StatPearls QOD

A patient of childbearing age presents with amenorrhea. She has had a normal puberty and has normal anatomy. Her thyroid stimulating hormone, prolactin, and follicle stimulating hormone levels are normal, and a pregnancy test is negative. What is the next step in management? A. Brain MRI B. A progestin challenge test C. Karyotyping D. Psychological evaluation

B. A progestin challenge test

A 2-year-old boy is brought to the office with a history of constipation "since he was a baby." Mom states he has been admitted to the hospital for enemas in the past, and he "never has a bowel movement on his own." She gives him an enema or a glycerine suppository about once a week, and he usually has a bowel movement after she intervenes. A complete physical exam shows only mild abdominal distention and a palpable cylindrical abdominal mass consistent with stool. Which of the following is most likely to be found on further evaluation? A. Absent ganglion cells on a suction rectal biopsy B. Occult myelomeningocele on MRI of the spine C. A "double bubble" sign on abdominal X-ray D. Delta F508 mutation on genetic testing

A. Absent ganglion cells on a suction rectal biopsy

A 16-year-old football player complains of pain and frequent 'giving way' of his right knee for 6 months. He gets occasional swelling of the knee as well. Physical examination reveals no joint line tenderness or swelling. Both anterior and posterior drawer tests are positive, but McMurray's test is negative. He states that the symptoms started following an injury of his knee while playing a tournament match; however, he does not remember the mechanism of injury. Which of the following is the most likely mechanism of the knee injury in this patient? A. Anteroposterior force- flexed knee B. Medial force- extended knee C. Lateral force- extended knee D. Posterior force- extended knee

A. Anteroposterior force- flexed knee

A 16-year-old boy with a seizure disorder presents to the hospital with a history of severe joint pain, fever, and fatigue. On examination, he has a low-grade fever, and his vitals are blood pressure 135/85 mmHg, heart rate 89 bpm, and respiratory rate 19 breaths/min. His seizures have been controlled with phenytoin for the past few years. The autoimmune assay is positive for ssDNA, anti-histones, and ANA. What is the most likely diagnosis? A. Drug-induced lupus erythematosus B. Systemic lupus erythematosus C. Purple glove syndrome D. Rheumatoid arthritis

A. Drug-induced lupus erythematosus

A teenager presents with a sore throat and a dry cough. She has had a low-grade fever for 3 days. She says her classmates have had similar symptoms. The chest radiograph shows a vague, ill-defined opacity in the left lower lobe. She has a WBC of 14.6/microliter. Which of the following is the best initial therapy for this patient? A. Azithromycin B. Ampicillin C. Trimethoprim/sulfamethoxazole D. Doxycycline

A. Azithromycin

A 1-week-old female infant is brought in for seizures and jaundice for the past 24 hours. Her birth history is uncomplicated, and the infant was normal prior to when the mother noticed yellowing of the skin extending to the palms and soles and seizures. Her vital signs show tachycardia, dyspnea, and impaired oxygen saturation. Physical examination performed shows weakness, lethargy, and poor feeding. Hypotonia is also noted. Laboratory studies show a total bilirubin level of 26 g/dL, indirect bilirubin of 24 g/dL, and direct bilirubin of 2 g/dL. What complication is the infant prone to due to the present condition? A. Cerebral palsy B. Blindness C. Cortical necrosis D. Dystonia

A. Cerebral palsy

An 11-year-old male is brought in with complaints of lower urinary tract symptoms including incomplete bladder emptying and dysuria. He reports retained urine within his foreskin and a weak stream. He saw a urologist six weeks ago who recommended betamethasone cream, which he has used every day since without improvement. On physical exam, the foreskin is so tight that the meatus cannot be identified. Which of the following is the next best step in the management of this patient? A. Circumcision B. Tropical triamcinolone for six more weeks C. Continue topical betamethasone for six more weeks D. Dorsal slit

A. Circumcision

A 17-year-old man comes to the emergency department with pain in his left elbow. He was practicing for his upcoming basketball competition when he fell on his elbow. He is holding his left elbow flexed. There is an obvious swelling on his left elbow. Tenderness on palpation and limited range of movement due to pain are noticed as well. He denies any numbness or tingling around his left arm. No significant medical history is noted. He denies any allergy to the medication. Radiologic examination shows anterior elbow dislocation without any fractures. Which of the following is the next best step in the management of this patient? A. Closed reduction and sling immobilization for 10 to 14 days B. Open reduction and sling immobilization for 14 to 24 days C. Closed reduction and sling immobilization for 14 to 24 days D. Open reduction and sling immobilization for 10 to 14 days

A. Closed reduction and sling immobilization for 10 to 14 days

A 6-year-old previously healthy girl has recently refused to go to sleep at night. Her parents state that she also recently started to have violent outbursts at home and at school. She has been having multiple episodes of enuresis and seems fearful of meeting new people, especially adults. She has been afebrile, and her parents deny any unexpected ingestion or burning with urination. When asked about new stressors, they do admit that recently the patient's uncle has moved into the household. Given the suspected diagnosis, which of the following conditions is the child at higher risk for in adulthood? A. Fibromyalgia B. Colon cancer C. Osteoporosis D. Breast cancer

A. Fibromyalgia

A 13-year-old girl presents for a routine checkup. Her past medical history includes atopic dermatitis for which she uses an intermediate-strength topical corticosteroid cream. She states that her atopic dermatitis has been under control. However, she recently noticed a new rash on her face. Physical exam shows a mild eczematous rash in a periorbital distribution. What is the most appropriate topical corticosteroid for this patient's facial lesions? A. Hydrocortisone cream B. Triamcinolone acetate cream C. Clobetasol cream D. Betamethasone ointment

