic arthritis B. Malignancy C. Reactive arthritis D. Septic arthritis
Juvenile idiopathic arthritis
A 9-year-old African-American girl presents to her pediatrician with complaints of progressively regular crampy abdominal pain, flatulence, and non-bloody diarrhea over the last two months. Her mom thinks her symptoms may be related to intake of dairy products. Which of the following is the best test to confirm lactose intolerance? A. Lactose hydrogen breath test B. Lactose tolerance test C. Small bowel biopsy D. Stool osmotic gap
Lactose hydrogen breath test
A 5-year-old boy presents to the emergency department with a barking cough, hoarseness, and a low-grade fever. Physical exam reveals inspiratory stridor. A cervical anteroposterior radiograph is performed and shows a "steeple sign." Which of the following is the most likely diagnosis? A. Acute epiglottitis B. Acute bronchiolitis C. Bacterial tracheitis D. Laryngotracheitis
Laryngotracheitis
A 15 year-old-boy is in the office for an asthma recheck. He has been using his albuterol inhaler three times weekly for the past four weeks. You want to add a daily preventative inhaler. Which class of inhaled medications do you choose for your next step? A. Anticholinergics B. Long-acting beta agonists C. Low dose glucocorticoids D. Short-acting beta agonist
Low dose glucocorticoids
A 16-year-old gymnast presents to the office with some mild low back pain that is worse with activity. Upon physical examination, her low back is non-tender to palpation, but pain is elicited upon extension of the back. Neurological exam is unremarkable. A lumbar radiograph series is ordered and shows a pars interarticularis defect at the L5 level in the oblique view. Which of the following is the most likely diagnosis? A. Lumbar disc herniation B. Lumbar spondylolisthesis C. Lumbar spondylolysis D. Lumbar spondylosis
Lumbar spondylolysis
A 5-year-old boy who recently traveled to southeast Asia presents with an exanthematous rash. Which of the following rash descriptions is consistent with rubella? A. Erythematous lesions in a Christmas tree pattern on the back B. Erythematous papular and vesicular lesions in various stages on the trunk and extremities C. Maculopapular rash that begins on the face and spreads caudally D. Vesicular rash on an erythematous base in a dermatomal distribution
Maculopapular rash that begins on the face and spreads caudally
A 16-year-old girl presents to the clinic for evaluation of her asthma. She is using a short-acting beta-agonist inhaler every day, sometimes twice per day. She also uses it at night about twice weekly. She misses an average of one day of school per month due to her symptoms. Which of the following best describes her asthma? A. Intermittent B. Mild persistent C. Moderate persistent D. Severe persistent
Moderate persistent
A 5-year-old boy presents to the clinic with flesh-colored, dome-shaped, papular lesions on his back. The lesions are firm with central umbilication. Which of the following is the most likely diagnosis? A. Common warts B. Molluscum contagiosum C. Scabies D. Tinea corporis
Molluscum contagiosum
A 5-year-old boy is brought to the pediatrician by his mother due to a new onset earache. The patient started complaining of this pain yesterday, and his mother reports he also had a fever with associated fatigue in the last couple of days. Physical exam reveals the findings shown above. Palpation of the swollen area reveals uniformity in composition with associated tenderness, and no purulent discharge is expressed within the oral cavity. Which of the following is the best diagnosis? A. Lymphoma B. Mumps C. Sialolithiasis D. Suppurative parotitis
Mumps
A 2-year-old girl presents with fussiness for three days. Her parents state her nose has been running quite a bit. On exam, you note one-sided mucopurulent discharge from her left nostril. What is the most likely diagnosis? A. Acute sinusitis B. Allergic rhinitis C. Nasal foreign body D. Nasal polyp
Nasal foreign body
A 2-year-old boy presents to the emergency department with fever, malaise, painful mucosal lesions, and generalized erythema of the trunk and extremities. Several vesicles and bullae are also noted on the trunk with an area of skin sloughing. The patient has a history of receiving antibiotic treatment for a cough two weeks ago. Stevens-Johnson syndrome is suspected. The examiner applies lateral pressure to a seemingly normal area of skin on the patient's arm, eliciting new skin sloughing. Which of the following best describes this sign? A. Asboe-Hansen sign B. Auspitz sign C. Koebner phenomenon D. Nikolsky sign
Nikolsky sign
