Pediatric EOR
A 3 month-old male presents with a hoarse cough and thick purulent rhinorrhea for the past 2 days. The mother noted that yesterday he appeared to get worse and seemed to have increasing problems breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-ray reveals hyperinflation with diffuse interstitial infiltrates. Which of the following is the most appropriate intervention? A. abx B. hospitalization C. racemic epinephrine D. inhaled corticosteroids
-hospitalization- This infant most likely has bronchiolitis. While most cases are mild and can be treated at home, hospitalization is recommended for infants with hypoxia on room air, moderate tachypnea with feeding difficulties and marked respiratory distress with retractions. Additionally hospitalization is recommended for infants less than 2-3 months of age, a history of apnea or an underlying chronic cardiopulmonary disease.
A 1-day-old male infant born by normal spontaneous vaginal delivery was found to have a scrotal mass on physical examination. The mass transilluminates and confirms your suspicion of hydrocele. How long should you recommend that the parents wait before the hydrocele is reassessed? A 1 day B 1 week C 1 month D 6 months E 1 year
1 year (Most hydroceles will resolve within the first 12 months of life and do not need to be reassessed unless present after 1 year.)
An adult must have symptoms of persistent depressive disorder for what length of time in order to meet DSM 5 criteria and receive a diagnosis? A Two years B Six months C One year D Two weeks
2 years
Most cases of ALL are diagnosed between which of the following age ranges? A birth and 2 years B 2 and 3 years C 12 and 15 years D 8 and 12 years E 5 and 15 years
2-3YO
Which thoracic curvature is an indication for treatment with bracing in an adolescent with scoliosis? A Less than 20 degrees B 20 to 40 degrees C 40 to 60 degrees D 40 degrees with lumbar curvature of 30 degrees E Greater than 70 degrees
20-40 degrees
At what age is it necessary to perform orchiopexy in a child affected with cryptorchidism? A 6-12 months B 36-48 months C 5 years D 7 years E Orchiopexy is not necessary
6-12mos
Of patients with generalized anxiety disorder, what percentage have at least one other similar psychiatric disorder at some time in their life? A 10% B 30% C 50% D 80%
80%
What is the prevalence of cardiac murmurs in childhood? A 50% B 60% C 70% D 80%
80%
How much time is available at onset of symptoms to detorse the testicle?
< 6hrs (90% salvage rate); after 24hrs <10% change of salvaging the testicle
Which of the following is indicative of viral and not bacterial meningitis? A CSF opening pressure of 90-200 mm H20, WBC count of 10-300/µL B CSF opening pressure of 200-300 mm H20, WBC count of 100-5000/µL C CSF opening pressure of 180-300 mm H20, WBC count of >100/µL D CSF opening pressure of 80-200 mm H20, WBC count of 0-5/µ
A In viral meningitis, the opening pressure is 90-200 mm H2O and the WBC count is 10-300/µL. Although the glucose concentration is typically normal, it can be low or normal in meningitis from lymphocytic choriomeningitis virus (LCM), herpes simplex virus (HSV), mumps virus, and poliovirus. The protein concentration tends to be slightly elevated, but it can be within the reference range.
Which of the following statements about the etiology of depression is true? A A genetic component is nearly always present B Decreased prolactin levels are responsible for depression in children C Major depressive disorder requires a "triggering event" D A bidirectional association is noted between depression and coronary artery disease
A bidirectional association is noted between depression and coronary artery disease (In older patients, depression is frequently comorbid with chronic medical conditions and can lead to worsening medical outcomes, including mortality. For example, coronary artery disease is a risk factor for the development of depression, and depression is an independent risk factor for the development of coronary disease. Patients with both conditions are more likely to die than those with coronary artery disease alone. Both behavioral and physiologic explanations are likely for these associations)
Which of the following are pharmacologic treatment options in the disorder described? A methylphenidate or its derivatives B dextroamphetamine or amphetamine derivatives C magnesium pemoline D modafinil E a or b
A or B
A mother brings her 6-year-old son to the office for a complete assessment. She states that "there is something very wrong with him." He just sprinkled baby powder all over the house, and last night he opened a bottle of ink and threw it on the floor. He is unable to sit still at school, is easily distracted, has difficulty waiting his turn in games, has difficulty in sustaining attention in play situations, talks all the time, always interrupts others, does not listen when talked to, and is constantly shifting from one activity to another. As you enter the examining room, the child is in the process of destroying it. On examination (what examination you can manage), you discover that there are no physical abnormalities demonstrated. What is the most likely diagnosis in this patient? A mental retardation B childhood depression C attention-deficit/hyperactivity disorder (ADHD) D maternal deprivation E childhood schizophrenia
ADHD
Which of the following statements is correct about ADHD? A ADHD is one of the most heritable psychiatric disorders B ADHD is more common in girls than boys C ADHD is rarely associated with other clinical diagnoses D ADHD is largely caused by environmental exposure
ADHD is one of the most heritable psychiatric disorders
Which of the following disorders often appear together in the same individual at various life stages? A mental retardation, attention-deficit/ hyperactivity disorder (ADHD), and learning disability B childhood depression, ADHD, and early-onset adult schizophrenia C ADHD, conduct disorder, and antisocial personality disorder D adjustment disorder, ADHD, and major depression E ADHD, bipolar disorder, and conduct disorder
ADHD, conduct disorder, and antisocial personality disorder (ADHD commonly leads to conduct disorder. Adolescents who have conduct disorder are predisposed to the development of antisocial personality disorder or alcoholism as adults)
A 3-year-old girl presents for her well-child visit. The physician notes pallor and bruising. On physical examination, the vital signs are normal, but there is a generalized lymphadenopathy and hepatosplenomegaly. A complete blood count (CBC) reveals a white blood cell (WBC) count of 33,000/ mm3 and a platelet count of 81,000/ mm3. The peripheral blood smear shows blasts, and the lactate dehydrogenase activity is elevated. CBC shows blasts as well as hypochromic red blood cells. The most common leukemia among children is which of the following? A acute myelogenous leukemia (AML) B acute lymphocytic leukemia (ALL) C chronic myelogenous leukemia (CML) D chronic lymphocytic leukemia (CLL) E equal numbers of AML and ALL
ALL
Which of the following is (are) true regarding the prevalence of ADHD? A prevalence rates are higher in preschool children than in school-age children B affected boys outnumber girls in surveys of school-age children C prevalence rates decline as a cohort of children ages into adulthood D all of the above
ALL THE ABOVE
Which of the following is commonly associated with non-Hodgkin lymphoma? A intussusception in a child older than 5 years B intra-abdominal mass C superior vena cava obstruction D airway obstruction E all of the above
ALL of the above
Which of the following statements regarding the diagnosis and treatment of status epilepticus is (are) true? A poor compliance with the anticonvulsant drug regimen is the most common cause of tonic-clonic status epilepticus B the mortality rate of status epilepticus may be as high as 20% C the establishment of an airway is the first priority in the management of status epilepticus D intravenous (IV) diazepam is the drug of first choice in the immediate management of status epilepticus E all of the above
ALL of the above
A 10-month-old girl was admitted to the hospital for cardiac catheterization. Her history included cyanosis noted at about 6 weeks of age, increasing over the last 7 months and becoming more severe with crying or physical activity. The chest x-ray demonstrates a "boot shaped heart" A presumptive diagnosis of tetralogy of Fallot (TOF) was made on admission. TOF has 4 components, which of the following below is not part of the diagnosis? A Pulmonary valve stenosis B VSD C Overriding aorta D Right ventricular hypertrophy E ASD
ASD (Four features (PROVe): Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, Ventricular septal defect)
A 9-year old girl is brought to the clinic by her mother on account of fever. She has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. On further enquiry, she reports a history of sore throat which occurred about 4 weeks ago. Which of the following would you do to support the diagnosis of acute rheumatic fever? A Erythrocyte sedimentation rate (ESR) B Antinuclear antibodies C White blood cell count D Anti-streptolysin O titer
ASO titer
Which of the following types of seizures consist of brief episodes (< 20 sec) of impaired consciousness with no aura or postictal confusion? A Myoclonic seizures B Atonic seizures C Absence seizures D Primary generalized tonic-clonic seizures
Absence seizures
A child exhibits short staring spells at school, which are sometimes accompanied by loss of postural tone. Episodes last less than a minute. Electroencephalography reveals bilateral 3-Hz spike-and-wave pattern. What is the medication of choice? A carbamazepine B ethosuximide C phenobarbital D phenytoin
Absence, or petit mal, seizures are best treated with either ethosuximide or valproic acid. Clonazepam is also effective but can be habit forming.