A. Hydrocortisone cream

A 17-year-old female patient presents with a complaint of a left-sided throbbing headache for the past 4 hours. She states that she had some blurry vision for about 15 minutes prior to the onset of the headache that has resolved. She denies any other symptoms or aggravating factors. She reports that she has had this type of headache multiple times throughout grade school. She says the pain is bearable but would like to have some medication. What medication could be chosen as a treatment for her headache? A. Ibuprofen B. Prochlorperazine C. Dihydroergotamine D. Tramadol

A. Ibuprofen

A premature infant was brought to the clinic with the complaint of difficulty breathing. On examination, the infant was cyanosed and had nasal flaring. What would be the most likely cause of this respiratory distress? A. Inadequate surfactant production B. Increased surfactant production C. Jaundice D. Necrotizing enterocolitis

A. Inadequate surfactant production

A 10-year-old girl presents for her yearly well-child visit. She is a competitive gymnast and has no complaints. Her height and weight are in the 30th and 20th percentiles, respectively, with a normal growth trajectory. Physical examination reveals a new cardiac murmur. The murmur is a grade 2/6, medium-pitched, blowing, systolic ejection murmur best heard over the left upper sternal border with some radiation to the back. The murmur is most audible when auscultated with the bell of the stethoscope. The S1 and S2 heart sounds are normal, and there are no ejection clicks. The child is otherwise healthy with no acute complaints. What is the most likely diagnosis? A. Innocent pulmonary flow murmur B. Pulmonic valve stenosis C. Aortic valve stenosis D. Still murmur

A. Innocent pulmonary flow murmur

A 1-year-old boy presents to his pediatrician for his 1-year wellness exam. He has a past medical history of otitis media at 8 months old. He takes no medications. He is eating and drinking appropriately and stooling 1-2 times a day. Vital signs show a temperature of 99.8 F (37.6 C), blood pressure of 102/64 mmHg, a pulse of 104/minute, and respiratory rate of 28/minute. Physical examination is unremarkable. The clinician states that the patient is due for vaccinations, particularly the measles, mumps, and rubella (MMR) vaccine. The mother is unsure about having her child receive this vaccination, as she has heard negative things about the vaccine. She asks the physician if the vaccine is safe for everyone. Which of the following would contraindicate the administration of the MMR vaccine? A. Medical history of severe combined immunodeficiency disease (SCID) B. Medical history of transient hypogammaglobulinemia of infancy C. History of preterm delivery D. Sinus congestion, cough, and fever at the time of the wellness exam

A. Medical history of severe combined immunodeficiency disease (SCID)

The mother of a 2-day-old neonate brings the child for evaluation due to two episodes of vomiting. The vomitus is green in color. She also reports that her child has not passed stool since birth. The child does not have a fever or a cough. On examination, there are no signs of dehydration. The abdominal examination reveals a soft, non-tender, non-distended abdomen. What is the best next step for this patient? A. Contrast enema B. Abdominal x-ray C. Ultrasonography of the abdomen D. Computed tomography (CT) scan of the abdomen

B. Abdominal x-ray

A 16-year-old male patient presents with complaints of a diffuse skin rash. He states he has also been feeling feverish for the last few days. The patient has just returned from a camping trip from North Carolina. He recently immigrated to the United States and was not fully vaccinated as a child. He is sexually active and admits to unprotected vaginal intercourse with at least 2 female partners in the past few months. He lives in a hostel and there had been a recent outbreak of Neisseria meningitides on his campus. His vitals are normal. His examination reveals a diffuse macular rash on his trunk and extremities including his palms and soles. He has generalized, non-tender lymphadenopathy. He is uncircumcised. His systemic examination is normal. His investigations revealed a WBC count of 11,000/microL, hemoglobin of 13 gm/dl, platelets of 125,000/microL, alanine transaminase (ALT) 75 IU/l, aspartate transaminase (AST) 65 IU/l, alkaline phosphatase (ALP) 600 IU/l, and serum creatinine of 0.7 mg/dl. His serological tests revealed anti-HIV negative, a reactive rapid plasma reagin (RPR), anti-HCV negative, and HbsAg negative. What measure could have prevented the development of this patient's condition? A. Practicing safe sex techniques B. Having a circumcision C. Using insect-repellant clothing D. Receiving prophylactic antibiotics

A. Practicing safe sex techniques

A term male neonate with hypoxic-ischemic encephalopathy is noted to have elevated blood pressure readings while being managed in NICU. The patient had APGAR scores of 3 and 4 after birth and is saturating 98 percent on CPAP. Physical examination is remarkable for generalized hypotonia and poor sucking reflex requiring parenteral nutrition. Which of the following will most likely resolve his hypertension? A. Removal of umbilical line catheter B. Fluid restriction C. Increasing oxygen pressures D. Closure of patent ductus arteriosus

A. Removal of umbilical line catheter

An 17-year-old girl with a past medical history of attention deficit hyperactivity disorder (ADHD) presents to the student health center as she is worried about her academic performance. She has recently started college and has found it difficult to balance between academics and extra-curricular activities. The patient did poorly on her recent midterms and has started skipping classes. She states that the classes are boring and really hard to focus on. In addition, she has been late to multiple cheer practices for which the coaches have already given her multiple warnings. The patient was initially on methylphenidate, and after noticing an improvement in symptoms, discontinued the medication several years ago. She requests being restarted on methylphenidate. The patient has no family history of cardiac disease or history of tobacco, alcohol, or illicit drug use. Her father does have a history of marijuana use. What is the best next step in management? A. Restart methylphenidate B. Recommend behavioral therapy C. Recommend non-stimulant medication D. Obtain an EKG and cardiac enzymes before re-starting methylphenidate

