Pediatric Quizzes

What is the usual age of presentation of children with pyloric stenosis?

2-12 weeks

What is the most common cause of congenital adrenal hyperplasia?

21-hydroxylase deficiency

You are seeing a 6-month old healthy baby boy who is exclusively breast fed in the office for a routine check up. The last time you saw him he was doing well and weighed 5.9 kg (13 lbs). Between 3 and 6 months of age how many ounces should a healthy infant normally gain?

0.5 ounces per day

You are seeing a 4-month-old African-American male in your office for a routine office visit. It is his first visit to you as a patient as they just moved to town. The mother notes his birth was unremarkable and he was full term and born at 39-weeks gestation via spontaneous vaginal delivery. He has been gaining weight and breast feeding. The child's mother is worried that he might have sickle cell anemia as the child's uncle has sickle cell disease and has to go to the hospital on numerous occasions with painful crises requiring narcotic pain medication and blood transfusions. The child's father and mother deny having sickle disease but do not know if they are carriers. What are the odds that the will have a sickle cell anemia, if the carrier rate for sickle cell disease in the African American population is 1/10?

1 in 60

A 10-year old male presents via fire rescue after he was saved from a burning house fire that started from a cigarette that was left burning on the table. Upon arrival EMS noted that he was confused, disoriented and then had a tonic clonic seizure right leaving for the hospital. The seizure lasted 30 seconds and subsided after IV ativan. His current vitals show an oral temperature of 97.6 F, heart rate 115, respiratory rate is 22/min, O2 saturation on room air 96%. He has no visible burns to his body, his lungs are clear, abdomen is soft and non tender. His oropharynx is normal without any visible burn injury or swelling. He is currently awake and appears slightly post ictal. His neurological exam is non focal as he is moving all of his extremities. Which of the following is the best initial treatment for this patient?

100% oxygen with facemask

You are seeing 5-year old in the office after developing a fever and rash. The rash appeared yesterday and is very itchy and covers his trunk, face, and extremities. On exam you note it to be a erythematous papulovesicular rash as seen in the image below. What is the average incubation period of this patients underlying illness?

14-16 days

Developmental delay occurs in approximately what percentage of children?

15%

You are seeing a 9-month old baby boy in your office for a routine visit and immunizations. Upon further discussion with his mother she is asking about developmental milestones and autism screening. Up to this point his mother has no specific complaints about his development thus far and she notes that he can get into a sitting position alone, pulls to stand, has an immature pincer grasp, uses "mamma" and "dada" nonspecifically and waves bye. He is also able to sit alone and push up on his arms while in a sitting position. Based on these findings, at what age is the next recommended screening for autism using a specific screening tool?

18 months

You are seeing a child in the office for a routine visit accompanied by his parents. His parents note he has been doing well and they have no complaints or worries. Since last visit his vocabulary has grown to about 20 words and he now will imitate and repeat words his parents say. They say he can throw a ball and use a spoon to feed and drink from a cup. On exam you find him scribbling on paper with marker. What is the most likely age of this patient?

18 months

You are seeing a 24-month old girl in the office for a routine evaluation. Her mother reports no complaints and she has been meeting all of her prior developmental milestones thus far. Her mother is concerned somewhat about her daughters speech and language development. She is able to follow 2 step commands and notes that she can say about 30 words but can only say things like "drink milk" and "go potty." What is the minimum number of word phrases that a 24-month old should have?

2 word phrases

A 7-year old male presents with gradual onset of abdominal pain, nausea & vomiting 18-hours prior to arrival. He did not say anything initially to his parents because he was embarrassed. Now the pain is severe, sharp, constant and radiates to his left testicle. Vitals Signs show a blood pressure of 125/90, pulse rate of 125 beats/min, respirations 28/min, oral temperature 98.7 F Physical exam shows a diffusely tender abdomen with guarding. Genital exam shows his right testicle is elevated and in a horizontal position. Cremasteric reflex is absent. His entire scrotum is edematous and swollen with the right testicle being very tender and difficult to examine. You suspect testicular torsion and you obtain an immediate urological evaluation before obtaining the testicular ultrasound with doppler that confirms the diagnosis. What is the testicular salvage rate when detorsion is performed between 12-24 hours?

20%

A 9-day old infant is brought to you for poor feeding, vomiting and lethargy. She was born full term and had no complications after birth. Vitals show a temperature of 98.5 F, blood pressure 71/50, pulse 160/min, respirations 40/min. Exam shows a dehydrated ill appearing child with sunken anterior fontanelle and dry mucous membranes. Cardiac and lung exams are normal. Genital exam shows an enlarged clitoris with fusion of her labioscrotal folds with the absence of gonads to palpation. Labs show a Na of 127 mEq/L, K 5.9 mEq/L, BUN 28 mg/dl, Cr 0.6 mg/dl, Karyotype is 46 XX. What is the most likely diagnosis?

21-hydroxylase deficiency

How many months does the American Academy of Pediatrics recommend exclusively breastfeeding for?

4-6 months

What is the average respiratory rate in a full term newborn?

40-50 breaths/minute

You have just delivered a premature baby boy via spontaneous vaginal delivery who was approximately 28-weeks gestation to a 19-year old mother who did not receive any prenatal care. His APGAR at one minute showed his heart rate to be 95 bpm, he has blue extremities, a weak cry with some flexion to his extremities and he grimaces with a feeble cry when stimulated. What is this patient's APGAR score?

5

You are seeing a 4-week old baby boy in clinic for routine evaluation. He was born at 7lb 4 oz (3.36 kg) at 39 weeks and history is unremarkable. He appears to be gaining appropriate weight and today is 5 kg. He is not breast feeding at this time and is solely formula fed. The parents ask questions of about caloric and fluid intake per day and want to know the appropriate amount. What is the calculated calories and cc's of formula should he be consuming per day?

500 calories, 750 cc

You are seeing an 8-week old boy in your office for a routine visit accompanied by his mother. He was born full term without any complications and has been gaining weight and currently being breastfed and gets daily vitamin D supplementation. He is in the 40th% for height, weight, and head circumference. His mother wants to know up to what age can she breastfeed him without any other food supplementation?

6 months

Which of the following is NOT true regarding acute appendicitis in children?

>50% of cases of appendicitis occur in those <5 years of age

True precocious puberty is defined as secondary sexual characteristics in males before age ____ and females before age ____ ?

9 years in males: 7 years in females

A single dose of measles vaccine administered to a child older than 12 months produces protective immunity in what percentage of individuals?

95%

Cricothyrotomy is contraindicated in children under what age?

<12 years

You are seeing a 12-year old male after he was brought in via EMS after he was rescued from a house fire. He appears uninjured and was not burned during the fire. When asked how he feels he is only complaining of a mild headache and some nausea. His vital signs are normal including an O2 saturation of 100% on room air. His physical exam shows a well appearing child in no acute distress with an unremarkable exam. You immediately place him on a 100% non re breather and order an arterial blood gas for further analysis. Above what carbon monoxide levels is Hyperbaric oxygen therapy (HBO) recommended in this patient?

>25%

A 16-year old male is brought to you office because his mother found him last night disoriented in the kitchen eating an entire bag of chips. She notes went out all weekend with his friends coming home both nights after his curfew. She noted that he was responding slow to questions and both his eyes were blood shot and his mouth was dry. If this patient continues to engage in the use of the substance in question, what is he most at for down the road?

A, B, and C

You are seeing a 3-week old newborn male in your office as he has developed a skin eruption on his forehead, nose, and cheeks. The lesions are mostly closed comedones with a few open comedones, papules, and pustules. No significant erythema is seen. Which one of the following is the most likely diagnosis?

Acne neonatorum

A 6-year old male presents to the ER with lethargy via EMS after his parents found him in his room next to her empty pill bottle of twelve hydrocodone/acetaminophen (5/325mg). Mom notes she last saw him 40 minutes ago playing downstairs but was in the room doing laundry. He has no past medical history and takes no medications. His vital signs upon arrival show an oral temperature of 98.2 F, Blood pressure 90/50, heart rate 79 beats/min, respiratory rate of 10/min, O2 saturation of 99% on a room air, finger stick glucose of 103 mg/dL. Physical exam shows him to be awake but sleepy, pinpoint pupils, and clammy skin. His lungs are clear, heart sounds are normal, and the rest of his exam is unremarkable. What is the next best step in management?

