Peds Book Questions
Which of the following medication groupings is most appropriate for a patient 12 years old with persistent asthma who has failed to achieve well-controlled asthma while receiving step 2 treatment?
Corticosteroid + long-acting B-agonist
A 13-year-old male patient presents with intermittent abdominal pain, diarrhea, weight loss, and growth failure, and is noted on colonoscopy to have inflammatory skip lesions throughout the colon with rectal sparing. Which of the following statements is true?
Crohn's disease typically is characterized by transmural disease
A child weighing 27 kg with a history of vomiting for 36 hours is judged to be 10% dehydrated based on vital signs and physical examination. The serum sodium measurement is 134 mEq/L. An initial 540-mL bolus of normal saline results in stabilization of the heart rate and improved capillary refill. Which of the following is the most appropriate parenteral fluid choice for the next8hours?
D5 0.2 normal saline with 20mEq/L KCL (added after urination) at 220 ml/hr
A 21-month-old girl arrives at clinic in May with a vaccination record that indicates that she has received 3 DTaP doses, 3 Hib doses, 3 IPV doses, 3 pneumococcal conjugate vaccine doses, 2 hepatitis A vaccine doses, and 3 hepatitis B Vaccine doses. Which of the following should be administered at this visit?
DTaP, Hib, PCV, MMR, and varicella
A newborn male child has a flat facial profile, up slanted palpebral fissures, epicanthal folds, small mouth with a protruding tongue, small genitalia, and transverse creases on hands. What of following chromosomal disorders is most likely in this child?
Down's Syndrome (Trisomy 21)
Which of the following conditions are often associated with polyhydramnios?
Duodenal atresia, T-E fistula, congenital hydrocephalus with myelomeningocele.
A 2-week-old female infant presents with generalized HYPOtonia, duodenal atresia and HYPOthyroidism. What other structural defect is she most likely to have?
Endocardial cushion defects
A 5-year-old girl presents to the emergency department with a 12-hour history of fever and respiratory distress. On physical examination, the girl appears toxic, is drooling, and leaning forward with her chin extended. She has a temperature of 104°F (40°C), and a respiratory rate of 32 breaths/min. Which of the following is the most likely diagnosis?
Epiglottitis
An 8-year-old girl thought to have attention-deficit disorder (inattentive-type) undergoes EEG testing and is found to have a 3-Hz spike-and-wave pattern. Results of the EEG, coupled with videotaping of episodes of the patient's "inattention," lead to a diagnosis of childhood absence epilepsy. Which of the following is most appropriate for initial treatment of the child's disorder?
Ethosuximide
A 12-year-old male adolescent presents with a 1-month history of fever, weight loss, fatigue, and pain and localized swelling of the MID proximal femur. Which of the following is the most likely diagnosis?
Ewing sarcoma
A 13-year-old girl presents with recurrent abdominal pain over the last 3 months. She has missed a total of 8 days of school. There is no associated fever, weight loss, gastrointestinal bleeding, and the pain does not occur in relation to meals or awaken her from sleep. There is diffuse abdominal tenderness but no other abnormal findings on examination. Which approach is likely to help in the diagnosis and management of her condition?
Explaining the likely etiology of her Sx using a biopsychosocial model & symptomatic therapy
An 11-year-old girl is referred to your office following an abnormal screen for scoliosis. You diagnose idiopathic scoliosis on exam using Adam's forward bending test. Subsequent radiographs reveal a lateral curvature of 35 degrees. The patient is premenarchal. You refer the patient to an orthopedic surgeon and counsel the parent that the specialist will probably recommend:
External bracing
A 15-month-old boy is brought to the ED with a fever and difficulty breathing. Right-sided wheezing is noted on the PE. The patient does not improve with aerosolized nebulizer Tx. An inspiratory CXR is normal; however, the expiratory film demonstrates right-sided hyperinflation, with mediastinal shift to the left. This patient's respiratory Sx are most likely due to:
Foreign body aspiration
The mother of a 2-month-old infant brings her daughter to your office during the summer for her regular health maintenance visit. The child is cared for by her maternal grand-mother 3 days a week while the mother is at work. The infant is exclusively fed a cow milk-based commercial formula when she is with the mother; the grandmother believes that the child should also receive juice diluted with water due to the warm weather. Which of the following represents the most appropriate dietary counseling regarding this infant's diet?