A. Restart methylphenidate

A mother brings her 18-month-old daughter for two days of low-grade fever and irritability. Her maximum temperature has been 100.4 F (38 C). She was born at term and has been healthy. She is in daycare, and her immunizations are up to date. On examination, both tympanic membranes are pink, flat, and hypomobile, air-fluid levels are visible in the middle ear space, and she has clear rhinorrhea. What is the most appropriate initial step in management? A. Symptomatic treatment B. Ototopical ciprofloxacin C. Oral amoxicillin D. Oral penicillin V

A. Symptomatic treatment

A mother brings in her six-month-old daughter for a routine checkup. The mother reports the child is doing well, and her vaccinations are up to date. The mother is concerned about continuing the DTaP vaccination for her daughter due to a fever of 102 F two days after the administration of her second dose of DTaP. The mother asks if the child should continue the DTaP vaccine series, and if so, when should the next dose be given? A. The daughter can continue the DTaP vaccine series and receive her next dose today B. The daughter can continue the DTaP vaccine series at the age of two C. The DTaP vaccine series should be stopped due to the fever D. The daughter can continue the DTaP vaccine series and receive her next dose today with close follow up in the next 24 to 48 hours

A. The daughter can continue the DTaP vaccine series and receive her next dose today

A 15-month-old girl is brought to the clinic for a scheduled visit. She is allergic to egg products. She is vaccinated with the MMRV vaccine during the visit. 3 days later, the child develops a 39 C fever at home and subsequently has a seizure. Which of the following steps would have most likely prevented this complication in this patient? A. Antihistamines at the first sign of high fever B. Administering the MMR vaccine and univalent varicella vaccine separately during the same visit C. Check for egg allergy before the administration of the MMRV vaccine D. Ensuring the child did not have a bacterial infection before the administration of the MMRV vaccine

B. Administering the MMR vaccine and univalent varicella vaccine separately during the same visit

A 16-year-old female with past medical history of asthma and advanced HIV and a CD4 count of 200 cells per cubic millimeter developed lesions and a worsening cough that was found to be caused by a Sporothrix infection after gardening. What is the best initial treatment for this Sporothrix infection? A. Potassium iodide B. Amphotericin B C. Amoxicillin D. Itraconazole

B. Amphotericin B

A teacher is on duty at recess watching children of all ages play on the playground. Which of the following scenarios may warrant further investigation and possible referral for evaluation? A. A group of four-year-olds is playing together. One of the children is obviously the leader and determines who will act as "the mother," "the father," "the baby," and "the dog." One of the other children says she does not want to be "the dog" but would like to be "the cat," however the leader says no and will not allow for negotiation. The other child leaves the group saying she does not want to play if she can't be "the cat." She changes her mind 2 minutes later and rejoins the group. The group is happy to welcome her back into their play B. An eight-year-old boy is playing alone on the tires, jumping from one tire to the next trying not to fall off when a group of boys the same age approach and start playing the same game. He does not want them to play on the tires and pushes the other boys off them. The boys eventually get fed up with being pushed off and go to the monkey bars C. A group of four girls are jump-roping and taking turns jumping in and out. One girl tends to mess up every time she jumps in and they have to restart the jump rope. The girls tell her that she has lost a turn. She gets upset and starts crying to the teacher saying, "It's not fair!" D. A 5-year-old boy is running around with a stick telling people he is Harry Potter and performing magical spells on people. He tells one girl the same age as him that he performed a spell that makes her invisible. She then goes around telling everyone she is invisible and that they cannot see her

B. An eight-year-old boy is playing alone on the tires, jumping from one tire to the next trying not to fall off when a group of boys the same age approach and start playing the same game. He does not want them to play on the tires and starts to push the other boys off the tires. The boys eventually get fed up with being pushed off and go to the monkey bars

A 16-year-old patient presents status post blunt abdominal trauma with active bleeding necessitating multiple packed red blood cell transfusions. The condition that is expected in this patient is characterized by which of the following? A. Abnormal appearing platelets B. Decreased platelets C. Low thrombopoietin D. Abnormal platelet function.

B. Decreased platelets

A 2-month-old male presents with a sudden cessation of breathing. He was born at 34 weeks age of gestation via normal spontaneous delivery. It was noticed that his breathing stopped for 30 seconds and is associated with bluish discoloration of his lips. He has no family history of seizure. The vital signs show a temperature of 37.5 C (99.5 F), heart rate 170/min, and a respiratory rate of 65 breaths/min and oxygen saturation of 85% that went up to 87% on 100% oxygen. The physical exam shows an open anterior and closed posterior fontanelle, pink palpebral conjunctiva, symmetrical chest expansion, intercostal and subcostal retractions, and clear breath sounds in both lung fields. Which of the following options is most likely lead to the cause of the described episode? A. Computed tomography head B. Echocardiography C. Serum glucose D. Blood culture