Activated Charcoal

You are seeing a 3-year old boy who presents with his mom after she states she picked him up from the baby sitter and he seems very sleepy unresponsive. The mom thinks he might have gotten into something while at the babysitter. Vital signs show a blood pressure of 83/51, heart rate 140/min, respiratory rate 24/min, oral temperature 98.4F, Wt 20 kg. On exam he is sleeping but arousable to voice and stimuli, lungs are clear, abdomen is soft and he is no acute distress. He has heme positive stool. Abdominal x-ray shows multiple radiopaque tablets in the stomach. His labs show a WBC of 20,000 mm3, Hgb 10 mg/dL, BUN 26 mgdL, Cr 0.8 mg/dL, K 4 meq/L, CL 100 meq/L, CO2 17, Glucose 160 mg/dL, LFTs are within normal limits, INR 1.1, ABG pH 7.29 PCO2 40 PO2 95, HCO3 22, Urinalysis is normal. Which of the following is not an acceptable treatment option for this patient?

Activated Charcoal

A 3-year old male presents to your office with increasing lethargy, decreased appetite, night sweats, and abdominal fullness. He has no past medical history and is otherwise healthy. His parents note that has not been eating the last few days and is sleeping a lot. On exam he appears pale and you note splenomegaly and generalized lymphadenopathy. You obtain labs which are shown below: WBC: 73,000 mm3 Hemoglobin 7.5 g/dl Platelets 22,000 mm3 Blasts 70% Prolymphocytes 15% Lymphocytes 15% Histiochemical staining reveals strongly positive periodic acid Schiff (PAS) reaction, without Auer rods. What is the most likely diagnosis?

Acute lymphoblastic leukemia

You are seeing a 2-year old male in the office for a follow up visit from 3 months ago. He is currently 11kg (24.2lb) and he has a past medical history of cystic fibrosis. His mother notes that he has a had productive cough with thick green sputum over the last 2 days but denies fever. Since his last visit 3 months ago he has only gained not 14-ounces. Mom denies him having excessive gas or greasy stools. Which of the following is the next best step in the management of this patient?

Add nutrition supplements to diet and follow up in 2 weeks

You are seeing a 7-year-old female in the ED with worsening wheezing and shortness of breath that started 2 days ago. Her mother gave her oral prednisolone this morning at a dose of 1mg/kg when she woke up plus she has been using albuterol and atrovent by metered-dose inhaler with a spacer every 30 minutes today prior to arrival. In the emergency department the she is alert, with a respiratory rate of 34/min, moderate 2+ intercostal retractions and an oxygen saturation of 96% on room air and is audibly wheezing during the entire respiratory phase with an inspiratory/expiratory ratio of 1:2. Peak flow is found to be 50% of the predicted value. Of the following options below, what is the next best treatment option?

Administer magnesium sulfate IV

You are seeing an 18-year-old female in your office for a first time visit as she just moved from out of town. She is accompanied by her parents and needing to be evaluated before college. She has no previous medical problems, is in good health, and is not taking any medications. She has never smoked cigarettes and denies any prior drug use in the past. She is sexually active with her boyfriend of three years and uses no birth control. Her family history is significant for hypertension, diabetes, and pancreatic cancer. On physical examination she appears in no acute distress. Her body mass index is 24. Her blood pressure is 114/65, heart rate 62 bpm, respirations 14/min, temperature 98.4 F orally. His physical examination is unremarkable. Which of the following screening tests is recommended by the U.S. Preventive Services Task Force for this patient?

Alcohol use and abuse screening with Alcohol Use Disorders Identification Test (AUDIT)

A 5-year female presents left sided neck swelling that her parents noticed when she awoke this morning. It is painful to palpation but she denies a sore throat or troubling breathing. Her parents note that she had a cold last week. Her vital signs show her to be febrile at 100.7 F, pulse rate 99 beats/min, respirations 16/min, and a blood pressure of 84/50. On physical exam she is not ill appearing and tolerating her secretions. On her left neck there a 4 cm warm, slightly erythematous, and mobile anterior cervical lymph node with non-indurated overlying skin. Intraorally she has good dentition without signs of caries. What is the best treatment option?

Amoxicillin-clavulanate

Which of the following is true regarding the Rotavirus vaccination?

All of the above

Which of the following options are advantages to breast feeding?

All of the above

Which of the following statements regarding Tracheoesophageal Fistulas (TEF) is correct?

All of the above

You are seeing a 9-year old girl in your office for a routine office visit and wellness exam. During the interview the patient's mother asks questions about when she will start getting her menstrual cycle and if she is done growing. Which of the following statements about normal female puberty is true?

All of the above

You are seeing a 12-month old baby boy in your office for routine office visit and immunizations. During your examination you talk with his parents about some developmental achievements at home. Which of the following would be considered a red flag for a developmental delay?

All of the above are red flags at this age

You are seeing 6-year old boy who is presenting with a "cold" for a week. His mother notes a week after going to Disney he developed a fever, malaise, dry cough, a runny and congested nose, and red eyes. Then two days ago he developed a rash on face that his since spread to his chest and arms (see image below). Which of the following statements accurately describes a possible complication of his illness?

All of the above complications are true

In addition to having pruritus in the past 12 months, which of the following must be present in order to diagnose atopic dermatitis?

All of the above must be present

You are referred a 5-year old white male from his PCP for an eye abnormality. During his last physical exam he had a white reflex in his right eye and the concern was for a congenital cataract. If not treated properly which of the following is likely to occur?

Amblyopia

A 16-year-old man is brought to the emergency department by his girlfriend because of increasing confusion over the last few hours. His sister states that he recently saw a psychiatrist for the first time because of hearing voices; he was prescribed a medication, but she is not sure what it is. She says that he has a history of excessive drinking, and she thinks that he has also experimented with illicit drugs. On exam he appears acutely ill. His temperature is 102.3°F, pulse is 124/min, and blood pressure is 160/102 mm Hg. Examination shows profuse diaphoresis and muscle rigidity. His neck is supple, abdomen is soft and non tender. Mental status examination shows psychomotor agitation alternating with lethargy. His leukocyte count is 15,600/mm3, and serum creatinine kinase activity is 1425 U/L. Which of the following is the most likely explanation for this patient's symptoms?

Amphetamine intoxication

Which one of the following options below would suggest that the sudden and unexpected death of a healthy infant resulted from deliberate suffocation rather than sudden infant death syndrome?

An age of 9 months

A 6-year-old boy is brought to the ER after injuring his arm after falling off the roof of his tree house. His mother says that he is extremely active and likes to climb on everything at home and at school. Because of this he has already broken 2 other bones in the last two years. She says that his teachers reprimand him frequently for running wildly in the classroom and he often forgets to turn in his homework. His mother notes that she is going through a divorce with his father because he has a history of illicit drug use. On exam he is afebrile, his pulse is 80/min, and blood pressure is 100/80 mm Hg. Physical examination shows a dislocated left shoulder, multiple healing abrasions over the elbows, and bruising in various stages of healing over the knees. Mental status examination shows him to calm with a neutral affect. Which of the following is the most likely explanation for these findings?

Attention-deficit/hyperactivity disorder

You are seeing a 10-year female following a witnessed tonic clonic seizure while she was watching TV with her parents. She has no past medical history but her parents note she has been having early morning headaches the last few weeks. On exam she is awake and alert but slightly lethargic. Her Neurological exam is normal. Her vital signs are within normal limits. Her CT scan shows a space occupying lesion in her left parietal lobe. What is the most likely diagnosis?

Benign Astrocytoma

You are seeing a previous healthy full term 18-month old male in the office for a routine evaluation. During your eye exam you note the following image below. What is the most common cause of this physical exam finding?

Cataract

A 5-year old male presents to your office with increasing lethargy, decreased appetite, night sweats, and abdominal fullness. He has no past medical history and is otherwise healthy. His parents note that he had bronchitis 2-weeks ago and a sore throat and seemed to get over it but has not been eating the last few days and is sleeping a lot. On exam he appears pale and you note splenomegaly and generalized lymphadenopathy. You obtain labs which are shown below: Chest X-ray shows an enlarged mediastinum, a normal cardiac silhouette, and no pulmonary infiltrates. WBC: 32,000 mm3 Hemoglobin 8.1 g/dl Platelets 29,000 mm3 Lymphoblasts 30% Prolymphocytes 10% Lymphocytes 60% What is the next best step?

Bone Marrow Biopsy

You are seeing a 2-year old previously healthy female who presents with to the ER with her parents after she had another episode of stopping breathing and turning blue. This is the 3rd episode in the last week and has happened right before she is put down for bed. The parents note she starts crying because she wants to keep playing and then stops breathing and turns blue for about 15-20 seconds. They note trying to wake her up right before they attempt CPR she wakes up and her color improves. On exam her vital signs are normal and physical exam is normal and the child is developmentally appropriate for his age. What is the next best step?