Formula-fed infants at this age do not require any additional supplements beyond formula for the first 6 months of life
A 3-year-old boy with a known diagnosis of factor XI deficiency presents to the emergency department with un-controlled bleeding from a lip laceration following a fall. The most appropriate product that can be used for factor replacement in this child prior to suturing is:
Fresh frozen plasma (FFP)
In response to your question concerning guns in the home during a routine adolescent health maintenance visit, the mother of the patient tells you that her husband, the boy's stepfather, keeps a loaded handgun in the bedside drawer for protection. You would be correct in telling this family that an adolescent who lives in a home with a gun:
Has a 10 fold greater risk of dying from suicide than peers who do not live in homes with guns.
A 3-year-old boy presents with an elbow hemarthrosis after falling on his elbow. There is no history of spontaneous bleeding. There is no history of epistaxis, gingival bleeding, or cutaneous bruising. The child's maternal grandfather had frequent spontaneous bleeding and hemarthroses after trauma on multiple occasions. Laboratory results revealed a prolonged PTT, normal PT, and a platelet count of 150,000 per mm. The factor VIII coagulant activity (VIII:c) is low and the factor IX level is normal. What is the most likely diagnosis?
Hemophilia A
A 4-year-old Caucasian boy presents for evaluation of persistent jaundice. The family reports that the boy had neonatal jaundice on the first day of life, and was treated with phototherapy. He has always had mild icterus, but has had increased icterus at times, especially following other mild illnesses, such as ear infections and colds. There is a family history of his father and paternal grand-mother having undergone splenectomy. On examination, the boy has mild scleral icterus, and his spleen is palpable about 3 cm below the left costal margin. The laboratory evaluation reveals a total bilirubin of 1.9 mg/dL (unconjugated fraction is 1.5 mg/dL), normal liver transaminases, hemoglobin of 11.2 gm/dL, a normal MCV, and an elevated reticulocyte count of 8%. An osmotic fragility test is performed and demonstrates positive results. What is the most likely diagnosis?
Hereditary spherocytosis
A 5-year-old boy who returned from a camping trip to his grandparents' farm in Virginia develops a fever of 103°F, a headache, vomiting, and an erythematous, macular rash on his wrists and ankles. On physical examination, he is moderately tachycardic with otherwise stable vital signs and no focal signs of infection. A CBC reveals a normal WBC count and differential and normal hemoglobin. However, the boy's platelet count is 65,000/mm. Serum electrolytes are normal. Blood cultures and immunofluorescent studies are sent. Which of the following is the most appropriate next course of action?
Hospitalization for IV doxycycline and cefotaxime
A 9-month-old girl presents with a 3-day history of fever to103°F (39.4°C). This morning, the girl developed a rash. On physical examination, the girl is afebrile and has an erythematous, maculopapular rash over her trunk, arms, and legs. Which of the following is the most likely cause of this patient's illness?
Human herpes virus 6
Which of the following statements is true regarding Tx of children with sickle cell disease?
Hydroxyurea maintenance therapy decreases the number and severity of vasoocclusive crisis
A 5-year-old boy presents to the emergency department with complaints of dizziness and confusion. Three days before presentation he developed a low-grade fever and vomited twice. Since then, the fever and vomiting have resolved, but the patient has passed 8 to 10 loose, foul-smelling stools per day. The boy's mother has been afraid to give him anything but water or diluted juice due to his history of vomiting. Deep tendon reflexes are diminished throughout. This patient's ataxia and confusion are most likely due to which of the following electrolyte imbalances?
Hyponatremia
A 4-month-old former 30-week premature infant is seen in late October for well-child care. His mother is concerned about the transfusions that the infant required during her course in the neonatal intensive care unit and wishes to restrict her exposure to blood products. Referral for administration of which of the following would be most appropriate to limit her risk of severe bronchiolitis?