A 26-year old female presents with colicky abdominal pain which was initially at the periumbilical region, then after about 3 hours radiated to the right iliac fossa. She also has nausea and anorexia and has had two episodes of vomiting. On examination, she's acutely ill looking, has low grade pyrexia (99.8oF), localized abdominal tenderness over McBurney's point with muscle guarding and rebound tenderness. Blood test reveals Leucocytosis and a shift to left. Which of the following is the most likely diagnosis? A Ruptured ectopic pregnancy. B Salpingitis C Torsion of an ovarian cyst. D Acute appendicitis
Acute appendicitis
Which of the following is not recognized as one of the diagnostic criteria of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)? A Fatigue B Agitation not influenced by external stimuli C Sleep disturbance D Significant weight change
Agitation not influenced by external stimuli
Which of the following is the major pathogenetic mechanism that causes asthma? A Airway inflammation B Increased pulmonary secretions C Presence of Ghon complexes D Irreversible fibrosis
Airway inflammation is the major pathogenetic mechanism that leads to the development of asthma.
A patient presents with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is 85% of predicted. Which of the following is the most appropriate initial treatment? A Albuterol (Proventil) inhaler B Montelukast (Singulair) C Salmeterol (Serevent) inhaler D Sustained release theophylline
Albuterol inhaler (This patient has mild intermittent asthma which is initially treated with inhaled beta 2-agonists as needed. No long-term control medications are indicated.)
Which of the following benzodiazepines has the shortest half life A diazepam (Valium) B chlordiazepoxide (Librium) C clorazepate (Tranxene) D alprazolam (Xanax) E clonazepam (Klonopin)
Alprazolam has the shortest half-life at 6-12 hours; clonazepam has a half life of 25 hours; and diazepam, clorazepate, and chlordiazepoxide have half lives of up to 50 hours.
Laboratory tests, usually blood tests, cannot alone provide the physician assistant with a clear diagnosis. But these tests can be used to help rule out other conditions and classify the type of juvenile arthritis that a patient has. Which of the following blood tests would not be indicated for the diagnosis of JRA? A Anticyclic citrullinated peptide (anti-CCP) antibodies B Rheumatoid factor (RF) C Antinuclear antibody (ANA) D Erythrocyte sedimentation rate (ESR or sed rate). E Antitissue transglutaminase (anti-tTG) antibodies
Antitissue transglutaminase (anti-tTG) antibodies are used in the diagnosis of celiac disease.
Which of the following is required for a diagnosis of ADHD? A Prolonged lethargy lasting at least 3 months B Presence of a comorbid psychiatric disorder C Positive findings on brain imaging (such as functional MRI or single-photon emission CT [SPECT]) D At least six symptoms of inattention or hyperactivity-impulsivity (or both) that have persisted for at least 6 months
At least six symptoms of inattention or hyperactivity-impulsivity (or both) that have persisted for at least 6 months
A 1-day-old female newborn is brought to the clinic because she has been regurgitating small amounts of bile-stained fluid. Physical examination shows a flat nasal bridge, clinodactyly, and a small mouth with protruding tongue. An abdominal X-ray is obtained and is shown here. Which of the following abnormalities is most likely to be present in this patient? A Anal atresia B Atrioventricular septal defect C Horseshoe kidney D Microphthalmia E Pickwickian syndrome
Atrioventricular septal defect (When evaluating a newborn for Down syndrome, clinical signs include "double bubble" on imaging (duodenal atresia), macroglossia, single palmar crease, and congenital heart defects)
The major complication of slipped capital femoral epiphysis is A Avascular necrosis of the hip B Osteochondritis dissecans C Leg-length discrepancy D Transient synovitis of the hip E Intoeing
Avascular necrosis of the hip
Which of the following is a complication of GERD? A Barrett's esophagus B Zenker's diverticulum C Gastritis D Diffuse esophageal spasm
Barrett's esophagus
A 22 year-old female with a history of asthma presents with complaints of increasing "asthma" attacks. The patient states she has been well controlled on albuterol inhaler until one month ago. Since that time she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime use averaging about three episodes in the past month. Spirometry reveals > 85% predicted value. Which of the following is the most appropriate intervention at this time? A. Oral prednisone B. Oral theophylline C. Salmeterol inhaler D. Beclomethasone inhaler
Beclomethasone inhaler (This patient has progressed to mild persistent asthma. In addition to her inhaled beta2- agonist (albuterol), she should be started on an anti-inflammatory agent. Inhaled corticosteroids, such as beclomethasone, are preferred for long-term control. Other options may include cromolyn or nedocromil.)
What is bell clapper deformity?
Bilateral nonattachement of the testicles by the gubernaculum to the scrotum (seen in Testicular Torsion)
Which of the following accurately describes how an SSRI functions? A Inhibits chemicals that remove neurotransmitters in the body B Increases the available amount of neurotransmitters in the brain C Blocks the reabsorption of the neurotransmitter at the cellular level in the brain D Induces brief seizures through the use of electric currents passed through the brain
Blocks the reabsorption of the neurotransmitter at the cellular level in the brain
Which of the statements regarding ALL is true? A the peak age at onset is 12 years B at the time of diagnosis, most patients have a thrombocytosis C CBC with differential is the most useful initial test D a chest radiograph is the most useful initial test
CBC with diff is most useful initial test
What is the psychotherapy of choice for this GAD? A cognitive-behavioral therapy (CBT) B hypnosis C supportive psychotherapy D psychoanalytic psychotherapy E none of the above
CBT
Household contacts of a patient with bacterial meningitis are best treated with which of the following? A Amoxicillin (Amoxil) B Ciprofloxacin (Cipro) C Tetracycline (Sumycin) D Vancomycin (Vancocin)
Cipro
Which of the following pharmacologic agents is not recommended in the treatment of GAD? A venlafaxine B buspirone C benzodiazepines D selective serotonin reuptake inhibitors (SSRIs) E clozapine
Clozapine (used for schizophrenia)
A child is found to have higher blood pressures in the arms than in the legs and pulses are bounding in the arms but decreased in the legs. The most likely condition is? A VSD B Tetralogy of Fallot C Transposition of the great arteries D Aortic stenosis E Coarctation of the aorta
Coarctation of the aorta
Which of the following is an evidence-supported concern in children with ADHD? A Comorbid bipolar disorder B Increased risk for cardiac conditions C An associated underlying immunodeficiency disease D Foods that contain food coloring or that are high in simple sugars, which exacerbate symptoms
Comorbid bipolar disorder
A 21 year-old male with a diagnosis of type 1 von Willebrand disease undergoes dental extraction of his wisdom teeth. The patient comes to the clinic with continued oozing of the dental sockets despite packing. Treatment should begin with which of the following? A DDAVP B Factor VIII C vWF concentrate D FFP
DDAVP causes the release of vWF and factor VIII from storage sites significantly which is needed to complete hemostasis. Intravenous or intranasal DDAVP is recommended as the initial treatment of minor bleeding or at the time of minor surgery in patients over the age of two years who have shown an adequate prior response to this agent. Factor VIII is indicated for patients with Hemophilia A. Fresh frozen plasma is indicated in Coumadin overdosage and VWF concentrate is suggested over DDAVP in cases of major bleeding and major surgery.