CBC and EKG

A 2-year old boy presents to your clinic with his parents for a rash on his face and forearms that appeared almost 2 weeks ago. The rash started off as small pustules on a red flat base that eventually ruptured. Now the rash has a honey colored crusted appearance and has since spread to his hands and arms. His facial is shown below. What is the most appropriate treatment?

Cephalexin

You have just delivered a newborn baby boy via spontaneous vaginal delivery at 39 weeks gestation. The delivery was prolonged and forceps were needed during the delivery which resulted in trauma and swelling to the his head. What type of injury is best described as a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum with the suture lines delineating its extent to mostly the parietal region?

Cephalhematoma

You are seeing a 4-week old baby boy with a worsening cough, difficulty breathing and poor feeding the last 2 days. His mother denies vomiting, diarrhea or fevers. He was born at 37 weeks gestation at home and mother did not have much prenatal care because they moved a lot during the pregnancy. His current vitals show a rectal temperature of 99.0 F, respiratory rate 40/min, heart rate 145 beats/min, blood pressure 72/40. On physical exam you note he has a stuccato cough. ENT exam shows him to have bilateral conjunctivitis, a normal oropharynx and tympanic membranes are within normal limits. Lung exam reveals bilateral rales. Skin exam shows no rash present. His chest x-ray is shown below. What is the most likely diagnosis?

Chlamydia Trachomatis Infection

You are seeing a 5-year-old Caucasian male who presents with recurrent congestion, sinus infections, cough, and ear infections. He has had 3 to 4 episodes in the past few year, as well as pneumonia. His parents also note that he gets recurrent bouts of diarrhea. His past medical history is unremarkable. He is up to date with his vaccinations but prior antibody titers failed to show a proper immunological response. You are suspicious of a possible immunological disorder and decide to admit the child for further evaluation and workup. His labs show a severe reduction in IgG, IgA and IgM from the last time he was testing 5 months ago along with thrombocytopenia and a hemolytic anemia. What is this child most likely suffering from?

Common variable immunodeficiency

You are seeing a 14-year old female in the office with her parents because she is acting out of control. She skips school frequently, steals from department stores, and is always getting into fights on school grounds which has resulted in numerous suspensions. What is the most likely diagnosis?

Conduct disorder

You are seeing a premature baby boy who was born at 35-weeks gestation who developed respiratory distress shortly after birth via vaginal delivery. His history in utero is limited as mom did not receive adequate prenatal care. On exam his temp is 37.2 C, HR 155, RR 45 and BP is 40/18. His APGAR scores were 3 and 4. His exam shows a newborn boy in distress who is cyanotic, grunting, scaphoid abdomen with absent breath sounds on the left with apparent high pitched bowel sounds auscultated in the lower left lung field. What is the most likely diagnosis?

Congenital diaphragmatic hernia

What is the most common food allergy seen in children?

Milk Allergy

You are seeing a 5-year old in your office for a routine examination. Upon eye examination you note him to have asymmetric corneal light reflexes and 20/60 vision in his right eye (left eye is 20/20). Which of the following tests will most likely be abnormal in this patient?

Cover/Uncover Test

What is the most common congenital abnormality of the genitourinary tract?

Cryptochordism

You are seeing a 15-year old male who is presenting a painless enlarging testicular mass in his right hemiscrotum. What is the most significant risk factor for testicular cancer?

Cryptochordism

You are seeing a 6-year girl in your office who is presenting with her parents because increased thirst, polyuria, and is now bed wetting again. The symptoms started about 3-weeks ago and seem to be getting worse. Her labs are show a serum Na of 153 mEq/L, K 3.8 mEq/L, Bicarbonate 25 mmol/L, Cl 108 mEq/L, BUN 12 mg/dL, Ca 9.1 mg/dL and glucose of 85 mg/dl. Serum Osmolarity is 298 mOsm/L, her first am urine osmolarity is 120 mOsm/L and specific gravity is 1.050. What is the most likely diagnosis?

Diabetes Insipidus

Which one of the following historical features is most suggestive of congestive heart failure in a 6-month-old infant that presents with tachypnea?

Diaphoresis with feeding

Which of the following X-linked disorders has the highest frequency?

Duchenne Muscular Dystrophy

You are seeing a 3-year-old white male in your office accompanied by his parents. His father tells you that over the past few days he has developed a rash on his hands and sores in his mouth. On physical examination you note a vesicular exanthem on his hands. The oral lesions are shallow, whitish, ulcerations distributed randomly over the hard palate, buccal mucosa, gingiva, tongue, lips, and pharynx. What is the most likely diagnosis?

Hand, foot, and mouth disease

You are seeing a newborn female (first born) in the hospital on day 2 following a breech delivery. She was born full term to a mother who has a past history of developmental dysplasia of the hip. On examination you note she has polydactyly of her right foot. You also note a positive Barlow and Ortalini maneuver. Which of the following is the most significant sequelae of this condition if properly treated?

Early Osteoarthritis

You are seeing a 5-year old girl who is accompanied by her mother because she continues to wet the bed at night despite the use of a star chart and they don't know what to do now. She has no past medical history and no known behavioral problems. There is no history of increased urinary frequency, urgency, and her urinalysis is normal. What is the best initial treatment option for the management of this patient?

Enuresis "Wet" Alarm

You are seeing a 5-year old boy who presents with a sore throat, fever and refusing to eat or drink over the last 12 hours. His vitals show a current temperature of 101.8 F, respirations 34/min, pulse rate of 125/min. Exam shows him to be drooling, tachypneic with mild retractions, his oropharynx looks red but otherwise unremarkable, his tonsils appear of normal size and their are no exudates. His lungs are clear and heart sounds are normal. What is the most likely diagnosis?

Epiglottitis

A 15-year old white male presents with atraumatic right thigh pain and swelling that been getting worse over the last few months. He also notes increasing fatigue and weight loss as well. His X-ray is shown below that shows an "Onion skin" periosteal reaction of his distal femur. A biopsy demonstrates a translocation of chromosome 11 to 22. What is the most likely diagnosis?

Ewing Sarcoma

You are seeing an 8-year old female who presents after feeling something got into her left eye while walking on the beach. She initially felt a foreign body sensation and tearing and pain. She went to sleep and woke up with severe photophobia and pain in her left eye. She has no past medical and wears no contacts or glasses. You apply a lidocaine ophthalmic drop in her eye and her pain is resolved. On exam her vision is 20/30 in her left eye and 20/20 in her right eye. Her conjunctiva is not injected and sclera is clear. He left eye is tearing and fluorescein staining reveals a 15% abrasion of her left cornea in the left upper quadrant with no imbedded foreign body. Which of the following is the best treatment option for this patient?

Erythromycin ointment qid

You are seeing a 6-month old boy in your office for a routine visit. He is currently up to date with his vaccinations from his previous 2 and 4 month visits. He has no past medical history and has been meeting all of this milestones. His mother is asking about a Hepatitis A vaccination and when should he receive it. What is the best response?

He does not need one today as he will be due only after he is 12-months of age

In the approach to a pediatric patient presenting with gastroenteritis, severe dehydration is a contraindication to oral rehydration therapy (ORT).

False

True or False: Studies show that treating febrile seizures with antipyretics such as acetaminophen or ibuprofen prevent seizure recurrence.

False

What is the most common form of inherited aplastic anemia (AA)?

Fanconi anemia

In children, what is the most commonly affected site of acute osteomyelitis?

Femur

A 5-year old male presents to the ER with lethargy after his grandmother, who was watching him today, noted finding him in her room after she awoke from a nap. He has no past medical history and takes no medications. His vital signs show an oral temperature of 99.1 F, Blood pressure 60/40, heart rate 50 beats/min, respiratory rate of 8/min, O2 saturation of 92% on a room air. Physical exam shows a lethargic child that is arousable to painful stimuli, pinpoint pupils, and clammy skin. His lungs are clear, respirations are shallow, heart sounds are normal, and he is moving all of his extremities to painful stimuli that appear non injured. While the patient's grandmother searches for her list of her medications that were accessible to the child as they were left on the nightstand, what is the next best step?

Finger Stick Glucose

You are seeing a 10-day old full term baby boy who was referred to your ENT clinic because of noisy breathing that is worse when he is on his back that improves when he is prone. There is no history of fever, coughing, or vomiting. His vitals are stable and physical exam shows a happy baby with no wheezing or retractions. Direct laryngoscopy reveals an epiglottis that rolls side to side. What is true of this patient's condition?