A 15-year-old boy presents to his pediatrician with fever and sore throat for the last three days. He also complains of fatigue and has missed school and football practice all week. A strep test is negative, but a Monospot test is positive. Which of the following is the most important recommendation to give the family? A. Amoxicillin treatment for 10 days B. Antibody testing to confirm infection C. No return to contact sports for at least four weeks D. No return to school for at least one week
No return to contact sports for at least four weeks
A 6-year-old boy presents to the clinic with hair loss and scaling of his scalp. Examination reveals two areas of hair loss with black dots. Potassium hydroxide preparation supports the diagnosis of tinea capitis. What is the recommended treatment? A. Oral griseofulvin B. Oral ketoconazole C. Prednisone D. Topical ketoconazole
Oral griseofulvin
A 6-month-old boy with a known history of cryptorchidism presents to your office with his parents. He is otherwise healthy and meeting his developmental milestones. His parents are concerned about the cryptorchidism and want to discuss next steps. Which of the following is the most appropriate treatment? A. Hormone therapy B. Orchiectomy C. Orchiopexy D. Watchful waiting
Orchiopexy
A 14-year-old boy presents to your office with left knee pain after colliding with another player during a basketball game one week ago. He notes a painful bump just above the knee on the medial side, which was not present before the injury. On physical examination, he has some resolving ecchymosis over the medial aspect of the knee. There is no effusion, and he has full range of motion of the knee. There is a firm, subcutaneous, well-circumscribed, mildly tender mass about 2 centimeters in diameter over the medial distal femur. X-rays of the knee show a bony, pedunculated mass arising from the medial distal femur just proximal to the physis. Which of the following is the most likely diagnosis? A. Myositis ossificans B. Nonossifying fibroma C. Osteochondroma D. Osteophyte
Osteochondroma
A 14-year-old boy presents to his pediatrician for follow-up on a left knee injury sustained during a soccer game three months ago. He has been treated symptomatically with ibuprofen but has not improved. He does not report systemic symptoms. On exam, he has tenderness around his left knee; and point tenderness over a swollen area on his medial knee. The palpable mass is about 4 cm in diameter, soft and fixed. The knee joint is stable. There are no other significant findings. Given the duration and persistence of his symptoms, radiographs of his left pelvis and left lower extremity are ordered, revealing a concerning "sunburst pattern" at the left distal femur. A complete blood count and complete metabolic panel are only notable for an elevated alkaline phosphatase. Which of the following is the most likely diagnosis? A. Ewing sarcoma B. Lymphoma C. Osteoblastoma D. Osteosarcoma
Osteosarcoma
A 16-year-old boy presents to the behavioral health clinic with his mother, who reports he has been getting in trouble at school for being violent towards classmates. She states he has always had trouble making friends due to his distrust of others' intentions. When questioned about his behavior, the patient states that his classmates all talk about him behind his back, as evidenced by their constant texting during class. He denies delusions, hallucinations, or disorganized thoughts or speech, and he endorses no history of depression, anxiety, or mania. Which of the following is the best diagnosis? A. Borderline personality disorder B. Delusional disorder C. Paranoid personality disorder D. Schizophrenia
Paranoid personality disorder
A 10-month-old boy is brought to the emergency department by his parents who noticed that he is not moving his right arm. X-rays of the humerus show a nondisplaced fracture of the humeral neck. Which of the following reports by a parent is most consistent with accidental injury versus abuse? A. Child fell onto floor while cruising along furniture B. Family dog ran into child while he was sitting on the floor C. Parent fell down stairs while carrying child D. Parent pulled child up from car seat by the arm
Parent fell down stairs while carrying child
A 6-year-old boy presents to his pediatrician for a red rash on his cheeks that gives him a "slapped-cheek" appearance and is warm and a little itchy. The rash does not affect the area around his mouth. He is afebrile and has no other symptoms, but a week ago he had a low-grade fever and upper respiratory symptoms. He is now also developing a rash on his trunk that has a lacelike appearance. His immunizations are up to date. Which of the following is the most likely causative organism? A. Group A StreptococcusYour Answer B. Parvovirus B19 C. Rubella D. Rubeola
Parvovirus B19