Which of the following medications should be avoided in patients with hypertrophic obstructive cardiomyopathy? A Aspirin B Digoxin C Disopyramide D Acetaminophen E Atenolol
Digoxin
What type of hernia involves passage of intestine through the external inguinal ring at Hesselbach triangle and rarely enters the scrotum A Indirect inguinal hernia B Direct inguinal hernia C Ventral hernia D Hiatal hernia
Direct inguinal hernia
A 26 year-old female required 12 units packed red blood cells during a trauma resuscitation and surgical repair of liver and splenic lacerations. The patient is now 6 hours postoperative and has blood oozing from the suture line and IV sites. There is bloody urine in the Foley bag. Laboratory evaluation demonstrates a platelet count of 10,000/microliter, prolonged prothrombin level, and the presence of fibrin split products. Which of the following is the most likely diagnosis? A acute ABO incompatibility reaction B disseminated intravascular coagulation C exacerbation of idiopathic thrombocytopenia D inadequate repair of the liver lacerations
Disseminated intravascular coagulation is characterized by bleeding from many sites as all coagulation factors are consumed and then broken down, leading to decreased fibrinogen level and platelet count, prolonged PT and PTT, and presence of fibrin split products.
Which of the following is essential to make a diagnosis of cystic fibrosis? A Positive family history B Elevated sweat chloride C Recurrent respiratory infections D Elevated trypsinogen levels
Elevated sweat chloride test
Which of the following statements is false? A Hiatal hernia contributes to the development of GERD. B Excessive reflux is defined as a pH <4 for >4% of the time C In most patients with GERD, baseline LES pressures are normal (10-35 mm Hg). D Endoscopy is indicated in all cases of GERD.
Endoscopy is indicated in all cases of GERD
Which of the following is the most common cause of viral meningitis? A Enteroviruses B HIV infection C Adenovirus D Toscana virus
Enteroviruses
Which of the following physical findings is suggestive of atrial septal defect? A Fixed split S2 B Increased pulse pressure C Continuous mechanical murmur D Difference in blood pressure between the left and right arm
Fixed split S2 (An atrial septal defect will cause a shunt of blood from the left to the right atrium. This will result in an equalization in the amount of blood entering both the left and right ventricles which effectively eliminates the normally wide splitting that inspiration typically causes in hearts without an atrial septal defect.)
Which of the following best describes Brudzinski's sign? A flexion of the hips during attempted passive flexion of the neck B inability to allow full extension of the knee when the hip is flexed 90° C pain in the neck with axial loading D superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
Flexion of the hips during attempted passive flexion of the neck
An 18 year-old college student took her goggles off in the chemistry lab while she was washing her glassware from an experiment she had just completed. She thinks the beaker had contained sodium hydroxide, and it splashed into her right eye. She rinsed her eye out for about five minutes in the lab. Which of the following is the most appropriate first step? A. check visual acuity B. Flush the eye with two liters saline C. Check for corneal damage with fluorescein D. Instill a topical anesthetic to facilitate examination
Flush the eye with 2L saline (Any chemical injury to the eye may result in severe injury and loss of sight, and is a true emergency. The eye should be irrigated copiously with at least two liters of saline, and pH checked to determine when the chemical has been cleared.)
Which of the following is necessary for a diagnosis of major depressive disorder with seasonal pattern? A At least four episodes of depressive disturbance in the previous 2 years B Full remission must occur at a characteristic time of year C Seasonal episodes must be at least equal to nonseasonal episodes D Seasonal-related psychosocial stressors must be present
Full remission must occur at a characteristic time of year
A 15-year-old man comes to the office with acute onset of nausea, severe pain and swelling within the right testis. He has no fever or irritative voiding symptoms. Which of the following scrotal physical examination findings would you expect in this patient? A Nodular mass within the testis B High-lying testis C Transilluminated fluid mass D Palpation of a soft bag of worms
High lying testis (Testicular torsion occurs in the 10-20 year age group, and is characterized by acute onset of severe pain and swelling of the testis.)
A 14-year-old boy is brought into the office by his parents. For the past 2 weeks, he has been very tired and has felt short of breath. The mother tells you that she thinks he has been losing weight. On physical examination, the child is alert and in no distress; vital signs are normal, but he has lost 8 pounds since his last visit 6 months ago. The lungs are clear bilaterally, and the heart examination is normal. You palpate an enlarged supraclavicular node. Chest radiography reveals a large mediastinal mass. A acute streptococcal pneumonia B Mycoplasma pneumonia C mononucleosis D Hodgkin disease
Hodgkin Disease
The presence of Reed-Sternberg cells in tissue is diagnostic of which disease? A Hodgkin disease B lymphoblastic lymphoma C Burkitt lymphoma D large cell lymphoma
Hodgkin Disease
A 23-year-old male presents with syncope. On physical examination you note a medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining. Which of the following is the most likely diagnosis? A Hypertrophic cardiomyopathy B Aortic stenosis C Mitral regurgitation D Pulmonic stenosis
Hypertrophic cardiomyopathy
A 25 year-old male with a history of asthma presents complaining of increasing episodes of evening and daytime symptoms. He is on a short acting inhaled beta agonist prn. He is presently using his short acting beta agonist on a daily basis. Which of the following is the most appropriate addition to this patient's regimen? A methylxanthine oxidase inhibitor B long acting beta agonist inhaler C leukotriene inhibitor D inhaled corticosteroid
ICS
Which of the following statement about intussusceptions is wrong? A Pneumatic reduction under fluoroscopy using air as a contrast medium is a treatment option. B Hydrostatic reduction is contraindicated if the child has signs of peritonitis or gangrenous bowel. C In adults, intussusception almost always is caused by viral infection. D Intussusception is the invagination of a segment of bowel into another immediately adjacent to it
In adults intussusception almost always is caused by viral infection. (FALSE because it is almost always caused by neoplasm in adults; in children it is viral infection)
What is used for both dx and tx in children with intussusception
In children, barium or air enema may be both diagnostic and therapeutic. In adults, barium enema should not be used.