He should be never be fed while lying down and he should be held in an upright position for 30 minutes after feeding

You are seeing a previously normal 8-year old African American child in clinic who just returned from Africa after visiting family for a week and was given malarial prophylaxis about 2 days ago. His mother notes that since returning he has experienced pallor, fatigue, and dark urine. You note his hemoglobin has dropped from 14.8 to 9 g/dL since his last labs 6 months ago. What is the most likely underlying diagnosis?

G6PD deficiency

You have just delivered a 33-week old newborn male to a 17-year old mother. She underwent no prenatal screening or prenatal care. The prenatal history is negative for drugs or infection. He was born with his abdominal contents protruding through a defect in his abdominal wall lateral to the umbilicus. On exam the defect is present in the abdominal wall lateral to the umbilicus and the intestines are edematous, matted and are not covered by a thin translucent sac. The rest of his exam is unremarkable. What is the most likely diagnosis?

Gastroschisis

An 18-month old baby boy is brought into your office for failure to thrive and chronic diarrhea which has been continuous. He was initially gaining weight and was in the 70th percentile but over the last 6 months he was not gained any weight and since fallen to the 5th percentile. There is no reported notable family history in his mother or father and his parents deny drug use and only drink on occasion. His mother mentions that her former boyfriend was a heroin addict but left him before the baby was born. Physical exam reveals oral thrush, generalized lymphadenopathy and eczema. What is the most likely diagnosis in this patient?

HIV infection

Which of the following is NOT true regarding hemophilia?

Hemophilia A is an X-linked recessive disorder caused by factor VIII deficiency and is less common than hemophilia B

You are examining a 2 hour old male newborn following an uncomplicated vaginal delivery. Per history you find out that the mother is positive for hepatitis B surface antigen. Out of the answers listed below, what is the correct protocol to follow?

Hepatitis B vaccination, hepatitis B immunoglobulin within 12 hours of birth, and the second dose of hepatitis B vaccination at 1 to 2 months, and a third dose of vaccine at six months.

A 5-day old male presents to your clinic with lethargy and worsening jaundice. He was born at 39 weeks via spontaneous vaginal delivery. His mother was blood type B+ and he was initially treated for ABO incompatibility. His bilirubin now is 25mg/dl and direct is 0.4mg/dl. His hemoglobin went from 14 to 10 g/dl and retic count is 4%. His blood type is also B+ and coombs test is negative. The mother's incubated red cell osmotic fragility study is abnormal. What is the most likely cause of this neonate's symptoms?

Hereditary spherocytosis

A 15-year old female presents with recurrent constipation and has missed her period over the last few months. Her mother also notes she has had about a 10-15 lb weight loss. She denies other complaints, she notes being otherwise happy and is doing well with school but having some problems fitting in with classmates. She runs track and "just wants to be healthy." Currently her BMI is 16 and she weighs 100 lbs. Vital Signs show a heart rate of 45 bpm, respiratory rate 14/min, blood pressure 93/55, and oral temperature 98.9 F. Upon standing her blood drops to 80/40 and heart rate increases to 65 bpm. Physical exam shows her to be thin, her skin is dry and hyperkeratotic, and she has downy black hair on the back of her neck. What is the most appropriate step at this time?

Hospitalization

You are seeing a 19-year old black male in the ER after he passed out while at football practice. He has no past medical history and takes no medications. He has a family history of some unknown cardiac condition as his father and older brother passed away in their mid 20s. On exam his pulse is 120, respirations are 20/min and blood pressure is 95/55. Cardiac exam reveals a loud holosystolic murmur at the apex and right upper sternal border. Lung ausculation is normal. His pulses are equal and there is no lower extremity swelling. What is the most likely diagnosis?

Hypertrophic Cardiomyopathy

In isolation, which of the following congenital heart diseases is considered to be a cyanotic congenital heart disease?

Hypoplastic left heart syndrome

A 13-year old male presents with acute onset of abdominal pain, nausea and vomiting about one hour prior to arriving. He notes the pain started while he was participating in gym class. The pain is severe, sharp, constant in his left lower quadrant and radiates to his left testicle. He says that he had a similar episode two days prior that resolved after only 15 minutes. Vitals Signs: Blood pressure 125/90, Pulse rate 125 beats/min, Respirations 16/min , Oral temperature 98.2 F Physical exam shows his abdomen to be diffusely tender but more in his lower quadrants. His scrotum is edematous and swollen. The right testicle is tender and difficult to examine and you are unable to palpate an epididymis. Cremasteric reflex is absent and the right testicle is elevated and in horizontal position. What is the next best step in management?

Immediate urological consultation

You are seeing a 4-year old boy in clinic who is presenting with recurrent lymphadenopathy that has needed surgical drainage 3 times now. This is his 4th bout over the last 18-months along with a prior episode of pneumonia that required hospitalization. Surgical drainage this episode revealed Staphylococcus aureus on culture and numerous bacteria filled segmented neutrophils on microscopy. Based on these findings what is the most likely mechanism for this patient's recurrent infections?

Impaired oxidative metabolism within phagocytes

Which of the following statements about Puberty in False?

In males, the appearance of pubic hair usually precedes an increase in testicular volume

You are seeing a child in your office with injuries that are suspicious of non accidental trauma. Which of the following is NOT true regarding the classic metaphyseal lesion (CML) or a "corner" or "bucket-handle" fracture?

In many cases CML fractures occur from unintentional mechanisms which result in significant twisting motion at the knee

You are seeing a 9-year old white female who presents with hair loss over the last few weeks. On exam you note 3 patches of alopecia to the top of his head along with some mild scaling to the underlying skin and a few scattered black dots. Neck exam reveals some enlarged posterior cervical lymph nodes. What is the most likely complication that he will develop?

Kerion

What preventive measure has been shown to decrease the incidence of sudden infant death syndrome (SIDS) in the United States the most?

Infant Supine Sleeping

Which of the following best describes a child's growth who has familial short stature?

Infant and parents are small. Growth runs parallel to and just below the normal curves

You are seeing a 15-year old male in your office who has been having abdominal pain over the last 3 months. He has no prior past medical history and is the 10th grade. He gets good grades and is not involved in any extracurricular activities and has few friends. He notes his pain is worse right when he wakes up before school. Pain is worse with eating but denies vomiting. He denies weight, constipation, fever or blood in his stool. He has gained 2 lbs since his last visit 10 months ago and remains in the 40th percentile for height and weight. Which of the following symptoms are supportive of a diagnosis of functional abdominal pain?

Intermittent Diarrhea

You are seeing a 4-year-old male in the office because of recurrent fevers over the last week. His current oral temperature is 102.1 F. Examination shows anterior cervical lymphadenopathy, nonexudative conjunctivitis bilaterally, an erythematous truncal rash, and edema of the hands and feet. A picture of his mouth is also shown below. Which of the following is the most appropriate pharmacotherapy to prevent aneurysm formation?

Intravenous immune globulin

You are seeing 3-year old black male who is presenting with several days of cough, runny nose, congestion, and wheezing. He has a past medical history of wheezing in the past and has been given albuterol for prior bouts of bronchiolitis. Since this morning his mother notes worsening shortness of breath and increased work of breathing despite three back to back nebulizer treatments. Vital Signs show his temperature orally is 99.2F, pulse 141 beats/minute, respirations 30/min, blood pressure 91/45 mm Hg, and pulse oximetry 88% on room air. Physical exam shows him to be lethergic, tachypneic with mild suprasternal retractions, diminished breath sounds with inspiratory and expiratory wheezing. You start him on ipratropium nebulizer along with continuous nebulizer treatments with albuterol, IV steroids with little to no response. Chest X-ray shows hyperinflation with no infiltrates and ABG results show a pH 7.24, PO2 62mm Hg, PCO2 50mm Hg. What is the next best step?

Intubation and mechanical ventilation

A 4-year old male presents to your office with his parents as he has been fatigued for a week and has had a swollen groin and a rash on his legs and left foot since yesterday. His parents note that he has had signs of an upper respiratory infection for about 2 weeks now with mild cough and runny nose. His mother denies other prior medical problems. On exam he appears ill and dehydrated. His mouth is dry and he is tachycardic. His skin exam is shown below. His right hemiscrotum is swollen and tender along with his abdomen in his right lower quadrant. His urinalysis shows a moderate amount of blood and 2+ protein. Which of the following adverse outcomes is he most likely to develop?