B. Echocardiography

A 3-year-old female presents to the clinic for immunization. She was administered an influenza vaccination after all aseptic measures. After the vaccine was administered, it was noticed by the provider that the child suddenly stopped breathing, fainted, and became pale. The vital signs show a blood pressure of 100/60 mmHg, a temperature of 37.5 C (99.5 F), a heart rate of 60/min, and a respiratory rate of 20 breaths/min. After 30 seconds, she regained consciousness and felt quite sleepy. She is conscious and coherent. The physical examination reveals pink palpebral conjunctiva, anicteric sclera, no nasal discharge, and no cervical lymphadenopathies. Chest examination reveals symmetrical chest expansion, no retractions, and clear breath sounds. The cardiac examination reveals no murmur. The neurological exam is unremarkable. Developmental milestones are age-appropriate. Which of the following tests is frequently done had this event occurred unsupervised and lasted greater than 2 minutes? A. Magnetic resonance imaging of the brain B. Electroencephalogram C. Computed tomography of the brain D. Lumbar puncture

B. Electroencephalogram

A 10-year-old boy is brought to the clinic for his weight. His mother states that her son snores but does not stop breathing. His height is at the 60th percentile, and his weight is at the 100th percentile. He currently weighs 182 pounds (82 kg). Which of the following is the best initial step in the management of this patient? A. Meal replacement B. Self-monitoring of dietary intake C. Orlistat D. Polysomnography

B. Self-monitoring of dietary intake

A newborn male is delivered by 27 years old primigravid at 38 weeks of gestation via normal spontaneous delivery. The newborn's APGAR score is 9 and 10 after 5 minutes, and his vital signs show a temperature of 36.7 C (98.06 F), heart rate 140/min, and a respiratory rate of 50/min. The physical examination shows a white cheesy substance covering his skin. The cheesy substance is sampled by a researcher with familial consent and identified it as Vernix caseosa. However, during the sample investigation, a noted decrease in lysozyme and lactoferrin was documented. Which of the following functions is most likely to be affected as a result of a decrease in these molecules? A. Visceral development B. Immunological development C. Limbs development D. Neuronal development

B. Immunological development

A 16-year-old is seen in the emergency department with a hoarse voice and dysphagia. His symptoms started 12 hours ago and have progressed. He has a fever and appears ill. He is unable to speak, and thus the mother provides the history. The tonsils are 4+/4 enlarged with grey exudates. There is bilateral cervical adenopathy. While waiting for the patient to be seen by an ENT surgeon, what is the most urgent study that should be ordered for this child? A. Blood culture B. Lateral neck x-ray C. Throat swab D. Arterial blood gas

B. Lateral neck x-ray

A patient with mild, persistent asthma has been well controlled with low-dose inhaled corticosteroids. He presents for follow up complaining of some limitation with normal activities and needing albuterol for symptom relief 3 to 4 days per week over the past month. Which of the following is the preferred next step? A. Begin an oral corticosteroid burst B. Medium-dose inhaled corticosteroid C. Add a leukotriene receptor antagonist D. Begin omalizumab

B. Medium-dose inhaled corticosteroid

A 9-year-old girl presents to the hospital due to cough and wheezing despite using an albuterol inhaler. Her symptoms occur daily during the daytime. She has 6 night-time awakenings per month due to her symptoms. On PFTs, she has an FEV-1 of 65%. Which of the following is the most appropriate treatment regimen? A. Short-acting beta-agonist and inhaled corticosteroid B. Medium-dose inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) C. High-dose inhaled corticosteroid (ICS), long-acting beta-2 agonist (LABA), and long-acting muscarinic agent D. Theophylline and oral steroids only

B. Medium-dose inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA)

A 5-year-old girl is brought to the hospital by her mother after accidentally ingesting several pills, which she mistook for candy. She is in an altered state of consciousness. The mother explains that the medication is used by her grandmother for diarrhea. On examination, the child is unresponsive, appears flushed, with a respiratory rate of 12 breaths/min, a temperature of 101 F (38.3 C), and a heart rate of 132 beats/min. What is the most appropriate medication to manage her altered mentation? A. Atropine B. Naloxone C. Pyridoxine D. N-acetylcysteine

B. Naloxone

A 9-year-old boy is brought in by his father due to abnormal behavior. The patient's father mentions that he repeats everything that is said to him. In addition to this, he frequently jerks his head, grimaces his face, and shrugs his shoulders. These symptoms started a year ago and have progressively worsened. The child's teachers have similar concerns. Vitals are within normal limits. Physical examination reveals a healthy child who frequently shrugs his shoulders. Which of the following disorders is associated with the patient's condition? A. Schizoaffective disorder B. Obsessive-compulsive disorder C. Psychotic disorder D. Autism

B. Obsessive-compulsive disorder

A 15-year-old otherwise healthy female presents with her mother for evaluation of abdominal pain. She describes her pain as occurring daily for the past year, though she recalls it being less severe over the summer. She describes the pain as crampy, located in the left upper and lower abdomen, and present throughout the day. She occasionally has increased pain with eating. She finds no association with any particular foods. She occasionally finds a bowel movement relieves the pain temporarily, but it soon returns. She has a bowel movement daily and describes her stool as pebble-like. She has a recollection of snake-like stool in the past before she had symptoms. Her weight and height have remained at the sixtieth percentile for age. On examination, her vital signs are within normal limits. Her left lower quadrant has a mobile mass present. Which of the following additional features would be most suggestive of a diagnosis of irritable bowel syndrome? A. Pain resolves with treatment of constipation B. Pain persists despite treatment of constipation C. Presence of blood in her stool D. Elevated C-reactive protein

B. Pain persists despite treatment of constipation

A 7-year-old child with acrodermatitis enteropathica on oral zinc supplementation presents with pallor and low hemoglobin levels of 8 mg/dl. Peripheral smear reveals a microcytic hypochromic anemia. Iron supplementation was initiated but failed to be of benefit. Which of the following investigations may be most relevant in this condition? A. Serum albumin levels B. Serum copper levels C. Serum potassium levels D. Serum calcium levels