A 4 year-old boy presents with pain and irritation of his left ear. Otoscopic examination reveals an insect in the left auditory canal. The tympanic membrane is not completely visualized. Which of the following is the most appropriate management of this patient? A Debrox insertion with suction removal B Irrigation with room temperature saline C Insertion of 2% lidocaine solution with suction or forceps removal D Polymyxin drop insertion via wick
Insertion of 2% lido with suction or forceps removal
A 7-month old male infant presents with sudden onset intermittent abdominal pain that subsides after a few seconds only to be repeated after intervals of some minutes; abdominal distention, bilious vomiting, passage of red-currant jelly stool. Abdominal pain is associated with screaming. Physical exam of the abdomen reveals a sausage-shaped mass at the right upper quadrant. The right lower quadrant feels empty. What is the most likely diagnosis? A Acute appendicitis B Intussusception C Acute gastric volvulus D Gastroenteritis
Intussusception
A 45-year-old woman with a known seizure disorder has been noncompliant with her anticonvulsant medication due to side effects she has been experiencing. While in your office, she starts convulsing at a frequency that does not allow consciousness. Which of the following is the most appropriate initial drug treatment? A lorazepam B phenytoin C phenobarbital D valproic acid
Lorazepam
A 26 year old mildly obese woman presents with 2-month history of heartburn, 2 weeks history of regurgitation. She drinks alcohol and smokes occasionally. Which of the following would you not advise her to do? A Eating smaller meals at a time B Elimination of acidic foods C Weight loss; stop smoking and alcohol ingestion D Lying down within 3 hours after meal
Lying down within 3 hours after meal
A 16-year-old male presents with complaint of syncope after basketball practice today. Physical examination reveals a systolic murmur along the left sternal border that increases with Valsalva maneuver. An electrocardiogram reveals left ventricular hypertrophy. Echocardiogram shows asymmetric left ventricular hypertrophy with a hypercontractile left ventricle. Which of the following is the initial medication of choice in this patient? A Metoprolol (Lopressor) B Cozaar C Lisinopril (Zestril) D Hydrochlorothiazide (Diuril)
Metoprolol (Beta-blockers are the initial drug of choice in a symptomatic patient with hypertrophic cardiomyopathy. Avoid nitrates and other drugs that decrease preload (eg, diuretics, ACE inhibitors, angiotensin II receptor blockers) because these decrease LV size and worsen LV function)
Which of the following statements about scoliosis is true? A The most common form is congenital B The patient has a normal Adam's test C Patients with abnormalities > 5 degrees should be referred to an orthopaedist D Most curvature is to the right in the thoracic spine, causing the right shoulder to be higher than the left E Syringomyelia is not associated with scoliosis
Most curvature is to the right in the thoracic spine, causing the right shoulder to be higher than the left
Which of the following signs is not associated with acute appendicitis? A Murphy's sign B Pointing sign C Rovsing's sign D Obturator sign
Murphy's Sign (acute cholecystitis)
Which of the following is not usually associated with autism? A Normal IQs B Echolalia C Repetitive movements D Self-injury behaviors E Seizures
Normal IQs
Which of the following is recognized as a symptom of the predominantly inattentive type of ADHD? A Fidgeting with or tapping hands or feet B Often loses things necessary for tasks or activities C Excessive talking D Interrupting others
Often loses things necessary for tasks or activities
A 22 month-old male infant presents with one day of barking cough preceded by three days of cold symptoms. On physical examination, his axillary temperature is 100.4°F and he has no stridor at rest. Inspiratory stridor is evident when he becomes agitated during the examination. There are no signs of respiratory distress or cyanosis. Which of the following is the most appropriate treatment for this patient? A Nebulized albuterol B Nebulized epinephrine C Oral amoxicillin D Oral dexamethasone
Oral dexamethasone (Corticosteroids are beneficial in the treatment of croup. Intramuscular administration has shown no benefit over oral administration.)
Abduction of the flexed hip of a 1-month-old elicits a "clunk." What test is this and what does it assess? A Ortolani sign; developmental dysplasia of the hip B Lachman test; slipped capital femoral epiphysis C Galeazzi test; Legg-Calvé-Perthes disease D Pavlik's sign; Osgood-Schlatter disease
Ortolani sign; developmental dysplasia of the hip
A 13-year-old boy presents to the clinic for a complaint of right knee pain that he first noticed about a year ago. It started out as mild discomfort in the area just below the kneecap, but has been getting progressively worse. Now, it hurts anytime he uses his leg, even when walking. He does not remember any injury to his knee. On examination of his knee there is swelling and exquisite tenderness over the tibial tubercle. Radiographs are normal. What is the most likely diagnosis? A Chondromalacia patellae B Legg-Calvé-Perthes disease C Osgood-Schlatter disease D Patellar dislocation
Osgood-Schlatter disease
An 8 year-old boy is brought to a health care provider complaining of dyspnea and fatigue. On physical examination, a continuous machinery murmur is heard best in the second left intercostal space and is widely transmitted over the precordium. The most likely diagnosis is A ventricular septal defect. B atrial septal defect. C congenital aortic stenosis. D patent ductus arteriosus.
PDA
Which of the following drug class is most effective in relieving symptoms of GERD? A Proton pump inhibitors (PPI) B The dopamine antagonist prokinetic agents C H2-receptor antagonists D Alginate-containing antacids
PPIs
During pregnancy which is the preferred treatment of hyperthyroidism PTU or methimazole?
PTU
An 18-month-old male presents with his parents who report symptoms of a barking cough and intermittent stridor that has worsened over the past 12 hours. They note improvement in symptoms when he was taken outdoors to the cool night air. Which of the following is the most likely organism causing this patient's symptoms A Rubeola virus B Adenovirus C Influenza virus D Parainfluenza virus
Parainfluenza virus (Croup is most often caused by parainfluenza virus)
A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing shortness of breath for 2 days. Her asthma has been well controlled until 2 days ago and since yesterday she has been using her albuterol inhaler every 4-6 hours. She is normally very active, however yesterday she did not complete her 30 minutes exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries or use of oral contraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment? A. chest x-ray B. sputum gram stain C. peak flow D. VQ scan
Peak flow (A peak flow reading will help you to gauge her current extent of airflow obstruction and is helpful in monitoring the effectiveness of any treatment interventions. Asthma exacerbation)
You are asked to evaluate a term infant in the delivery room. He was born a few minutes earlier by spontaneous vaginal delivery with Apgar scores of 9 and 9. The mother had good prenatal care and a normal pregnancy. No significant family history is noted. On physical examination, the infant appears alert and is active and crying. Acrocyanosis is noted on extremities. A grade 2/6 soft, systolic murmur is audible at the left upper sternal border. Otherwise, the examination is completely normal. What should be your next step in the management of this patient? A order an echocardiogram B perform a second detailed physical exam at 24 hours C order an ECG and chest radiograph D get a cardiology consultation
Perform a second detailed PE at 24hrs (This is the transient systolic murmur of patent ductus arteriosus. It is audible at the upper left sternal border and in the left infraclavicular area on the first day, and it usually disappears soon thereafter.)