IM palivizumab
A 2-month-old infant presents to your emergency department with a heart rate of 220 beats/minute, pulses, and adequate perfusion. After giving the infant oxygen, you note abnormal P waves and a narrow QRS (0.08 sec) on the cardiac monitor. Which of the following is the best course of action?
IV Adenosine by rapid bolus
A 3-week-old male infant presents to the emergency department with 24-hour history of vomiting and poor feeding. He is found to be HYPOtensive and HYPOglycemic. His serum electrolyte values are as follows: Na 121 mmol/L, K6.9 mmol/L, CO2 20 mmol/L, chloride 105 mmol/L, BUN 17mg/dL, creatinine 0.7 mg/dL, glucose 36 mg/dL. He receives 20 mL/kg NS fluid bolus and 2mL/kg dextrose 25.What other life-saving intervention should this infant receive?
IV hydrocortisone
A previously healthy 4-year-old girl presents with a history of diarrhea and vomiting for the past 3 days and decreased urine output for the past 12 hours. On examination, she has a heart rate of 120 beats per minute, blood pressure of105/65 mm Hg, and no edema. The blood tests reveal serum sodium of 128 mEq/L, potassium 5.6 mEq/L, bicarbonate 12 mEq/L, BUN 55 mg/dL, creatinine 1.6 mg/dL. The urine tests reveal a fractional excretion of sodium of 0.1.The kidney ultrasound is normal. Which of the following constitutes the most appropriate immediate management of this child's acute renal failure?
IV normal saline bolus to correct the renal hypoperfusion
A 4-year-old male child presents with abrupt-onset petechiae and ecchymoses. Other than the skin findings, the child appears well and is hemodynamically stable. No splenomegaly is noted. A complete blood count reveals a normal white blood cell count, a normal hematocrit, and a platelet count of 12,000 per mm3. Large platelets are seen on the peripheral smear. Child had a viral illness 2 weeks prior presentation. Which is the most likely diagnosis?
Immune thrombocytopenic purpura
A 10-week-old boy is brought to the ED-ment by his mother with a history of failure to thrive and poor feeding. He occasionally vomits small amounts of for-mula. His birth weight, length, and head circumference were at the 50th percentile; however, his weight has dropped to the 10th percentile and his length to between25th and 40th percentiles. His vital signs are normal, and the physical exam is otherwise unrevealing. Venous blood gas and electrolyte study results include: pH 7.32, sodium134 mEq/L, potassium 4.5 mEq/L, chloride 106 mEq/L, and bicarbonate 10 mEq/L. Which of the following diagnoses is the most likely?
Inborn error of metabolism
At a 2-year well-child visit, you collect information that your patient lives in a very old rental home with peeling paint. Both the capillary (screening) and venous blood lead measurements are 50 g/dL. The patient has a history of constipation but is otherwise asymptomatic. Which of the following courses of action for potential lead poisoning is most appropriate?
Initiate chelation therapy in a lead-free environment within 47 hours
A 12-month-old male infant presents with hemoglobin of 7.5 and a hematocrit of 22%. The mean corpuscular volume is 65 and the adjusted reticulocyte count is 1.0%.What is the most likely cause of anemia in this child?
Iron deficiency anemia
A previously healthy 3-year-old boy presents with a history of fever and diarrhea for the past 2 days. The fever has not responded to ibuprofen, and his urine output has decreased today. On examination, he is alert, has a temperature of 101°F, heart rate of 115 beats per minute, blood pressure of 105/60 mm Hg, and mild diffuse abdominal tenderness. The serum electrolytes are normal, but his BUN is 60 mg/dL and his serum creatinine is 1.8 mg/dL. The complete blood count is normal. Urinalysis shows 1 protein, small blood, and occasional hyaline casts. The kidney ultra-sound is normal. Which of the following statements regarding his acute renal failure is most accurate?
It is due to the ibuprofen and being in a dehydrated state
A 3-year-old girl is diagnosed with new-onset insulin-dependent diabetes mellitus. Which of the following laboratory findings is consistent with diabetic ketoacidosis?