B. Serum copper levels

A 1-month-old female infant is brought to the healthcare provider for a visit. The infant was born via a spontaneous vaginal delivery at 36 weeks gestation. The third-trimester ultrasound showed a breech position. The mother has no past medical history. The physical examination shows a one-month-old infant with an asymmetric skin fold and slight hip instability. What is the optimal imaging modality that will help in the diagnosis of this condition? A. X-ray of the hip B. Ultrasound of the hip C. CT of the hip D. No imaging as there is instability

B. Ultrasound of the hip

A 13-year-old child is brought in by his mother because he is acting strangely. He has become "lazier" at school, and as a result, his grades have decreased. She believes he has been more depressed because he spends his free time sitting in his room and eating more than usual. On physical exam, his conjunctivae are injected, but there are no other pertinent findings. What is the best next step? A. Referral to a psychiatrist for depression B. Urine drug screen C. Call child protective services D. Referral to ophthalmologist

B. Urine drug screen

A 16-year-old male is found to have a dilated cardiomyopathy on chest x-ray. He has been eating a diet of fast food. Which nutritional deficiency might be responsible his radiographic findings? A. Vitamin B12 deficiency B. Vitamin B1 deficiency C. Vitamin B6 deficiency D. Vitamin B7 deficiency

B. Vitamin B1 deficiency

A 1-year-old boy presents to the pediatric clinic in the summer with a low-grade fever for two days and a decreased appetite. His mother reports a rash on both feet. On examination, he is alert and active with dry mucous membranes. There are erythematous macules present on the soles of the feet. Where else does the clinician expect to find lesions on this child's body? A. Chest B. Abdomen C. Palate D. Extensor surfaces of the lower extremities

C. Palate

A 6-year-old male is brought to the clinic for a well-child visit. On exploring his progress in school, the parents reveal that he is struggling to keep up with his peers in class, and they are afraid that he will be held back. During the evaluation, the clinician notes that the child has no mastery of conservation and inductive reasoning. At which of the following ages should a child normally develop these functions? A. 4 to 6 B. 5 to 8 C. 7 to 11 D. 10 to 13

C. 7 to 11

A 15-year-old female is brought to the clinic for evaluation of primary amenorrhea. Her mother states that the patient started pubertal changes at age 11 but did not seem to progress. Her rate of growth has been low normal for age and there has been no menarche. Physical examination shows Tanner stage III breast development and Tanner III-IV pubic hair. There are no dysmorphic features on physical exam. Upon review of systems, the patient states that she has had some headaches. What is the next best step in the management of this patient? A. Order brain MRI B. Order blood chromosomes for karyotype C. Order pituitary function tests including thyroid and prolactin D. Reassure parent that everything is fine and follow up in six months

C. Order pituitary function tests including thyroid and prolactin

A mother brings her 16-year-old son, known to have sickle cell disease, to the emergency department with "difficulty breathing." He was well until approximately 1 week ago when he began having bilateral leg and arm pain, which are his usual sites for sickle cell pain. During the past evening, the pain worsened, and he also began having fevers to 101.6 F (38.6 C). The patient has had several past admissions for his sickle cell disease for vaso-occlusive crisis pain management. He has never received a blood transfusion. On physical exam, the patient is awake and alert but clearly in pain. His sclerae are icteric bilaterally. He has a 3/6 systolic ejection murmur, and he has decreased breath sounds in his right lung base. His blood count reveals a white blood cell count of 16,500, with a hemoglobin of 6.5 g/dL, and a platelet count of 426,004. His differential has 65% neutrophils, 25% lymphocytes, 8% monocytes, and 2% eosinophils, and his reticulocyte count is 18.6%. A chest radiograph reveals a small fluffy infiltrate in the right lower lobe. Which of the following should not be included in the management of this patient? A. Opioids for pain control B. Broad spectrum antibiotics C. Aerosolized nitrous oxide D. Incentive spirometry

C. Aerosolized nitrous oxide

To prevent peanut allergy, at what age does the National Institute of Allergy and Infectious Disease recommend that babies with eczema be introduced to peanuts? A. Immediately after birth B. 8 to 12 weeks after birth C. At 4 to 6 months D. When the infant is 12 months

C. At 4 to 6 months

A 1-year-old is seen for a left groin mass. The mother says the child has a hernia. Which of the following is true about the diagnosis of an inguinal hernia? A. In infants, it rarely depends on the mother's description B. In adults, it is easily seen while the patient is sleeping C. Cough impulse is transmitted D. Scrotal swelling is always a visible sign

C. Cough impulse is transmitted

A 5-month-old boy is brought to the office by his mother for a well-child visit. His last visit was when he was 2 months old because his mother had some insurance issues. He was born full-term, appropriate for gestational age, without perinatal complications. His growth and development had been normal the last time he was seen, and he does not have any known medical conditions. Upon the physical examination, his head falls behind when he is pulled to sit. Which of the following is the next best step in management for this condition? A. Follow up in 2 months B. CT head C. Detailed evaluation of motor developmental milestones D. Early intervention