Treatment options for lactose intolerance include all of the following except A Supplemental calcium B Lactase enzyme preparations C Pre-hydrolyzed milk D Promethazine
Promethazine
A 3 year-old male with cystic fibrosis develops pneumonia. Which of the following is the most likely etiology of the pneumonia? A Escherichia coli B Staphylococcus epidermidis Pseudomonas aeruginosa D Streptococcus pneumoniae
Pseudomonas aeruginosa
A 26-year-old woman, gravida 2, para 1, comes to the clinic for a first trimester aneuploidy screen at 11 weeks' gestation. The nuchal translucency testing is normal. However, her human chorionic gonadotropin concentration is high and her pregnancy associated plasma protein A concentration is low. After learning that these findings may be associated with Down syndrome, she says that she is considering terminating her pregnancy if her child is affected, and asks if there is another test that can offer her more information. Which of the following is the most appropriate next step in management? A Amniocentesis B Chorionic villus sampling C Microarray chromosomal analysis D Percutaneous umbilical blood sampling E Quadruple screen (maternal serum α fetoprotein (AFP), human chorionic gonadotropin, unconjugated estriol, and inhibin A)
Question 1 Explanation: Chorionic villus sampling is a diagnostic test for Down syndrome and other aneuploidies. It can be performed between 10-14 weeks' gestation.
A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days, but symptoms worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 7 pounds, and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 100.8° F, pulse of 120 beats/minute, blood pressure within normal limits, and respiratory rate of 60 breaths/minute. The infant is well hydrated but appears ill. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical examination. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. The most common cause of this condition is:
RSV (RSV is the most common agent in bronchiolitis. Other viruses that cause bronchiolitis are adenoviruses, influenza virus, parainfluenza virus, and human metapneumovirus. A less common agent is Mycoplasma pneumoniae, which occurs sporadically.)
What is the mechanism of action of salmeterol (Serevent) in the treatment of asthma? A Anti-inflammatory B Immunotherapy for specific allergens C Relaxing of bronchial smooth muscle D Reduction of leukotriene production
Relaxing of bronchial smooth muscle (Salmeterol is a LABA)
A 32-year-old man with a history of easy bruising and joint swelling is being prepped for an appendectomy. During the physical examination, the patient states that he had surgery to correct a heart defect when he was 4, and during the procedure, he was bleeding uncontrollably. Since then he has been diagnosed with a bleeding disorder and must be treated prophylactically prior to any surgical procedure. He adds that his maternal grandfather and 2 of his grandfather's brothers also had the same disorder. Which of the following is the best primary perioperative treatment to prevent uncontrollable bleeding? A Intravenous infusion of antifibrinolytics B Corticosteroids C Replacement therapy of factor X D Replacement therapy of factor VIII E Platelet transfusion
Replacement therapy of Factor VIII
An infant born at 30 weeks' gestation begins to have respiratory difficulty shortly after birth. Examination reveals rapid, shallow respirations at 80 per minute with associated intercostal retractions, nasal flaring and progressive cyanosis. Chest x-ray reveals the presence of air bronchograms and diffuse bilateral atelectasis. Which of the following is the most likely diagnosis? A Respiratory distress syndrome B Spontaneous pneumothorax C Transient tachypnea syndrome D Meconium aspiration syndrome
Respiratory distress syndrome (hyaline membrane disease) is the most common cause of respiratory distress in a premature infant. This diagnosis is supported by the chest x-ray findings of air bronchograms and diffuse bilateral atelectasis, causing a ground-glass appearance.
Which of the following is associated with acute rheumatic fever A Manning criteria B Revised Jones criteria C Ranson criteria D Duke criteria
Revised Jones criteria is used to make a diagnosis of acute rheumatic fever. It consists of 5 major and 4 minor criteria and an absolute requirement for evidence (microbiologic or serologic) of recent Group A beta hemolytic streptococcus infection.
A 12-year-old boy was diagnosed with an atrial septal defect (ASD). What would you expect to see on his ECG?
Right bundle branch block (Almost all patients with an atrial septal defect will have an RBBB on their ECG. Left ventricular hypertrophy (LVH) can be seen on conditions such as a ventricular septal defect. Right ventricular hypertrophy and right axis deviation can be seen with tetralogy of Fallot. Left bundle branch block in pediatric patients can be seen in LVH, left ventricular noncompaction, and Wolff-Parkinson-White syndrome.)
Deep palpation of the left iliac fossa causing pain in the right iliac fossa is A Rovsing's sign B Psoas sign C Obturator sign D Dunphy's sign
Rovsing's Sign
What is considered first line in the long term treatment of panic disorder A Benzodiazepines B TCAs C SSRIs D Wellbutrin
SSRIs
Which of the following is generally accepted as the most effective first-line therapeutic option in children with ADHD? A Norepinephrine reuptake inhibitors B Behavioral psychotherapy alone C Stimulants and cognitive therapy D Cognitive therapy alone
Stimulants and cognitive therapy
Which of the following is the most common bacterial cause of meningitis? A Pseudomonas aeruginosa B Staphylococcus epidermidis C Enterobacteria D Streptococcus pneumoniae
Streptococcus pneumoniae
The initial management of a patient with strangulated inguinal hernia includes all of the following except A Placing of intravenous line for rehydration and electrolyte correction. B Passage of nasogastric tube for decompression. C Administration of oxygen D Surgery
Surgery, when indicated for acute intestinal obstruction is done after the patient has been adequately resuscitated. All other options are resuscitative measures.
A 50-year-old male presents to the ED complaining of chest pain, palpitations, and dizziness after a syncopal episode. The patient feels his heart racing. The EKG reveals a narrow complex tachycardia consistent with paroxysmal supraventricular tachycardia (PSVT). Vitals: P: 188 bpm, regular, BP: 78/52 supine. What is the best treatment for this patient in this scenario? A Defibrillation B IV adenosine (Adenocard) C IV diltiazem (Cardizem) D Synchronized cardioversion E Vagal maneuvers
Synchronized cardioversion
True or False: A patient presenting with testicular torsion will have a negative prehn's sign A True B False
TRUE (A patient presenting with testicular torsion will have a negative prehn's sign (lifting of testicle will not relieve pain). A positive prehn's sign is seen in patients with epididymitis, they will have relief of pain with lifting of the testicle.)
True or False: PH Monitoring with intra-esophageal electrode is the GOLD STANDARD for diagnosing GERD. True/False
TRUE: although this is RARELY necessary
Which of the following statements regarding lactose intolerance is incorrect? A Osteopenia is a possible complication. B Hydrogen breath test is the diagnostic test of choice. C The congenital form is inherited as an autosomal dominant trait. D May be secondarily due to Crohn's disease.
The congenital form is inherited as an autosomal dominant trait. (The congenital form is inherited as an autosomal RECESSIVE trait.)
A 2 year-old presents to the emergency department in acute respiratory distress. The parents relate a history of a recent upper respiratory illness that was followed by a sudden onset of barking cough during the night, but this morning they noted increased difficulty breathing. The child is noted to have stridor at rest, but has no evidence of cyanosis. Which of the following is the most appropriate initial intervention? A Intravenous antibiotics B Endotracheal intubation C Inhaled mucolytic agent D Nebulized racemic epinephrine
This patient most likely has laryngotracheobronchitis (viral croup). Treatment with nebulized racemic epinephrine and glucocorticosteroids is indicated for patients with stridor at rest.
Which of the following statements about fluoxetine is true? A Side effects often include dry mouth, urinary retention, and blurred vision B The treatment of panic disorder typically requires higher doses than the recommended starting dose for depression. C The mechanism of action involves the reuptake of dopamine at the postsynaptic junction. D The drug has significant anticholinergic activity. E Treatment of bulimia typically requires higher doses than the recommended starting dose for depression.