Intussusception

You are seeing an 11-month-old male in your office as his parents think he has been having abdominal pain today along one episode of non bilious vomiting. They note he has had several episodes over the last few hours that last 1-2 minutes. During these episodes there is associated screaming, and lifting his legs to his chest. Afterward these episodes subside, he seems normal. On exam his vital signs or normal. Physical examination shows some fullness in the right upper quadrant of the abdomen without rebound. What is the most likely diagnosis?

Intussusception

You are called in to see a 5-year old girl in the ED who was brought in by her grandmother for vomiting, diarrhea and abdominal pain. The nurse noted her to be vomiting blood shortly after being triaged. The patient's grandmother mentioned finding her in her mother's bathroom (she is pregnant) with unknown pills scattered on the floor 3 hours prior to her developing symptoms. On exam her temperature is 99.1 F, HR 145 bpm, RR 40, BP 82/44. Physical exam shows her to appear uncomfortable, tachypneic and has mild diffuse abdominal pain to palpation. Her skin is cool and clammy. Cardiac exam is unremarkable. Her abdominal x-ray and laboratory studies are shown below: Which of the following substance was most likely ingested? WBC 16,200 mm3, Hgb of 14.1 g/dl, platelets of 310,000 Na 138 meq/L, K 3.7 meq/L, Cl 100 meq/L, Bicarbonate 14 meq/L, BUN 15 mg/dl, Creatinine 0.4 mg/dl, Glucose 154 mg/dl, lactic acid 4.1 meq/L. ABG: pH 7.29, PaO2 92 mmHg, PaCO2 27 mm Hg

Iron

You are seeing a 12-week old male in the office as a new patient. He was full term born at 39-weeks gestation and pregnancy was uncomplicated. Both parents have no past medical history of genetic abnormalities. His image is shown below. Which of the following is not correct regarding this patient's underlying illness?

Is a heritable disorder and future pregnancies are at risk

Which of the following is true about breast feeding?

Is composed of approximately 30% casein protein and 70% whey protein

You are seeing a 7-year old child in your office who is presenting with a rash to his body that is acrally distributed along with painful mouth blisters. The rash was preceded by fever, malaise and loss of appetite. The initial lesions began as round erythematous papules that evolved into the target lesion shown below. Which of the following is not true regarding this child's illness?

Is more common in children than adults and has a female predominance

Which of the following facts about internal tibial torsion is False?

It is the most common cause of out-toeing in toddlers as they begin to walk

You are seeing a previously healthy 2-week old male who was born full term. Prior to today his mother notes he has been feeding poorly, slightly more lethargic and vomiting the last few days. He presented today after suffering a seizure and his glucose was found to be 31 mg/dl. On exam he has a protuberant abdomen and palpable liver. His labs show an elevated direct bilirubin level of 9.8 mg/dl, ALT of 567 U/L, INR or 1.8 sec, creatinine of 5.6 mg/dl, urine shows glycosuria and aminoaciduria and he has a serum pH of 7.12. Which of the following statements if correct regarding this patient's underlying illness?

Lactose free-soy based formulas should be substituted for all feedings

What is the best indicator for developmental delay in children?

Language Disorder

You are seeing a 5-year old female in clinic because she is unable to be toilet trained. She keeps her on a normal bathroom regimen and she goes when she is supposed to but her mother notes that she is wet with urine all the time. What is the most likely diagnosis?

Low implantation of one ureter

A previously healthy 18-month old male is brought to your office with a bloody stools the last 24-hours. Just after arriving at your office he passes large bloody stool. Parents deny he has had any abdominal pain or vomiting. His vital signs are normal, and abdominal exam shows no tenderness, guarding and tenderness in his right lower quadrant. A rectal examination shows blood on the examining finger. Which one of the following is the most likely diagnosis?

Meckels diverticulum

You are seeing a 9-year old female who is presenting with facial swelling, fatigue, and lower extremity edema. She has no know past medical history but is adopted from Vietnam and her family history is unknown. Her vitals signs are normal including her blood pressure of 105/70. Physical exam shows a well appearing child with facial edema periorbitally, a soft non tender abdomen, and lower extremity swelling of 2+ bilaterally. Her labs show are shown below. What is the most likely diagnosis? Urinalysis: 4+ urinary protein with microscopic hematuria Blood: Na 137 mg/dL, K 3.8 mg/dL, Creatinine 1.0 mg/dL, albumin 1.0 g/dL, bilirubin 0.8 mg/dL, AST 60 U/L, ALT 66 U/L, HBs Ag positive, HBeAg positive, Anti-HBsAg antibodies negative, Anti-HCV antibodies negative.

Membranous glomerulonephritis

What is the most common pediatric foot deformity?

Metatarsus adductus

You are seeing a 6-year male in your office because of decreased energy and swelling over the last two days. His father notes he just got over a stomach bug last which caused mild vomiting, diarrhea, and abdominal pain but was given an some antibiotic but doesn't remember the name. On exam he appears tired, his conjunctiva are pale and you note scattered diffuse petechiae on his skin along with mild bilateral lower extremity swelling. You draw some labs and the results are shown below. What is the most likely cause of his anemia? Hgb: 8.3g/dL, WBC: 11.600/cmm, Platelets: 61,200/cmm, BUN 38 mg/dL, Creatinine: 2.9 mg/dL, Total Bilirubin: 4 mg/dL, LDH: 1100IU/L, Reticulocyte count 8%, Protime (PT): 11 sec, Partial thromboplastin time (PTT): 26 sec. Peripheral smear shows multiple schistocytes.

Microangiopathic Hemolytic Anemia

A 3-week old male presents with bilious vomiting. His Upper GI series is shown below. What is the diagnosis?

Midgut Volvulus

A 3-week-old male is brought to your office because of a sudden onset of bilious vomiting. He was delivered at term after a normal pregnancy, and has had no health problems to date. He is irritable and refuses to breastfeed, but has been having normal wet diapers and his stools have been normal. Physical examination shows a fussy child with a distended abdomen. His upper GI series shows a corkscrew appearance. Which one of the following is the most likely diagnosis?

Midgut volvulus

Which of the following below is incorrect regarding headaches in the pediatric population?

Migraines in children are often located in the occiptal region

Which of the following statement about endocarditis in children is incorrect?

Most children with infective endocarditis (IE) DO NOT have an identifiable risk factor for the disease

Which of the following is most accurate regarding Cerebral Palsy?

Most common form is spastic CP

Which of the following statements regarding Juvenile Idiopathic Arthritis (JIA) is true?

Most patients with Systemic Juvenile Idiopathic Arthritis present with fever

An unconscious 16-year-old male is brought into the emergency department via EMS after he was found unresponsive at home. He has a past medical history of depression and takes paroxetine. Vitals signs are significant for a respiratory rate of 8/min, pulse rate is 60 beats/min and regular, blood pressure 98/62, and oral temperature 96.5 F. On physical exam he is obtunded and moans to painful stimuli. His pupils are miotic and minimally reactive. What is the most likely cause of his altered mental status?

Narcotics overdose

You are seeing a 2-week old female in the ER with a fever since last night. She was born at 36 weeks via sponataneous vaginal delivery to a young mom who recieved no prenatal care. Her delivery was uncomplicated and she went home on Day #3. Her current rectal temperature is 101.2 F. On exam she is letheragic appearing and her anterior fontanelle is bulging. Her labs show a CBC of 22,000mm3, urinalysis shows 0 wbc/hpf, chest x-ray is clear, and CSF studies show 400 WBC's/hpf with a neutrophil predominant. Which of the following is not a common cause of meningitis in the newborn?

Neisseria meningitidis

You are consulted to see a 2-week old male infant in the neonatal ICU after he needed a gastrostomy tube placed because of poor feeding, lethargy, and weight loss. On exam you note him to have odd physical features such upslanting almond shaped eyes, down turned mouth, and small hands and feet. Which of the following is true of this patient's underlying disease?

Paternal deletion of 15q11-13 is found in 70% of individuals affected

You are seeing a 6-year old male who is presenting with generalized edema, fatigue, and abdominal discomfort. His symptoms started over the last two weeks with the swelling initially starting in his eyes and has since spread. He has no past medical and takes no medications. Vital signs show his blood pressure of 98/60, heart rate 95 beats/min, oral temperature 99.1 F, and O2 saturation of 100% on room air. His in office urinalysis shows 4+ proteinuria, no blood, and a normal urinary sediment. What is the most likely finding if you were to biopsy his kidney?

Normal Findings

You are seeing a 2-month old for evaluation of a fever for the last 12 hours. He was born at 37-week gestation via spontaneous vaginal delivery. Pregnancy was uncomplicated and he has been doing well up until he awoke with a fever of 101.5 F. Despite the fever, he has tolerated his oral formula well during all his feedings. On exam he has clear rhinorrhea and sneezing. His 3-year old brother had an upper respiratory infection about a week ago and has since gotten better. His chest x-ray is shown below, what finding is seen?