C. Detailed evaluation of motor developmental milestones

A 16-year-old male presents for the evaluation of a persistent cough. He reports being homeless for the last five years, and reports sleeping in various homeless shelters for the previous two years. He complains of chronic productive cough for the last three months. His condition was associated with fever and significant weight loss. The vital signs show a blood pressure of 110/70 mmHg, temperature 37.8 C (100.4 F), cardiac rate 105/min, and respiratory rate of 22 breaths/min. The chest and lung examination shows symmetrical chest expansion, no retractions, and crackles on the right upper lobe. The chest x-ray shows a cavitary lesion in the right upper lobe along with reticulonodular shadowing. Quadruple therapy was started. He returns one month later to the clinic complaining of blurry vision in his right eye. Which of the following drugs is responsible for his blurry vision? A. Isoniazid B. Rifampin C. Ethambutol D. Pyrazinamide

C. Ethambutol

A 6-month-old African American female presents to the clinic with a bulge in her belly button. It was noticed that the bulge in her belly button enlarges when she is crying, coughing or straining. Physical exam reveals globular abdomen, normoactive bowel sounds, and a 1 cm defect in her umbilical area. Which of the following pathology is associated with this condition? A. Persistent omphalomesenteric duct B. Persistent urachus C. Failed obliteration of the umbilical ring D. Omphalocele

C. Failed obliteration of the umbilical ring

A 3-year-old boy is being evaluated in the office at her mother's concern. She reports that his son has difficulty in speech and cannot speak in full sentences and is not paying attention. Sometimes, he does not respond to his name even, and she has to shout. There is no significant family history. On further evaluation, the mother states that his birth history, immunization, nutritional, and hospitalization histories are unremarkable. His newborn screening tests for hypothyroidism and hearing were normal. His milestones were appropriate for his age on previous well-child encounters. After conducting thorough developmental screening instruments, an expressive language delay is suspected. Which of the following is the next best step in the management of this patient? A. Karyotyping B. Reassurance C. Hearing assessment D. Amphetamine

C. Hearing assessment

A 12-old-female patient presents complaining of red, pruritic, and irritated eyes over the past few weeks, associated with a recent increase of pollen in the air. On exam, the clinician finds palpebral conjunctival papillae in both eyes. What is the mechanism of action of the initial treatment for this disease? A. Binding to the bacterial 30S ribosome B. Reaction with receptor proteins in the cytoplasm to form a steroid-receptor complex C. Histamine 1 receptor antagonist D. Competitively inhibits dihydrofolate reductase

C. Histamine 1 receptor antagonist

A 6-years old boy is brought in for care with symptoms of marked nasal blockage. His mother states that he sustained a nasal injury with a badminton shuttle on the previous day. External nasal examination showed no obvious signs of injury. Anterior rhinoscopy showed a bilateral cherry red swelling arising from the nasal septum. This swelling was fluctuant on palpation and did not regress in size with a nasal decongestant spray. Which of the following statement is true? A. This is likely to be infected B. This is not a case of nasal septal hematoma since there was no obvious sign of external nasal injury C. Immediate surgical intervention is required in such cases D. Children develop nasal septal hematoma only after a major injury

C. Immediate surgical intervention is required in such cases

A 1-year-old child develops sudden flexion of the trunk and extension of both arms. This movement repeats in clusters and is more often seen when the child wakes up. Which of the following is the most accurate description of this condition? A. Tonic seizures B. Myoclonic seizures C. Infantile spasms D. Tonic-clonic seizures

C. Infantile spasms

A patient is diagnosed with Lyme disease and started on doxycycline 100 mg PO BID for 4 weeks. After the first dose, the patient is worse with dizziness, shaking, and fever. What is the cause of the change in the patient's condition? A. Reaction to the antibiotic B. Resistance to the doxycycline C. Jarisch-Herxheimer reaction D. Sepsis secondary to B. burgdorferi

C. Jarisch-Herxheimer reaction

A mother presents with her 9-month-old son to a pediatric outpatient department. She mentions that she had given birth at 29 weeks of gestation, the baby had been kept on a mechanical ventilator after the delivery, and only three months back, his condition has started improving. Now, since the winter season is approaching and her baby's lungs are already weak, she is worried about him catching a cold. Which of the following is the most likely to help prevent such a scenario from happening? A. Steroids B. Oseltamivir C. Palivizumab D. Antibiotics

C. Palivizumab

An otherwise healthy 8-week-old boy is brought in by his parents for concerns about a rash on his scalp and in his diaper area for the past two weeks. On examination, there is a thick, scaly plaque on the scalp covered with a whitish-yellow crust. It is less scaly but more erythematous in the diaper region. The condition has not responded to any over-the-counter preparation. What is the most appropriate management? A. Low potency corticosteroid cream B. Antifungal cream C. Parental education and reassurance D. Skin biopsy

C. Parental education and reassurance

An 11-year-old boy presents with complaints of insidious onset of left knee pain that is getting progressively worse for the past three days. History reveals that the patient is a tennis player and says that the pain exacerbates while playing while gets better when rests. The rest of history is unremarkable. On physical examination, tenderness over the tibial tuberosity is noted, and the pain is induced by active flexion and passive extension of the knee joint. What would his radiographs most likely show that would confirm the diagnosis? A. Patellar tendon edema and a sliver-like osseous density posterior to the apophysis of the tibial tuberosity B. Patellar tendon edema and a disc-like osseous density posterior to the apophysis of the tibial tuberosity C. Patellar tendon edema and a sliver-like osseous density anterior to the apophysis of the tibial tuberosity D. Patellar tendon edema and a disc-like osseous density anterior to the apophysis of the tibial tuberosity