Treatment of bulimia typically requires higher doses than the recommended starting dose for depression
Which of the following statements about the treatment of major depressive disorder is true? A Treatment should be altered if the patient does not have an adequate response to pharmacotherapy in 3-4 weeks B Clinical response to pharmacotherapy is typically seen within 1-2 weeks C Pharmacotherapy is not indicated in patients who have had more than two depressive episodes D Treatment should be continued for 4-9 months in patients with a first episode of major depression not associated with suicidality
Treatment should be continued for 4-9 months in patients with a first episode of major depression not associated with suicidality
A 5-year-old presents to your office complaining of scrotal pain and you note swelling of the left testis. What is the appropriate next step? A Elevation of the scrotum and ice therapy B Ultrasound evaluation with Doppler color flow C Continued observation D Computed tomography (CT) scan of the pelvis E Doppler stethoscope evaluation
Ultrasound evaluation with Doppler color flow
A 2-week-old infant is brought to your office by his mother for a checkup and establishment of care. They have just moved into the area, and you have not seen the baby before. The mother states that the baby was born at term and she had a normal pregnancy. On examination, the infant has a grade 3/6 harsh pansystolic heart murmur heard along the lower left sternal edge. There is no radiation of the murmur. The heart rate is 82 beats/minute and regular. There is no thrill. The blood pressure is 80/60 mm Hg. No other abnormalities are found on examination. The infant is in the 50th percentile for height and weight. What is the most likely cardiac diagnosis in this infant? A ventricular septal defect (VSD) B innocent cardiac murmur C tetralogy of Fallot D pulmonary atresia E coarctation of the aorta
VSD
What is the most common pathologic murmur in childhood? A ASD B VSD C patent ductus arteriosus D Mitral valve prolapse
VSD
A 23-year-old female comes to the emergency department for a syncopal episode. Just prior to the syncopal episode, the patient experienced painful menstrual cramping. She experienced a cold sweat and palpitations with the cramping. The patient describes similar episodes to her menstrual cramps in the past. Her vital signs and physical examination are normal. ECG is unremarkable. What is the likely diagnosis for her syncope? A. Vasovagal syndrome B. AV-nodal re-entrant tachycardia C. Long QT syndrome D. Hypertrophic obstructive cardiomyopathy
Vasovagal syndrome
Which of the following laboratory markers would be most helpful in supporting the diagnosis of acute appendicitis? A amylase B white blood cell (WBC) count C C-reactive protein D urinalysis
WBC count
A 32 year-old carpenter complains of right eye irritation all day after driving a metal stake into the ground with his hammer. He states that "something flew into my eye." Visual acuity is 20/20. Pupils are equal, round, reactive to light and accommodation. Extraocular movements are intact. There is minimal right corneal injection. No foreign body is noted with lid eversion. Fluorescein stain reveals a tiny pinpoint uptake in the area of the corneal injection. Which of the following is the most appropriate diagnostic test at this stage? A. MRI B. X-ray orbits C. Applanation tonometry D. Fluorescein angiography
XR orbits (or a CT)
A patient presents with reflux. When further questioned, he reports the regurgitation of small amounts of food back into his mouth. You notice he has very foul-smelling breath. What do you suspect? A Zenker's diverticulum B Peptic Ulcer Disease C Achalasia D Gastric Cancer E Pyloric stenosis
Zenker Diverticulum is an outpouching of the hypopharynx which causes foul smelling breath and regurgitation of solid foods.
The diagnosis of conduct disorder is made when which of the following criteria is (are) fulfilled? A repetitive and persistent patterns of behavior that violate the rights of others B stealing C lying D vandalism E a and any two of b, c, and d
a and any two of b, c, and d
'Target sign' associated with intussusception is seen with which imaging modality? A Barium enema B Abdominal Ultrasonography C Abdominal radiograph D None of the above
abd ULS
A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin) presents to the emergency department after vomiting large amounts of bright red blood. INR is 3. Which of the following is most appropriate to rapidly lower the patient's INR? A Discontinue warfarin B Administer fresh frozen plasma C Administer protamine sulfate D Administer heparin sulphate
administer FFP
A 17 year-old male who is trying out for the track team notes excessive coughing with chest tightness when running. Which of the following is the most appropriate preventive agent for this patient? A. Albuterol inhaler (Proventil) B. Inhaled corticosteroids C. Aminophylline (Theo-Dur) D. Ipratropium (Atrovent)
albuterol inhaler (Albuterol is a beta-2 agonist that results in bronchodilation that makes this a useful agent in a patient with exercise-induced asthma when used just prior to exercise.)
Which of the following symptoms is generally not characteristic of GAD? A awakening with apprehension and unrealistic concern about future misfortune B worry out of proportion to the likelihood or impact of feared events C a 6-month or longer course of anxiety and associated symptoms D association of the anxiety with depression E anxiety exclusively focused on health concerns
anxiety exclusively focused on health concerns
A 3 year-old girl is diagnosed with atopic dermatitis. Which of the following disorders is this child at risk for in the future? A Asthma B Tinea pedis C Squamous carcinoma D Systemic lupus erythematosus (SLE)
asthma
Down syndrome is associated with what three cardiac defects?
atrioventricular septal defects (endocardial cushion defect); ventricular septal defects; atrial septal defect.
A 4-year-old boy is noted to have impaired language development, compulsive repetitive behavior, impaired intelligence, and a preoccupation with inanimate objects. The most likely diagnosis is A Conductive hearing loss B Attention-deficit disorder C Autism D Manic- depressive disorder E Dyslexia
autism
Which is the gold standard for confirming the diagnosis of intussusception in children? A Barium enema B Abdominal ultrasonography C Abdominal radiograph D None of the above
barium enema
Which of the following is a common symptom associated with laryngotracheobronchitis (viral croup)? A. drooling B. high fever C. "hot potato" voice D. barking cough
barking cough
A 20-year-old college student presents to her dentist. Her vital signs are normal, and her weight is 120 lb. On examination, extensive upper dental erosion is noted. The most likely diagnosis is A OCD B Anorexia nervosa C Hypothyroidism D Crohn's disease E Bulimia nervosa
bulimia nervosa
A 12 year-old boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. Blood pressure obtained in both arms is elevated. Chest x-ray reveals rib notching. Which of the following is the most likely diagnosis? A abdominal aortic aneurysm B pheochromocytoma C coarctation of the aorta D thoracic outlet syndrome
coarctation of the aorta
The test with the highest sensitivity in diagnosis of this condition is A ultrasonography B barium enema C abdominal radiograph D computed tomography (CT) with intravenous and oral administration of contrast agents
computed tomography (CT) with intravenous and oral administration of contrast agents
An otherwise-healthy 7-month old female infant was brought to the clinic by her mother on account of a 3-month history of umbilical swelling which is usually more apparent when she cries. On examination, the swelling was reducible and a defect was felt through the umbilicus. The appropriate management option is A Umbilical herniorrhaphy. B Conservative treatment. C Mayo's overlapping operation. D None of the above
conservative tx (In most cases (85%) the hernial defect in the linea alba closes spontaneously by age 4 - 5 years. The patient should therefore be left alone without any form of treatment except in the event of strangulation or incarceration.)