Normal cardiothymic silhouette

You are seeing a new 3-year old male in clinic today along with his parents. They are concerned that he doesn't like being held, doesn't interact much with other children, and rarely smiles. They are also concerned that he has some sort of developmental delay. Of the following, which feature would be most helpful in distinguishing Asperger's syndrome from Autism in this patient?

Normal language development

You are seeing a 6-month old boy in your office for immunizations and a wellness exam. He was born full and had an uneventful hospital stay. He has doing well since his last visit and has been tolerating stage I foods. He is still being breastfed and his mother notes no feeding issues. Today his weight is in the 30th percentile, height is 50th percentile and head circumference is in the 45th percentile. On exam you note he is happy and babbling while sitting up on his own but will not say any words such as "dada or mama." He smiles at his parents when they call his name but when you approach he appears anxious and cries. He is able to sit up on his own and stand up if being held by his arms. When shown a toy he doesn't reach for it but will hold it when put in his hand. He is unable to transfer it from side to side and doesn't reach for the toy after dropping it. What is the most accurate assessment of his Gross Motor/Fine Motor/Cognitive development thus far?

Normal/ Delayed/ Normal

A 35-week newborn male is born to a 44-year old mother with his abdominal contents protruding through a midline defect in his abdominal wall. The prenatal history is negative for drugs or infection. Prenatal screening and ultrasound showed polyhydraminos. On exam the defect is present in the abdominal wall in the umbilical and supraumbilical region with intestines covered by a thin translucent sac. The rest of his exam is unremarkable. An image is shown below. What is the most likely diagnosis?

Omphalocele

You are seeing a mother and her two kids in the office for routine examination. The children are aged 4 months and two years. Their mother is requesting that her children get vaccinated for influenza. Which of the following represents current immunization recommendations for influenza?

Only the two-year-old should be vaccinated

You are seeing a 3-year old in your office for a routine evaluation. He has no significant past medical history, was born full term without complications or infection and has thus far achieved most of his developmental milestones. He has gotten sick a few times in the past year since starting day care and has had 1-2 ear infections. His parents not that his language has not been developing since his last visit and he has trouble pronouncing certain words and strangers are unable to understand him. He can only say 1-2 word sentences and has trouble saying words with "R". What is the most frequent cause of mild-moderate hearing loss in young children?

Otitis Media with Effusion

You are seeing a 16-month-old white female in your office for follow up on blood work that showed a hemoglobin level of 8.0 g/dL (Normal for age 10.5-13.5 g/dl) and a serum ferritin of 10 mcg/L. Her parents noted that she started whole milk at 9 months of age and drinks about 60 ounces per day. She appears healthy otherwise and has no family history of anemia. Her CBC reveals a mild microcytic (65 fL), reticulocytes 1.8%), hypochromic anemia with RBC poikilocytosis, and an elevated RBC distribution width (RDW). You decide to initiate treatment with ferrous sulfate and you obtain follow up labs in a few weeks. What would you expect the labs to show assuming the therapy is successful?

Option C

You are seeing a 20 month old male who is presenting with 3 days of subjective fevers, decreased appetite, and crying all night. He is previously healthy and up to date on his immunizations. He has never had an ear infection in the past. He is not in day care and has no sick siblings. His vitals show an oral temp of 101.3 F. He is crying on exam and upset but otherwise well appearing. Otoscopic exam which shows a red bulging left TM and a dull gray right TM. He has a snotty nose and the rest of his exam is normal. What is the most appropriate treatment?

Oral amoxicillin for 10 days with outpatient follow up

Which one of the following is true regarding current U.S. Preventive Services Task Force guidelines for fluoride supplementation?

Oral fluoride supplementation is recommended if the primary drinking water source is low in fluoride

A 15-month-old male is brought to your office with 2 days of a dry cough, nasal discharge, increased respiratory rate and wheezing. His immunizations are up to date and he attends day care regularly. His vitals show a temperature of 100.8°F, respiratory rate 42/min, O2 saturation is 94% on room air, and pulse rate 118 beats/min. On physical exam he appears to be well hydrated and is child is sitting quietly on his mother's lap. Pulmonary exam reveals inspiratory crackles in the left lower lung field. The remainder of the examination, including an cardiac and HEENT examination, is otherwise normal. You start a nebulized albuterol treatment but no improvement is noted. What is the most appropriate treatment in the management of this patient?

Oral high-dose amoxicillin (90 mg/kg/day), with close outpatient follow-up

You are seeing a 5-year old black male in clinic with right hip pain over the last 5 months and a new limp which prompted his office visit. His parents note that he takes short steps with his right leg during ambulation. On exam there is decreased range of motion along with some atrophy to his right proximal thigh muscles. His x-ray is shown below. What is the most likely diagnosis?

Osteonecrosis

You are seeing a 13-year old boy who presents with worsening right lower leg pain over the last 2 months. He denies fever, chills, weakness, or fatigue. He is an avid soccer player and is very active but denies an acute injury. On exam you note his left leg is swollen, tender just above his left knee along with a mass. His X-ray is shown below. His labs show an elevated alkaline phosphatase, sedimentation rate, and lactate dehydrogenase. What is the most likely diagnosis?

Osteosarcoma

A 5-year old male presents to the ER via EMS with lethargy after his grandmother, who was watching him today, noted finding him in her room after she awoke from a nap. He has no past medical history and takes no medications. His vital signs show an oral temperature of 99.1 F, Blood pressure 60/40, heart rate 50 beats/min, respiratory rate of 8/min, O2 saturation of 100% on a non rebreather, and finger stick glucose with EMS was 131 mg/dL. Physical exam shows a lethargic child that is arousable to painful stimuli, pinpoint pupils, and clammy skin. His lungs are clear, heart sounds are normal, and he is moving all of his extremities that appear non injured. The patient's grandmother provides you a list of her medications that were accessible to the child as they were left on the nightstand . Which of the following is the likely cause of his symptoms?

Oxycodone

You are seeing a 10-month old white boy in your office due to poor weight gain. In the past you have tried different formulas to help with weight gain as he had continued to have recurrent diarrhea. Since birth his father notes his stools remain loose and greasy. His past medical history is remarkable for a recurrent cough along with a few hospitalizations secondary to bronchiolitis and pneumonia. His father smokes cigarettes and mother does not smoke. His growth curve shows him to be below the 5% percentile in weight and his growth has fallen off since his last visit and as he has fallen into the 10th percentile, which is down from the 20th percentile last visit. His physical exam shows a thin frail child, there are a few scattered bruises and ecchymosis on his arms and legs, along with mild bilateral expiratory wheezes. What is the likely cause of his growth failure?

Pancreatic Insufficiency

A 6-year old girl presents to you today with a 1 week history of fever, generalized abdominal pain, vomiting, fatigue, and weakness. Her mother states that she has an autosomal dominant inherited blood disorder that is located on the ankyrin gene causing her to have a chronic anemia, splenomegaly, and a blood smear that shows spherical erythrocytes. She also notes that when she was a neonate she had an anemia and hyperbilirubinemia that required phototherapy. Her in office Hbg has dropped from her typical 10 g/dL to 4 g/dL , bilirubin is 1 mg/dL and reticulocyte count has gone from 9% to 1 %. What is the most likely cause for this girl's present illness?

Parvovirus B19

You are seeing a 3-day old neonate in your office with bilateral eye lid swelling and mucopurulent discharge that started when he woke up. He was born prematurely to a mother who did not receive any prenatal care. His mother notes leaving the hospital against medical advice shortly after birth because of a family emergency. Which of following options below is true regarding this patients underlying illness?

Patients should be hospitalized and observed for response to therapy and for disseminated disease such as sepsis or meningitis

Which of the following is NOT commonly associated in patients with midgut volvulus?

Peak incidence is after 1 year of age

Which of the following diseases produces a restrictive lung disease?

Pectus Carinatum

You are seeing a 2-month old boy in your office for a routine evaluation. He was born full term without any complications and is currently being breastfed only. Upon discussing his immunization schedule his parents inquire about the pneumococcal vaccination (PCV-13) and how it works. Which of the following options below accurately describes the correct mechanism of how this vaccination induces immunity?