A 7-year-old girl presents to her pediatrician with a malar rash with circumoral pallor. Her mother states that the rash was preceded by fever and rhinorrhea. Which of the following is the most likely causative pathogen? A. Human herpesvirus 6 B. Parvovirus B19 C. Rubella D. Rubeola
Parvovirus B19
A 2-year-old boy is presented at his pediatrician's office. His mother states that he has not started walking. His vocabulary is limited to three words. She is also concerned by the mousy smell of his urine. On physical exam, the child is well nourished and is in the 75th percentile of weight and height. It appears that the child has missed milestones despite normal Apgar scores at the time of his birth. An eczematous rash is present on his extremities. Which of the following is the most likely cause of his developmental delay? A. Down syndrome B. Fragile X syndrome C. Hypothyroidism D. Phenylketonuria
Phenylketonuria
A 10-year-old boy presents with gross hematuria, hypertension, and edema. His throat was sore two weeks ago, but he was not seen by his pediatrician. His sore throat resolved one week ago. He has been well until two days ago when he noticed some blood in his urine. His face and extremities are puffy this morning. Laboratory studies show elevated antistreptolysin titers and low serum complement levels. Which of the following is the most likely explanation for these findings? A. Henoch-Schönlein purpura B. Immunoglobulin A nephropathy C. Infection-related glomerulonephritis D. Post-infectious glomerulonephritis
Post-infectious glomerulonephritis
A 7-year-old boy is brought by his mother to the emergency department for brown, "cola colored" urine. She also feels he looks swollen. He is usually healthy with no significant medical history, though he did have a febrile illness with rash two weeks ago that resolved without any special treatment. His vital signs are stable other than a slightly increased blood pressure. A urinalysis is notable for both a gross and microscopic hematuria with proteinuria. Which of the following is the most likely diagnosis? A. Henoch-Schöenlein purpura nephritis B. Immunoglobulin A nephropathy C. Membranoproliferative glomerulonephritis D. Poststreptococcal glomerulonephritis
Poststreptococcal glomerulonephritis
An 11-year-old boy presents to the pediatrician with a pruritic, circular, erythematous, and scaling plaque. The lesion began three days ago and spread outwards with central clearing. His sibling has a similar lesion. What is the best method to confirm the most likely diagnosis? A. Clinical findings B. Gram stain and culture C. Potassium hydroxide preparation D. Skin biopsy
Potassium hydroxide preparation
A 15-year-old boy returns to the clinic complaining of left eyelid pain, swelling, and itching for four days with no relief from gentamicin drops. He has recently been camping. Physical exam reveals an edematous, erythematous upper and lower left lid with the patient recoiling from touch. Extraocular motilities are normal without pain or diplopia and the bulbar conjunctiva is white. Which of the following causes of painful eyelid swelling represents the most likely diagnosis? A. Bacterial conjunctivitis B. Hordeolum C. Orbital cellulitis D. Preseptal cellulitis
Preseptal cellulitis
A 4-year-old boy who is otherwise healthy presents to his pediatrician with a widespread rash. The rash has vesicular lesions in multiple stages involving the face, trunk, and extremities. Which of the following symptoms is another common clinical finding of this condition? A. Conjunctivitis B. Dermatomal distribution of the rash C. Inflammation of the parotid glands D. Prodrome of fever and pharyngitis
Prodrome of fever and pharyngitis
A 3-year-old girl is brought to the urgent care department by her parents who noticed that she has not been moving her right arm since her mother pulled her up out of her car seat. On examination, she holds her right arm at her side and has no visible swelling, deformity, or ecchymoses. X-rays of the elbow and forearm do not show any bony abnormalities, but the X-ray technician reports feeling a "pop" when she was positioning the patient, and shortly afterward, the child began to use her arm to reach for an object. Which of the following is the most likely diagnosis? A. Occult fracture B. Posterior dislocation of elbow C. Radial head subluxation D. Ulnar collateral ligament injury
Radial head subluxation
A 3-year-old boy presents to the emergency department with his parents who witnessed the patient swallow a small plastic button one hour prior. The patient is in no distress and is playing happily. His physical exam is normal, and he is eating and drinking well. Which of the following is the most appropriate next step in management? A. Abdominal CT B. Expectant management C. Radiographs of the neck, chest, and abdomen D. Urgent referral to a gastroenterologist