What type of stool is pathognomonic for intussusception?
currant jelly stools
A 12 month-old child with tetralogy of Fallot is most likely to have which of the following clinical features? A Chest pain B Cyanosis C Convulsions D Palpitations
cyanosis
Which of the following is not recommended in the workup of patients with suspected meningitis? A Prompt performance of lumbar puncture B Delay of antibiotics until brain CT scan results are obtained C CBC count D Serologic syphilis testing
delay of abx until brain CT scan results are obtained (A CT scan of the head may be performed before lumbar puncture to determine the risk for herniation. However, the decision to obtain a brain CT scan before lumbar puncture should not delay the institution of antibiotic therapy; such delay can increase mortality. It should also be noted that herniation can occur in patients with bacterial meningitis who have a normal brain CT scan. The most reliable clinical signs that indicate the risk for herniation include deteriorating level of consciousness, brainstem signs, and a very recent seizure)
Which of the following is not a risk factor for abdominal hernias? A Chronic cough B Obesity C Heavy lifting D Diarrhea
diarrhea (Diarrhea is not a risk factor for abdominal hernias, but chronic constipation is. Any condition that increases intra-abdominal pressure may contribute to the formation of abdominal hernia. All other options are correct.)
A 28-year-old woman is admitted to the hospital for further evaluation of her syncopal episodes after a Holter monitor reveals three runs of sustained ventricular tachycardia that lasted between 20 and 30 seconds. While in the hospital, her monitor tracings reveal multifocal premature ventricular contractions. She has no symptoms, and a 12-lead ECG is without evidence of ST-segment elevation or depression. What study would you recommend to evaluate her ventricular excitability? A Loop recorder B Electrophysiology study C Exercise treadmill stress test D Transesophageal echocardiogram
electrophysiology study (Electrophysiology studies are used to evaluate the excitability of the myocardium and to reproduce the ventricular tachycardia (VT). Catheter ablation can cure VT in 90% of cases in those without structural heart disease. Repeating the ECG when she has no symptoms and documented Holter monitor demonstrates the likely etiology of the syncope. Exercise treadmill test is not indicated as she has had multiple sustained ventricular tachycardia episodes. Transesophageal echocardiography is used most commonly to evaluate the aorta for evidence of dissection, to elucidate evidence of atrial clots, and to assess for evidence of valvular vegetations.)
A 16 year-old male presents with increasing pain and swelling of his right scrotum. The right testicle is extremely tender to palpation on examination. A Doppler ultrasound demonstrates decreased blood flow. Which of the following is the most appropriate intervention? A oral doxycycline B emergent surgery C incision and drainage D scrotal elevation and ice packs
emergent surgery
Down syndrome has four classic physical features. What are they?
flat facies, prominent epicanthal folds, single palmar crease, and a gap between the first two toes.
What examination finding would be expected in a patient with von Willebrand disease? A Gingival bleeding B Splenomegaly C Muscle weakness D Hemarthrosis
gingival bleeding (may also see epistaxis and menorrhagia)
Lactase enzyme breaks down lactose into A Glucose and galactose B Glucose and sucrose C Fructose and galactose D Glucose and fructose
glucose and galactose
Which of the following is the most common known cause of epilepsy in young adults? A Strokes B Head trauma C Tumors D Infection
head trauma
Which ethnic group has the highest frequency of ALL? A white B Hispanic C African American D Asian E no ethnic variation
hispanic
You are called to the nursery to see a male infant, born by uncomplicated vaginal delivery. He weighs 2,600 grams and has one deep crease on the anterior third of each foot. Respirations are 88 breaths/minute with expiratory grunting and intercostals retractions. He is cyanotic on room air and becomes pink when placed in 60% oxygen. Chest x-ray shows atelectasis with air bronchograms. Which of the following is the most likely diagnosis? A neonatal pneumonia B congenital heart disease C hyaline membrane disease D chronic lung disease of prematurity
hyaline membrane disease
Which of the following is the diagnostic test of choice for lactose intolerance? A urea breath test B hydrogen breath test C endoscopy D ileocolonoscopy
hydrogen breath test (administered 50 g of lactose after an overnight fast, a rise in breath hydrogen of >20 ppm within 90 minutes is a positive test, indicative of bacterial carbohydrate metabolism)
Upon genital examination of a newborn male, the urethral meatus is found located proximal to the tip of the glans on the ventral aspect of the penis. This finding is defined as which of the following conditions? A Epispadias B Hypospadias C Phimosis D Urethral stricture E Urethrorectal fistula
hypospadias
A 12-year-old boy is brought in to your office by his mother and father. The child has been experiencing swelling of his joints, fevers, and a rash. An examination reveals hepatosplenomegaly and lymphadenopathy. Laboratory evaluation shows anemia, leukocytosis, and thrombocytosis. You suspect juvenile rheumatoid arthritis (JRA). Which of the following medications would be first-line treatment? A Acetaminophen B Ibuprofen C Codeine D Methotrexate
ibuprofen
Which of the following best describes Kernig's sign? A pain in the neck with axial loading B inability to allow full extension of the knee when the hip is flexed 90° C flexion of the hips during attempted passive flexion of the neck D superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
inability to allow full extension of the knee when the hip is flexed 90°
You are evaluating a patient whom you suspect has asthma. You perform spirometry before and after administration of an inhaled short-acting bronchodilator. After administration of the bronchodilator, which of the following spirometry results would suggest reversibility? A Decrease In FEV1 B Increase in FEV1 C Decrease in FVC D Increase in FVC
increase in FEV1 (In asthma, the airway obstruction should be at least partially relieved be a short-acting bronchodilator. This would be reflected in an increased forced expiratory volume in 1 second (FEV1).)
What type of hernia involves passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one? A Direct inguinal hernia B Indirect inguinal hernia C Umbilical hernia D Ventral hernia
indirect inguinal hernia
Which of the following medications is indicated in the treatment of patent ductus arteriosus? A prednisolone B dexamethasone C indomethacin D cyanoacrylate tissue adhesive
indomethacin (Give premature infants a prostaglandin inhibitor (eg, indomethacin) to close the PDA; surgical closure has not been shown to improve outcomes. Prostaglandin inhibitors are usually ineffective in full-term infants, but catheter-delivered occlusion devices or surgery is typically beneficial.)
A 10 year-old boy was playing with sparklers (magnesium sulfate) and got some of the "sparkle" in his right eye. Which of the following is the most appropriate initial treatment? A irrigate the eye for at least 20 minutes B apply Bacitracin ointment and patch the eye C remove the sparkle with a moistened cotton swab D protect the eye with a metal shield and refer to an eye ophthalmologist
irrigate the eye for at least 20min
A 9-year old boy was brought to the clinic by his mother on account of 5-month history of abdominal cramps, bloating, diarrhea and flatulence that occur usually about 2 hours after ingesting milk. What is his most likely diagnosis? A Giardiasis B Celiac disease C Lactose intolerance D Gastrinoma
lactose intolerance
A 6 year-old boy is brought to the pediatric clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. Which of the following would be the most appropriate treatment for this patient? A Mast cell stabilizer B Long acting beta agonist C Leukotriene receptor antagonist D Low dose inhaled corticosteroid
low dose ICS
Which of the following concerning femoral hernias is not true? A They are more common in women. B Has a low incidence of strangulation. C Cannot be controlled with a TRUSS. D accounts for about of 5% hernias in men
low incidence of strangulation (Femoral hernias have a high incidence of strangulation mainly because of the narrowness of the neck of the sac and the rigidity of the femoral ring.)