C. Patellar tendon edema and a sliver-like osseous density anterior to the apophysis of the tibial tuberosity

A 13-year-old male presents to the outpatient clinic with complaints of right breast tenderness and swelling. He has no significant past medical history. Physical examination is notable for a 1.5 cm tender, firm, mobile mass beneath the right nipple without any skin changes or discharge. The remainder of the examination is normal. Tanner's stage is 3 with dark pubic hair and bilateral scrotal volume of 8 ml. The rest of the physical examination is unremarkable. Which of the following is the next step in the management of this patient? A. Referral for excisional biopsy B. Measurement of estrogen, prolactin, and testosterone C. Reassurance D. MRI of the pituitary

C. Reassurance

A 6-year-old male presents to the hospital with abdominal pain, low-grade fever, and a rash over his legs and buttocks. A detailed history reveals that he had an upper respiratory tract infection one week ago, after which he developed the rash. His blood urea nitrogen and creatinine are elevated, and urinalysis reveals microscopic hematuria and proteinuria. What type of vessels are most likely to be affected in this patient? A. Large vessels B. Medium vessels C. Small vessels D. Large arteries

C. Small vessels

A 2-year-old boy is brought to the emergency department after a reported drowning incident. Cardiopulmonary resuscitation was initiated on the scene, with spontaneous recovery. Upon arrival in the emergency department, his vital signs demonstrate a heart rate of 110/min, a respiratory rate of 25/min, a blood pressure of 90/58 mmHg, a temperature of 98.7 F, and an oxygen saturation of 92% on room air. Which of the following is the best initial step in the management of this patient? A. Chest radiography B. Venous blood gas C. Supplemental oxygen D. Intubation

C. Supplemental oxygen

An adopted 10-month-old child is brought to the office by the adoptive parents to establish care. No immunization records are available currently. The adoptive parents were told that the child's vaccinations were up to date. If on the recommended schedule, when should the next dose of the DTaP series be administered? A. The next DTaP vaccine can be given now as the third dose of a three-dose series B. The next DTaP vaccine can be given now as the fourth dose of a five-dose series C. The next DTaP vaccine can be given five months from now as the fourth dose of a five-dose series D. The next DTaP vaccine can be given in two months as the fifth and final dose

C. The next DTaP vaccine can be given five months from now as the fourth dose of a five-dose series

A 17-year-old female presents with a round mass in her right breast. She detected the mass two weeks ago while taking a shower. It is painless and has not increased or decreased in size. She is worried that she might have breast cancer. Her family history is positive for HER2-negative breast cancer in a maternal aunt. She is sexually active, and her last menstrual period was seven days ago. On examination, the mass is mobile, soft, and rubbery. What is the best next step in the management of this patient? A. Fine needle aspiration cytology B. Reassurance C. Ultrasound D. Mammogram

C. Ultrasound

A 17-year-old presents with complaints of pain in his right leg for 2 weeks when he plays tennis. On exam, the circumferences of his right thigh and his left thigh are the same, but his right mid-calf measures nearly 3 cm larger in diameter than the left calf. You also observe some purplish discoloration around the medial aspect of the right ankle. What is the preferred diagnostic test? A. Request the plasma D-dimer B. CT-angiography without intravenous contrast C. Ultrasound D. CT-angiography with intravenous contrast

C. Ultrasound

A toddler has swallowed a coin. She is drooling, refuses to drink, and seems uncomfortable, but is breathing comfortably. Imaging reveals the coin in the upper esophagus. What is the most appropriate next step in caring for this child? A. Inducing vomiting, such as with syrup of ipecac B. Administration of glucagon or diazepam for muscle relaxation C. Urgent referral to a specialist in pediatric endoscopy D. Alternating back blows and chest thrusts

C. Urgent referral to a specialist in pediatric endoscopy

A patient presents with diminished vision at night, xerophthalmia, keratomalacia, and follicular hyperkeratosis. What vitamin deficiency would cause these symptoms? A. Vitamin C B. Vitamin K C. Vitamin B D. Vitamin A

D. Vitamin A

A 2-year-old female presents to the emergency department with a dry cough and a low-grade fever. Over the last 2 days, she has become very irritable and refused to eat. The mother reports that the girl also had a runny nose. On examination, the child has significant wheezing and is tachycardic. A test of the nasal discharge shows a respiratory syncytial virus infection. What condition is she at risk for developing later in life? A. Lung cancer B. Lung abscess C. Bronchiectasis D. Asthma

D. Asthma

A 17-year-old man with a past medical history of asthma and allergic rhinitis presents with cough, shortness of breath, abdominal pain, myalgias, weight loss, and malaise for six weeks. Evaluation shows tachypnea, hypoxia, nasal crusting, and a tender subcutaneous nodule on the left elbow. Laboratory findings are significant for eosinophilia and positive antineutrophil cytoplasmic antibodies (ANCA). Chest x-ray shows pulmonary infiltrates. What is the first line treatment for this patient? A. Methotrexate B. Intravenous fluids C. Vancomycin D. Corticosteroids

D. Corticosteroids

A 16-year-old male presents to the emergency department with acute right scrotal pain following a fall in a football match. His symptoms came on rapidly 2 hours ago and were associated with nausea and vomiting. What is the most appropriate next step in management of this problem? A. Computed tomography scan B. Immediate surgical scrotal exploration C. Scrotal nuclear scan D. Doppler sonography of the scrotum

D. Doppler sonography of the scrotum

A 6-year-old boy is brought to the clinic by his parents for a school physical. Clinical examination revealed small reducible umbilical hernia, and the rest of the examination is unremarkable. What is the most appropriate management strategy for this patient? A. Emergency repair with mesh B. Emergency repair with absorbable suture C. Elective repair with non-absorbable suture D. Elective repair with absorbable suture