T-cell-dependent B-cell response

You are seeing a 16-month-old white female in your office for follow up on blood work that showed a hemoglobin level of 9.0 g/dL (Normal for age 10.5-13.5 g/dl) and a serum ferritin of 10 mcg/L. Her parents noted that she started whole milk at 9 months of age and drinks about 60 ounces per day. She appears healthy otherwise and has no family history of anemia. Her CBC reveals a mild microcytic, hypochromic anemia with RBC poikilocytosis, and an elevated RBC distribution width (RDW). Of the following, what is the most appropriate next step?

Prescribe oral iron

You are seeing a 16-year old male in your office who presents with feeling dizzy, lightheaded with standing, weak, fatigued, always nauseated, and not eating or gaining weight. It also seems his pubertal development is delayed. Prior to this recent illness his parents note he has been in good health and has had no problems except he broke his ankle playing soccer 6-months ago and incidentally the radiologist noted that his bone age to be of a 13 year old. His vital signs show his BP to be 88/61, HR is 80 bpm with sitting and upon standing his HR increases to 115 bpm and BP drops to 70/50. He is afebrile and his O2 on room air is 98%. On physical exam you note him to have a darker complexion than his parents, he appears well hydrated and thin. Plotting him on the growth chart shows his height to be in the 65th percentile and weight in the 20th percentile. His axillary and pubic hair appears very thin and scant and his nipples and buccal mucosa appear dark. The rest of his exam is unremarkable. Laboratory Values: Serum Potassium 5.9 meq/L Serum total T4 is 8.4 mcg/dl (normal 4.5 -12.5) TSH 2.1 mcgU/ml (normal 0.3-5) FSH 4.8 mU/ml (normal 5-30) Prolactin 6.8 ng/ml (normal 3-24) Cortisol at 8 am is 3.2 mcg/dl (normal 7-28 mcg/dl) What is the most likely diagnosis?

Primary Adrenal Insufficiency

You are seeing a 15-year old in your office for a routine office visit prior to school started. He has no past medical history and takes no medications. Per his records he is up to date on all his immunizations. You ask his mother to leave and conduct the remainder of his exam. During the HEADSS assessment, you note that he has been suicidal recently and has thought of a plan in the past. What is this patient's largest risk factor for attempting suicide?

Prior suicide attempt

You are seeing a 6-day old infant for a well child check following an uncomplicated vaginal delivery. The father reports that he is primarily breastfeeding, with occasional formula supplementation. Which one of the following should you advise him regarding vitamin D intake?

The baby should be given 400 IU of supplemental vitamin D daily

You are seeing a 2-year old male who has a past medical history of tetralogy of fallot. His mother notes that about an hour ago he began to cry, turn blue and has remained very upset. A "tet spell" or "blue" spell of tetralogy of Fallot is treated with all of the following options below except which of the following?

Prostaglandin

Six hours after delivery, a 1200-g (2-lb 11-oz) newborn develops respiratory distress. She was born at 32 weeks' gestation. Her pulse is 136/min, respirations are 60/min, and blood pressure is 60/30 mm Hg. Examination shows grunting and moderate intercostal and subcostal retractions. The lungs are clear to auscultation. Umbilical artery blood gas analysis on 60% oxygen shows: pH 7.32, PCO2 32 mm Hg, PO2 60 mm Hg An x-ray of the chest shows diffuse reticulogranular densities with an air bronchogram. Which of the following is the most likely underlying mechanism?

Pulmonary surfactant deficiency

You are seeing a 6-year old boy who is presenting with two days of worsening lower abdominal cramps, headache, and bloody diarrhea (5-6 episodes per day). He has no past medical history and takes no medications. You are suspecting E-coli O:157 infection as she noted eating hamburgers at a cookout the day prior. His vital signs are normal and physical examination reveals a well appearing child with a soft benign abdominal exam. Which of the following complications should you be monitoring?

Renal Complications

You are seeing a 4-month old in the office for a follow up visit because poor weight gain despite adequate oral intake with formula (about 30 ounces/day) after switching from breast milk at age one month. He has no past medical history and was born at 38 weeks via SVD. His current weight is in the 3rd percentile (down from the 10th percentile last visit). Physical exam shows a normal appearing thin child in no acute distress. His chemistry panel is shown below: Na: 142 mEq/L, K: 3.1 mEq/L, Cl: 115 mEq/L, HCO3: 16 mEq/L, BUN: 12 mg/dL, Cr: 0.3 mg.dL, Ca: 8.8 mg/dL, Glucose 85 mg/dL Urine pH is elevated at 8.0 and Urinary Electrolytes, Na and K are normal. What is the most likely diagnosis?

Renal Tubular Acidosis

You are seeing a 4-year old female who is presenting with a fever and difficulty urinating and increased frequency over the last day or two. Her past medical history is unremarkable except for a cold virus a few times since day care started, a UTI at ago two followed by an normal renal ultrasound. Her vitals today show an oral temperature of 101.2 F, heart rate of 121 beats/min, respirations 20/min, and blood pressure 99/54. Physical exam shows a non ill appearing child with minimal suprapubic tenderness and no flank or back pain. Her in office urinalysis shows nitrite positive, negative protein, ketones, and blood but there are 50-75 wbc/hpf. You order a contrast voiding cystourethrogram (VCUG) moderate ureteral ureteral tortuosity and dilation of the renal pelvis and calyces which is consistent with grade IV reflux. What is the most likely long term complication for this patient if left untreated?

Renal scarring

A 4-year old boy presents with 24 hours of a fever, dysphagia, drooling, and a hot potato voice. His symptoms were preceded a mild cough and runny nose two days prior to his sore throat starting. On physical he is febrile and you are unable to view his oropharynx because he is unable to open his mouth wide enough for visualization. What diagnosis does the x-ray below confirm?

Retropharyngeal Abscess

You are seeing an ambulatory 15-month old boy in the ER accompanied by his mother. She is worried about possible child abuse by the boy's estranged father who was just released from prison. She noted him to be very irritable after picking him up from his house. Which of the following fractures is more specifically associated with non-accidental trauma?

Rib Fracture

What maculopapular viral exanthem ("morbilliform") classically appears on the face first usually on the fourth day of a high fever, is contagious for several days before the onset of rash & up to 5 days after lesions appear?

Rubeolla

You are seeing a 7-year old male who presents after a witnessed seizure at home. He has no past medical and takes no medications. His mother notes finding all her medications (consisting of lisinopril, ibupfrofen, amytriptiline, and metformin) opened and on the floor but she is not sure what meds are missing. His vitals show an oral temperature of 98.5 F, blood pressure of 80/40, heart rate 110/min, respirations 14/min, O2 saturation 94% on room air, and blood glucose via fingerstick is 120 mg/dL. Physical exam shows a lethargic child that appears post ictal, dilated pupils, dry mucous membranes, and normal heart and lung exams. His ECG is shown below. What is the next best step in management?

Sodium Bicarbonate

You are seeing a 16-year old female following an overdose after she ingested her entire bottle of her mother's alprazolam and imipramine about 2 hours ago. She has a past medical history of depression and substance abuse. Vital signs show a blood pressure of 130/73, heart rate 110 beats/min, respiratory rate 16/min, oral temperature of 98.1 F. Physical exam shows her to be awake and talking but appears very sleepy and needs to be stimulated verbally or physically to keep her awake. Her labs and drug screen are normal. Her 12 lead ECG shows a normal sinus rhythm, QT interval 410 msec, QRS 130 msec . What is the most appropriate treatment?

Sodium bicarbonate

You are seeing a 5-month old girl in the office with her father because of persistent sluggishness and crying. Her father notes that ever since she started rolling over she has seemed to regress and appears tired and not as active. Her last visit was at two months and she appeared well. Her vital signs are normal and she is afebrile. Physical examination reveals a relatively hypotonic child with hepatosplenomegaly and cervical lymphadenopathy. Retinal exam can be seen below. What is the cause of this patient's symptoms?

Sphingolipidosis

Which of the following options below best describes a Toddler Fracture?

Spiral fracture of the tiba

Which of the following is NOT one of the three most common causes of otitis media in the pediatric patient?

Staphylococcus aureus

You are seeing an asymptomatic 2-year-old male patient in your clinic with his parents for a routine check-up. Physical examination reveals a systolic heart murmur. It is heard best in the lower precordium and has a low, short tone. It does not radiate to the axillae or the back and seems to decrease with inspiration. The remainder of the examination is normal. Which one of the following is the most likely diagnosis?

Still's murmur

You are seeing a 1-year old boy in clinic as he was referred to you for an abnormal eye exam. He is otherwise healthy and was born full term. On exam you note the corneal reflection from each eye is coming from a different spot on each of his eyes. He has a normal corneal reflex bilaterally.What does this patient likely have and what is the best treatment for this child?