Which of the following electrolyte abnormalities is associated with bulimic patients? A Metabolic acidosis B Respiratory acidosis C Metabolic alkalosis D Respiratory alkalosis E Normal electrolytes
metabolic alkalosis
Which of the following is an indication for hospitalization in a patient who has acute bronchiolitis? a. pulse ox 94% on room air b. children 4-6mos old c. mod tachypnea with feeding difficulty d. hyperinflation and interstitial infiltrates on CXR
moderate tachypnea with feeding difficulty
Which of the following is the most effective way for patients with persistent asthma to monitor the severity of their symptoms? A call the health care provider regularly B keep a diary of symptoms C monitor peak flow D ask a family member to monitor symptoms
monitor peak flow
A 4 year-old boy presents with purulent, foul-smelling nasal discharge for three days. He has not had any other symptoms of respiratory illness, cough, wheeze, or fever. His activity level and appetite has been normal. On exam, he is afebrile. TM's have normal light reflex, canals are clear. Left nare is clear; there is considerable amount of purulent exudate from the right nare, and a bright reflection of light is noticed. Oropharynx is without inflammation or exudate. Neck is supple, without lymphadenopathy. Lungs are clear, with equal breath sounds and no wheezing. Heart has regular rhythm without murmurs. Which of the following is the most likely diagnosis? A Viral URI B Acute sinusitis C Allergic rhinitis D Nasal foreign body
nasal FB
A previously healthy 8-month-old boy is hospitalized for acute bronchiolitis. He has no known significant past medical or family history. On admission, he exhibits nasal flaring and retractions with a respiratory rate of 68, axillary temperature of 102.0 degrees F and O2 saturation of 86%. Which of the following medications is indicated? a. prednisolone b. oxygen c. ceftriaxone d. Palivizumab (Synagis)
oxygen
A 14 year-old male presents to the ED experiencing a severe asthma attack. His respiratory effort is shallow and he is using accessory muscles to breathe. Auscultation of his chest reveals no audible wheezing. Vital signs include BP 90/60 mmHg, P 160 bpm, RR 52. An arterial blood gas (ABG) is ordered. Normal ABG values at your institution are pH 7.35-7.45, CO2 35-45, pO2 80-95. Which of the following ABG findings suggests the poorest prognosis? A. pH = 7.27 pCO2 = 46 pO2 = 56 B. pH = 7.60, pCO2 = 18 pO2 = 80 C. pH = 7.44, pCO2 = 38 pO2 = 90 D. pH = 7.52, pCO2 = 28, pO2 = 80
pH = 7.27 pCO2 = 46 pO2 = 56 is associated with the poorest prognosis in this patient. The clinical presentation of asthma is a respiratory alkalosis with high RR, low pCO2, and decreased pO2. The fact that the pCO2 is elevated despite the high respiratory rate suggests profound air trapping and respiratory failure.
A phobia is an excessive fear of an object or place that leads to or can be preceded by: A panic attack B depression C hallucinations D delusions E confabulations
panic attack
Which of the following is not a major criterion for diagnosing acute rheumatic fever? A Polyarthralgia B Sydenham's Chorea C Migratory polyarthritis D Erythema marginatum
polyarthralgia (this is a minor criterion)
One theory of persistent depressive disorder states that the disorder is the result of anger experienced in childhood that manifests as self-loathing and results in depressed mood and maladaptive thoughts. What type of theory would this be classified as? A Behavioral B Humanistic C Cognitive D Psychodynamic
psychodynamic (Many psychodynamic theories focus on how experiences in childhood shape adulthood.)
A pediatric patient presents with a history of multiple recurrent respiratory infections associated with failure to thrive. A sweat chloride test is elevated. Which of the following is a common cause of death in patients with this condition? A Diabetic ketoacidosis B Pulmonary infection C Intestinal obstruction D Acute respiratory failure
pulmonary infection (This patient has cystic fibrosis. The most common causes of death include pulmonary complications, such as infections, and terminal chronic respiratory failure associated with cor pulmonale.)
Which of the following history findings would trigger a workup for vesicoureteral reflux in a young female patient? A Dark-colored urine B Epigastric abdominal pain C Nocturnal enuresis D Painless hematuria E Recurrent cystitis
recurrent cystitis
A blacksmith presents to your clinic after feeling like something went in his eye while he was grinding on a piece of metal. You stain the eye with Fluorescein and can visualize uptake with what appears like a deep abrasion. You are unable to visualize any foreign body with your indirect ophthalmoscope. Although he makes an attempt, he complains of some visual loss in that eye. His last Tetanus booster was 4 years ago. What is the most appropriate next step in the management of this patient? A Administer tetanus B Prescribe Tetracaine ophthalmic C Provide reassurance only D Refer to ophthalmologist
refer
Which statement regarding management of this condition is true? A. bronchodilators provide a consistent benefit for this illness B. corticosteroids are routinely indicated for initial management C. ribavirin should not be used routinely in this condition D. intravenous fluids are required for infants younger than year E. chest physiotherapy provides proven benefit for this condition
ribavirin should not be used routinely in this condition (Inhaled ribavirin is an antiviral medication used to treat bronchiolitis. Some studies document improvement in the respiratory score and decreased hospital length of stay with ribavirin. Indications for its use are controversial. It may be considered for treatment of patients predisposed to development of severe RSV-related morbidity because of underlying health problems.)
Where are murmurs for ASD best heard? A second intercostal left sternal edge B at the upper left sternal border and in the infraclavicular area C the apex with radiation to the left axilla D the second and third left intercostal space with radiation to the left shoulder
second intercostal left sternal edge
A 45 year-old male presents with sudden onset of pleuritic chest pain, productive cough and fever for 1 day. He relates having symptoms of a "cold" for the past week that suddenly became worse yesterday. Which of the following findings will most likely be seen on physical examination of this patient? A spoken "ee" heard as "ay" B hyperresonant percussion note C wheezes over the involved area D vesicular breath sounds over involved area
spoken "ee" heard as "ay"
A hernia whose blood supply has been cut off is called A Obstructed hernia B Strangulated hernia C Incarcerated hernia D None of the above
strangulated
Which of the following is not considered an indication for hospitalization in an infant diagnosed with bronchiolitis? A < 95% by pulse ox on RA B Age < 3 months C Temperature > 100.5 D Respiratory rate > 70 breaths per minute E Atelectasis on chest radiograph
temp >100.5 (Patients with bronchiolitis will commonly present with a fever. Fever alone is not an indication for admission although you must be sure to rule out pneumonia based on your physical exam findings. All the rest of the options are reasons to hospitalize patients with bronchiolitis.)
In young female patients, any history that points to recurrent infection, especially cystitis or pyelonephritis, should trigger an evaluation for what?
vescicoureteral reflux (VUR)
Which of the following is the criterion standard for classifying the type of seizure or syndrome or for diagnosing pseudoseizures? A MRI B CT scanning C Positron emission tomography (PET) scanning D Video electroencephalography (video EEG)
video EEG
A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was negative. Which of the following is the most likely diagnosis? A acute bronchitis B viral pneumonia C mycoplasma pneumonia D pneumococcal pneumonia
viral pneumonia
GAD is more common in which of the following? A elderly white men B school-age children C married people D those of higher socioeconomic status E young to middle-aged women
young to middle-aged women (GAD is slightly more common in young and middle-aged women, ethnic minorities, those not currently married, and those of lower socioeconomic status.)