Radiographs of the neck, chest, and abdomen
15-year-old boy is brought into the office for a rash that appeared on his neck and trunk yesterday. He had been treated for tinea corporis due to a lesion on his back about two weeks ago, but the lesion has not resolved. Upon physical examination, he has a diffuse maculopapular rash that is bilateral and symmetrical following the lines of cleavage of the skin. The rash is not pruritic. The patient is otherwise healthy with no chronic illnesses and has no other complaints. Which of the following is the best initial treatment? A. Oral acyclovir B. Oral erythromycin C. Reassurance and supportive care D. Ultraviolet radiation therapy
Reassurance and supportive care
A 14-year-old boy presents to the clinic with fever, chills, headache, and malaise. He has also developed an erythematous ulcerative lesion with a central eschar on his left hand. Serologic studies are pending. Which additional historical information would support a diagnosis of tularemia? A. Cleaning aquariums B. Contact with a bat in a cave C. Recent exposure to a poorly ventilated barn with rodent feces D. Recently skinning a hare without gloves
Recently skinning a hare without gloves
A 6-year-old boy is brought into the emergency department for two days of neck pain, severe sore throat, and fever after recovering from a recent cold. Upon physical exam, the patient has a fever of 102°F and has decreased range of motion of the neck. He also has bilateral cervical lymphadenopathy, has difficulty opening his mouth, and refuses to swallow. A lateral neck X-ray shows some soft tissue swelling anterior to the cervical vertebrae from C2-C4. Which of the following is the most likely diagnosis? A. Angioedema B. Foreign body aspiration C. Peritonsillar abscess D. Retropharyngeal abscess
Retropharyngeal abscess
An 18-month-old girl is brought to the emergency department by her mother who states that her child has been continually vomiting for the past 12 hours. The mother denies previous episodes of vomiting but reports that the patient recently recovered from chicken pox and is still experiencing residual pain. The mother notes administering acetylsalicylic acid to her daughter for the last 24 hours as a means of pain relief. Vital signs for the child are T 99.8°F, HR 132, BP 92/46, and RR 22 with age-appropriate height and weight. On physical exam, the child appears lethargic, palpation reveals mild hepatomegaly, and her diaper is clean and free of stool. Which of the following is the most likely diagnosis? A. Inborn error of metabolism B. Intussusception C. Meningitis D. Reye syndrome
Reye syndrome
A 3-year-old boy is brought to the emergency department by his parents after he swallowed a coin. The child is in no acute distress and his vital signs are normal. X-ray of the chest is shown above. Which of the following is the best step in management? A. Activated charcoal B. Expectant management C. Flexible bronchoscopy D. Rigid bronchoscopy
Rigid bronchoscopy
A 10-year-old boy with a diagnosis of autism spectrum disorder presents to your psychiatric clinic with his parents. His parents report good school support and in-home behavioral therapy. At this time, they state that the patient continues to experience irritability, angry outbursts, and self-injury. Which of the following medications would you be likely to prescribe in this situation? A. Haloperidol B. Methylphenidate C. Risperidone D. Valproate
Risperidone
A 10-month-old boy presents to the emergency department with a widespread maculopapular rash. His mother states he had a fever for three days that suddenly resolved prior to the development of the rash. Which of the following infectious exanthems is the most likely cause? A. Erythema infectiosum B. Roseola infantum C. Rubella D. Rubeola
Roseola infantum
An unvaccinated, 6-year-old boy presents to his pediatrician with an exanthematous macular rash that began two days after a fever. He is also noted to have cough, coryza, and conjunctivitis. The rash began on the face and spread to the trunk and extremities. The child is still febrile. What is the most likely diagnosis? A. Roseola B. Rubella C. Rubeola D. Varicella
Rubeola
A 10-year-old boy accompanied by his father presents to the clinic with a sudden onset of fever and sore throat. He denies a cough. He noticed a rash yesterday on his armpit and groin that has since spread to his trunk and extremities. Physical examination reveals tonsillar edema, erythema, and exudates and tender anterior cervical adenopathy. A diffuse blanchable, erythematous sandpaper-like rash is noted on his armpit, extremities, groin, and trunk. The palms and soles are spared. Which of the following is the most likely explanation of the rash? A. Acute rheumatic fever B. Poststreptococcal glomerulonephritis C. Scarlet fever D. Streptococcal toxic shock syndrome