Strabismus: Surgery now to prevent amblyopia

You have just delivered a newborn female after a long 23 hour labor. Mom pushed for over 3 hours and a vacuum was needed for delivery. Which of the following options is best described as a fluctuant, boggy mass developing over the scalp (especially over the occiput) that starts > 12 hours after delivery, crosses the suture lines and can cause hyperbilirubinemia and anemia.

Subgaleal hematoma

A 5-year old male presents with right elbow pain after a fall from the monkey bars. There is swelling noted to his elbow and he notes pain with elbow flexion/extension along with pronation and supination. His x-ray is shown below. What type of injury does this patient have?

Supracondylar Fracture

You are seeing a 10-year old male in your office with his parents as they are worried about his short stature and seems to not be growing since his last visit 16 months ago. His current height is in the 4th percentile as it was during his last visit. On exam you note mild thyroid fullness and dry skin. Which of the following lab values most likely represents this patient? Normal Lab values: Serum T4: 5-12 mcg/dl Free T4: 1.1-4.0 ng/dl TSH: 0.5 and 4.0 mIU/L 24 hour radioactive iodine uptake: 10%-25%

T4: 1.2 mcg/dl, Free T4: 0.2 ng/dl, TSH: 62 mU/ml, 24hRU 2%

You are seeing a 12-day-old newborn boy who was brought in by his parents because his lips have turned blue while feeding. He was born at 38-weeks' gestation and weighed 5 lb 2 oz; he currently weighs 2778 g (6 lb 2 oz). On exam his vitals show his temperature is 99.1°F, pulse is 177/min, respirations are 50/min, and blood pressure is 75/45 mm Hg. Cardiac exam reveals a grade 3/6 harsh systolic ejection murmur best heard at the left upper sternal border. An x-ray of the chest shows a small boot-shaped heart and decreased pulmonary vascular markings. What is the most likely diagnosis?

Tetralogy of Fallot

Which of the following statements regarding the polio vaccination is correct?

The fourth and final booster should be given after the 4th birthday and at least and 6 months after the previous dose

You are seeing a 9-year old female in your office with her parents as they are worried about her short stature and seems to not be growing since her last visit 12 months ago. Her current height is in the 4th percentile and last visit it was in the 5th percentile. She is doing well in school and gets all A's and B's. She denies complaints except that she has had a decreased appetite and is always constipated. On exam you note mild thyroid fullness/enlargement and dry skin. Which of following statements is not true regarding the underlying cause of this patient's diagnosis?

The incidence is 4 times greater in boys than in girls

A 12-year old black male with Sickle Cell disease presents with right sided chest pain and upper back pain for one day. Vitals show a pulse oximetry of 86%, heart rate 124 beats/min, respirations 22/min. Physical exam shows decreased breath sounds on the right. His chest x-ray shows a new right lower lobe infiltrate. Which of the following statements below is FALSE?

The most common etiologic agent in adults is Strep pneumonia.

Which of the following options below is not representative of Autism Spectrum Disorders?

The ratio of females to males in autism is 4-5 to 1 in autism

You are counseling a mother and father about their 6 week old child's immunization schedule. Which of the following statements is true regarding the Haemophilus influenza type B (HiB) vaccination?

The vaccination is between 95% in hundred percent effective in preventing invasive disease.

You are meeting with parents of a 10-day old baby girl with Down Syndrome in the office for a routine office visit following her uneventful birth and discharge from the hospital. Which of the following statements is accurate?

There is a possibility that she could be fertile in the future but there is a 50% chance her child will have Down Syndrome as well

You are seeing a 2-day old boy in the ICU with worsening cyanosis (greater in the upper extremities than lower extremities). His ECG shows right ventricular hypertrophy and on chest xray you see an "egg on a string. " What is the most common cyanotic congenital heart disease in the newborn infant?

Transposition of the great vessels

Which one of the following tinea (fungal) infections in children always requires systemic antifungal therapy vs that of topical treatment?

Tinea capitis

You are seeing a 16-year-old white female in clinic for advice about the treatment of her acne. On exam she has a few mild inflammatory papules on her face but no nodules are noted. She has not tried any over-the-counter acne treatments as of yet. Which one of the following would be considered first-line therapy for this condition?

Topical benzoyl peroxide

You are seeing 2-day old neonate who presents with cyanosis, difficulty breathing, grunting, and lethargy. He was born at home to a mother with no prenatal care. Cardiac exam findings suggest a right ventricular heave, wide and fixed split S2 with an ejection murmur at the left upper sternal border. Chest x-ray shows a small heart with increased pulmonary vascularity. What is the most likely diagnosis?

Total anomalous pulmonary venous return

You are seeing a 7-year old boy who is presenting with right ankle pain after he fell off the monkey bars at school. He was unable to walk on his right leg because of the pain. His exam shows swelling to his right medial ankle and there is tenderness over his posterior right medial malleolus. What is the most common type of Salter Harris Fracture and the most fracture seen in this patients x-ray?

Type II

You are seeing a 7-day old baby girl in the office following her discharge from the hospital which was uneventful. She was full term and born at 39 weeks 2 days, via spontaneous vaginal delivery. Her APGARs were 8 and 9 and his exam was normal. She was discharged on day 3 without any complications. Since his arrival at home she has not been feeding as well as in the hospital. On exam you hear a 3/6 harsh systolic murmur along the lower left sternal border and a prominent P2. What is the most likely cause of this patient's exam findings ?

Ventricular Septal Defect

You are seeing a 5-year girl in your office who is presenting with her parents because increased thirst, polyuria, and is now bed wetting again. The symptoms started about 2-weeks ago and seem to be getting worse. Her labs are show a serum Na of 150 mEq/L, K 34.1 mEq/L, Bicarbonate 24 mmol/L, Cl 104 mEq/L, BUN 15 mg/dL, Ca 9.4 mg/dL and glucose of 78 mg/dl. Serum Osmolarity is 298 mOsm/L and first am urine osmolarity is 120 mOsm/L and specific gravity is 1.050. What is the next best test?

Vasopressin test

You are seeing a 13-year-old girl in your office to follow up on some lab work after she presented with frequent nosebleeds. She has no past medical history, her family history is unremarkable except her older sister and mother also have similar symptoms. Upon further review of systems she notes that menarche began at the age of 12 years, and her menses have occurred at regular 28-day intervals and last 9 to 10 days; she has heavy bleeding on all but the last day. Her labs showed a hemoglobin concentration of 9 g/dL, platelet count of 290,000/mm3, PT and PTT are within normal limits. Physical and pelvic examinations show no abnormalities. What is the most likely diagnosis?

Von Willebrand factor deficiency

You are seeing 10-year old healthy female in your office who is presenting with eye pain and swelling since yesterday. On exam you see the image below. She has no pain with eye movement and her conjunctiva is clear with no signs of infection or abrasion. What is the next best step in management?

Warm compresses, placed off and on for about 15 minutes at a time approximately four times per day

You are seeing a 16-month old female who presents for a well child check. Since her last visit her weight has fallen from the 15th percentile to significantly less than the 5th percentile. Her height has remained at the 10th percentile, while her head circumference has remained at about the 15th percentile. On exam her language, motor, cognitive, and social development appear normal on exam and by history. Upon questioning her mother notes that she tends to have issues at mealtimes. Her stools and urine are normal. There are no symptoms of respiratory or neurological disease, and her review of systems is otherwise negative. With regard to the diagnosis of failure to thrive, which of the following is not true?

When head circumference is affected it is likely due to inadequate nutritional intake

Which of the following is not a well-documented risk factor for ischemic stroke in sickle cell anemia?

high steady-state hemoglobin levels

You are seeing a 13-year old male in the office for repeat visit following a recent diagnosis of Attention deficit hyperactivity disorder (ADHD). His mother asks why he has this condition and if there is an abnormality in his brain. What is the most likely cerebral abnormality causing this patients symptoms?

hypoactivity of the dorsolateral prefrontal cortex

You are seeing a previously healthy 2-month old female in your office for a routine examination. Her mother notes that she occasionally appears cross eyed and on exam you note a slightly asymmetric corneal light reflex. At what age does this patient need a ophthalmology referral?

if no resolution by 6 months

You are seeing a 2-year-old boy after he fell about an hour ago while walking with his mom in the store. Mom noted she kept him from falling all the way to the ground by pulling up on his right arm. Shortly after the child refused to use his right arm and cries when his mother tries to move it. His exam shows a non swollen elbow. What is the most likely diagnosis?

subluxation of the head of the radius

Which of the following statements regarding Hodgkin Lymphoma is NOT true?

the presence of Auer rods is characteristic