D. Elective repair with absorbable suture

A 3-year-old boy is brought to the emergency department with complaints of gait problems. The mother mentions that the child started walking at the age of 1 year but suddenly developed difficulty walking yesterday. He has not experienced this before. The mother says that the child has a past medical history of a blood disorder and has been hospitalized several times since infancy. His last admission was a few months ago when he developed acute pain and swelling in the hands. The child is adopted, and his family history is unknown. Vitals show a blood pressure of 92/65 mm Hg, a pulse of 123/min, a respiratory rate of 19/min, and a temperature of 37 C (98.6 F). Which of the following may help indicate a diagnosis in this patient? A. Chest X-ray B. Echocardiogram C. Carotid ultrasound D. Hemoglobin electrophoresis

D. Hemoglobin electrophoresis

A 12-year-old boy is brought to the clinic for follow up. He has a history of generalized tonic-clonic seizures for which he has been using a medication for about three years. Examination of the mouth and oropharynx shows inflammation and enlargement of the gums. The patient has no complaints. Which of the following best explains the pathophysiology of this side effect? A. Increased Ca2+ influx B. Increased endothelium-derived growth factor C. Increased macrophage production D. Increased platelet-derived growth factor expression

D. Increased platelet-derived growth factor expression

A 17-year-old patient presents with slowly progressive lower extremity weakness and difficulty walking. Physical exam findings demonstrate lower extremity weakness localized to muscles involved in the dorsiflexion of the foot. When the patient walks the foot drags against the ground. Radiographs demonstrate a pedunculated mass arising from the anterolateral aspect of the fibular head directed away from the joint with medullary continuity. What is the most likely cause of the patient's clinical complaints and exam findings? A. Fracture of the bone tumor B. Bursitis related to the bone tumor C. Entrapment of the tibial nerve D. Mass effect and neuropathy of the peroneal nerve

D. Mass effect and neuropathy of the peroneal nerve

A 6-months-old, otherwise healthy, male presents with an oval pigmented lesion on his right arm. The lesion's maximal diameter is 2 cm and there is hypertrichosis with perifollicular hypopigmentation. When asked, the patient's parents assure the patient was born with that lesion. What would be the most appropriate management for this patient? A. Excision of the lesion with a 1cm-margin B. Close follow-up of the patient with excision after 2 years of life C. Incisional biopsy of the lesion in order to rule out malignancy D. No treatment is required

D. No treatment is required

An 11-year-old girl who has not started menstruating is brought in by her mother for intermittent white, odorless vaginal discharge without pruritus for the last three days. The mother reports that this is the first time her daughter has noticed vaginal discharge. The girl is fit and healthy, has met developmental milestones appropriately, and has no significant past medical history. She has one brother and lives with her mother and father. Vital signs show a pulse of 85 beats per minute, blood pressure of 115/64 mmHg, a respiratory rate of 19/min, and a temperature of 98.6 F (37 C). Physical examination shows breast development of Tanner stage 2. Inspection of the vulva is negative for signs of inflammation. Microscopic examination of the vaginal discharge shows three leukocytes per high power field and epithelial cells but no clue cells or other abnormalities. Which of the following is the most appropriate next step in the management of this patient? A. Suspect child abuse and notify Child Protective Services B. Obtain vaginal cultures for gonorrhea and chlamydia C. Prescribe empiric antifungal treatment D. Reassure the mother and her daughter and provide them with a patient information handout

D. Reassure the mother and her daughter and provide them with a patient information handout

A 1-month-old girl presents with nasal congestion and increased work of breathing for the last three days. On examination, she has significant rhinorrhea, cough, bilateral wheezing on auscultation, and upper airway sounds in both lung fields. Her elder sister had a cough and flu last week. The mother is adamant that her child should have further blood and radiographic testing done. Oxygen saturation is 97%. What is the most appropriate next step in the management of this patient? A. Obtain a chest radiograph B. Obtain serum for a viral polymerase chain reaction C. Admit the patient for continuous pulse oximetry and aggressive pulmonary hygiene D. Reassure the mother that her child's condition is a clinical one and is self-limiting

D. Reassure the mother that her child's condition is a clinical one and is self-limiting

A mother brings her 5-year-old son to the clinic with red sores around the mouth, some of which have developed a honey-colored crust. His mother believes this is a contact allergy and asks if she can use her halobetasol cream for psoriasis on the child's face. Which of the following best describes the best reason why this treatment is contraindicated? A. The patient is too young for the use of topical corticosteroids B. The sores will not be affected by a topical corticosteroid C. Short term steroid use can cause depigmentation D. Steroids can make diagnosis and treatment of the infection difficult

D. Steroids can make diagnosis and treatment of the infection difficu

A 3-month-old infant presents to the clinic for a well-child visit. On examination, the child had a bluish discoloration of the skin and the mucous membranes and also had poor weight gain since his last visit. Which of the following could be the most likely diagnosis? A. Patent ductus arteriosus B. Coarctation of aorta C. Patent foramen ovale D. Tetralogy of Fallot

D. Tetralogy of Fallot

A 17-year-old boy presents to the office for a routine physical examination. He has a family history of sudden cardiac deaths in his father and grandfather. He had two episodes of syncope while playing basketball. He denies any fever, shortness of breath, leg swelling, and cough. On examination, his vitals are stable. Chest auscultation reveals a systolic murmur on the left sternal border, which increases in intensity while standing while handgrip decreases the intensity of the murmur. ECG shows left ventricular hypertrophy. Which of the following is the most likely drug given for this condition? A. Nitroglycerin B. Hydrochlorothiazide (HCTZ) C. Aspirin D. Verapamil

D. Verapamil