Scarlet fever
A 5-year-old girl presents to the emergency department with progressive swelling and puffiness over the last week. She has not had a fever or other recent concerning symptoms. On physical exam, generalized edema is appreciated on the child, and there is concern for nephrotic syndrome. Which of the following tests is necessary to confirm this diagnosis? A. 24-hour urine B. Renal biopsy C. Serum albumin D. Urinalysis
Serum albumin
A 12-year-old boy presents to the clinic for asthma evaluation. He has daytime symptoms three days per week. He has nighttime awakenings due to asthma four times per month. He uses his rescue inhaler three times per week, and he states that he thinks his asthma causes mild limitation on his activities. Which of the following is the most appropriate treatment regimen for this patient? A. Short-acting bronchodilator alone B. Short-acting bronchodilator and low-dose inhaled corticosteroid C. Short-acting bronchodilator, low-dose inhaled corticosteroid, and long-acting bronchodilator D. Short-acting bronchodilator, low-dose inhaled corticosteroid, long-acting bronchodilator, and oral steroids
Short-acting bronchodilator and low-dose inhaled corticosteroid
A 13-year-old obese boy presents to the clinic with insidious left-sided hip pain and altered gait for the past three months. The hip pain is worse with activity. He reports no history of trauma. Based on the X-ray above, which of the following is the most likely cause of this patient's hip pain? A. Avascular necrosis of the hip B. Developmental dysplasia of the hip C. Slipped capital femoral epiphysis D. Transient synovitis
Slipped capital femoral epiphysis
An 8-year-old boy presents for his annual physical with complaints of night-time cough and intermittent wheezing. Which of the following diagnostic studies would confirm a diagnosis of asthma? A. Arterial blood gas B. Bronchoscopy C. Chest radiograph D. Spirometry
Spirometry
A 4-year-old boy presents to the clinic with erythematous papules and an overlying thick and adherent gold-colored crust on his left cheek. He is diagnosed with nonbullous impetigo. Which pathogen is the most likely cause? A. Escherichia coli B. Staphylococcus aureus C. Streptococcus pneumoniae D. Streptococcus pyogenes
Staphylococcus aureus
A 6-year-old boy presents with right elbow pain after a fall from the monkey bars. Given the mechanism of injury and the location of the pain, which of the following should be included in the differential diagnosis? A. Anterior capsule strain B. Nursemaid elbow C. Olecranon apophysitis D. Supracondylar fracture
Supracondylar fracture
A 2-month-old male infant is brought into the clinic by his mother because he seems to have crossed eyes. Upon physical examination, the child has a constant medial deviation of the left eye. A corneal light reflex measurement shows a large angle of deviation of more than 40 prism diopters. He is diagnosed with infantile esotropia and is referred to an ophthalmologist. Which of the following interventions will yield the best outcomes for his condition? A. Botulinum toxin injections to the medial rectus muscle B. Occlusion therapy with an eye patch C. Prism lenses D. Surgical realignment
Surgical realignment
An unvaccinated boy presents to the pediatrician with bilateral parotid gland swelling. His mother states that the swelling was preceded by fever, fatigue, and decreased appetite. Which of the following describes the causative pathogen of this condition? A. The condition is caused by a gram-negative bacterial pathogen B. The condition is caused by a gram-positive bacterial pathogen C. The condition is caused by a virus from the Herpesviridae family D. The condition is caused by a virus from the Paramyxovirus genus
The condition is caused by a virus from the Paramyxovirus genus
A 5-year-old boy presents complaining of ear pain. On physical exam he has moderate tragal tenderness and a partially closed ear canal. The tympanic membrane is intact. Which of the following pharmacologic regimens is first-line treatment for otitis externa with moderate inflammation of the external auditory canal? A. Oral ciprofloxacin B. Oral prednisone C. Topical acetic acid and hydrocortisone D. Topical ciprofloxacin and hydrocortisone
Topical ciprofloxacin and hydrocortisone
A 10-year-old boy presents to the office with painful sores in his mouth for the past three days. He has not had any fever, recent upper respiratory infection, or oral trauma. He has had several episodes of mouth sores in the past year. Which of the following is the best initial treatment for aphthous ulcers? A. Oral B12 supplementation B. Oral corticosteroids C. Topical corticosteroids D. Topical tetracycline
Topical corticosteroids
A 3-year-old boy presents to the clinic with two golden crusted lesions around his lips. There are no other lesions. His twin brother has similar symptoms and was recently diagnosed with impetigo. What is the best treatment for this patient? A. Oral cephalexin B. Oral dicloxacillin C. Oral doxycycline D. Topical mupirocin
Topical mupirocin
A 14-year-old boy presents with a common wart on his hand. Which of the following would be the most appropriate first-line treatment? A. Duct tape occlusion B. Pulsed dye laser therapy C. Topical imiquimod D. Topical salicylic acid
Topical salicylic acid
A 5-year-old boy presents to the clinic with his foster family for an initial health evaluation. His family history and past medical history are unknown. The patient is thin, well-appearing, and afebrile. His blood pressure is 165/100 mm Hg in both arms and femoral pulses are strong bilaterally. Several ash-leaf-shaped hypopigmented macules are noted on his arms and torso. Which of the following is the most likely etiology of his hypertension? A. Atherosclerosis of the renal arteries B. Coarctation of the aorta C. Essential (primary) hypertension D. Tuberous sclerosis
Tuberous sclerosis
A 10-month-old boy presents to the emergency department with his mother with complaints of vomiting, intermittent abdominal pain, and lethargy. On physical exam, a sausage-shaped mass is palpated in the right upper quadrant of the abdomen, and a sensation of emptiness is found in the right lower quadrant. Which of the following diagnostic testing methods is recommended to confirm the diagnosis of intussusception? A. Computed tomography scan B. Magnetic resonance imaging C. Plain radiography D. Ultrasound
Ultrasound
A 2-day-old female newborn presents to her pediatrician for her first visit after birth. When she cries, the pediatrician notices her nail beds and lips have a bluish color. She is sent for echocardiogram to confirm the pediatrician's suspicions of Tetralogy of Fallot. Which anatomic findings on echogram confirm the diagnosis? A. Aorta rising from the right ventricle and pulmonary artery arising from the left ventricle B. Tricuspid atresia and ventricular septal defect C. Ventricular septal defect and a single great vessel arising from the heart D. Ventricular septal defect and overriding aorta
Ventricular septal defect and overriding aorta
An 8-year-old boy presents to the emergency department with a five-day history of low-grade fever, runny nose, and hacking cough. Yesterday, he started complaining of some chest pain that is worse with lying flat on his back. The patient appears non-toxic, and you note that while seated on the exam table, he is leaning forward in a tripod position. Physical exam reveals a pericardial friction rub on auscultation, and a chest radiograph shows a slightly enlarged heart. Which of the following is the most likely diagnosis? A. Bacterial endocarditis B. Constrictive pericarditis C. Systemic lupus erythematosus D. Viral pericarditis
Viral pericarditis
A 12-year-old boy presents to the emergency department with swelling in the left lower extremity and is found to have a deep venous thrombosis. He is diagnosed with congenital protein C deficiency. Which of the following vitamins is required for protein C to be activated in the coagulation cascade? A. Vitamin B6 B. Vitamin C C. Vitamin E D. Vitamin K
Vitamin K
A 2-year-old, previously healthy patient presents to the clinic with an abdominal mass. The child's mother noticed the mass two months ago and states it has been steadily growing in size. Upon physical exam, the mass is firm, minimally-mobile, nontender, and located to the left of midline, extending from the costal margin to the level of the umbilicus. Physical exam is otherwise normal. Family history is unremarkable. The patient has no fever, no hematuria, and no weight loss. Vitals are within normal limits except for a blood pressure of 130/90 mm Hg. Which of the following is the most likely diagnosis? A. Hodgkin lymphoma B. Polycystic kidney disease C. Renal medullary carcinoma D. Wilms tumor
Wilms tumor
A 12-year-old girl is referred to you for treatment of scoliosis which was discovered on a recent physical examination. She is in good health, has no back pain, and her neurologic examination is normal. X-rays show a right thoracic curve with a Cobb angle of 32° and a left lumbar curve with a Cobb angle of 26°. Which of the following pieces of information will be most helpful in deciding whether bracing is appropriate for this patient? A. Genetic testing B. Magnetic resonance imaging of the spine C. Measurement of the patient's and parents' height D. X-ray of the pelvis
X-ray of the pelvis