Ketones in urine
A 5-year-old boy presents with a waddling limp and hashed a stiff right hip for the last 2 months. He has minimal complaints of pain. The most likely diagnosis is:
Legg-Calve-Perthes disease
Crops of papular, vesicular, pustular lesions starting on the trunk and spreading to the extremities, in addition to small, irregular red spots with central gray or bluish-white specks that appear on the buccal mucosa, is the classic description of which of the following infections
Measles
A 2-year-old presents with painless rectal bleeding. The hemoglobin is 9 g/dL. Capillary refill remains normal. The best next step to positively identify the cause of bleeding is:
Merkel diverticulum scan
A child presents with a reduced number of CD3 T cells, an increased number of B lymphocytes that are mildly abnormal in function, has a con truncal heart lesion, HYPOplastic thymus, and HYPOcalcemia. Which of the following chromosomal disorders is most likely in this child?
Microdeletion of 22q11.2
During a male newborn examination, the testes are not palpable in the scrotal sacs. One testis is palpable high in the right inguinal canal and cannot be gently manipulated into the anatomically correct position. The left testis is not palpable but is discovered in the abdomen after consultation with a pediatric urologist and an abdominal ultrasound. In counseling the parents, which one of these statements regarding cryptorchidism is true?
More than 99% of males have bilateral descended testes by 1yo
An unresponsive adolescent patient is brought to the emergency department with suspected ingestion of an unknown substance. EMS received a call from the hotel room where the youth was found, but no one else was there when they arrived. The patient is on 100% inspired oxygen and has required several bouts of positive pressure ventilation in the ambulance. On exam, the patient has a heart rate of 55, blood pressure 85/50, pinpoint pupils, and track lines on his left arm. Along with ongoing cardiovascular and respiratory support, which of the following should be administered to this patient?
Naloxone
An infant who was discharged from the hospital on day 2 of life presents to your office 3 days later for follow-up. The mother did not receive prenatal care. You notice bilateral purulent discharge from the eyes. There is marked eyelid edema and conjunctival swelling (chemosis). What is the most likely pathologic agent?
Neisseria gonorrhoeae
A 16-year-old girl who is 2 years post menarche presents with mildly uneven shoulders and a small degree of one-sided rib prominence. Radiographs reveal a 25 degree scoliosis. Which of the following represents the best treatment?
Observation and repeat X-ray in 1 year
A 12-year-old boy with Crohn's disease for 2 years is seen with an acute exacerbation. He is complaining of abdominal pain and diarrhea and has right lower quadrant fullness. The most effective approach in this acute setting is which of the following?
Obtain a stool culture and to exclude acute infectious colitis and imaging studies to evaluate for abscess or fistula.
24-month-old male in your office for his regular health maintenance visit has the following results on screening tests: hemoglobin 9.6 g/dL; capillary blood lead level 16mcg/dL. He lives in Section 8 housing in poor repair built before 1960. Which of the following is the most appropriate next course of action?
Obtain a venous lead level for confirmation
An 8-year-old patient of yours with attention-deficit/hyperactivity disorder is experiencing unacceptable ad-verse effects due to his stimulant medication. You have prescribed immediate- and extended-release preparations of two separate agents in the past. You believe that the patient may benefit from switching to a NON-stimulant medication. Which of the following medications approved for the treatment of attention-deficit/hyperactivity disorder is classified as a NON-stimulant?
Oral Atomoxetine
A 14-year-old patient familiar to the emergency room staff due to multiple visits in the last 3 months is brought in by her mother for ingestion of an unknown number of acetaminophen tablets. The mother states that she keeps all the medicines in the house locked up because "this is just the sort of thing my daughter would do to me." She saw the girl stuffing something into her bedside drawer while she was passing the girl's room and discovered a bottle marked" acetaminophen, 250 tablets." Only 4 tablets remained in the bottle. The mother did not believe that the daughter took the tablets until she began vomiting about an hour later. The girl refuses to speak in her mother's presence but eventually admits that she took "many tablets" about4:00p.m. (3 hours ago). Which of the following is recommended as an antidote for this patient's Tylenol ingestion?
Oral N-acetyl cysteine
A 12-year-old female patient presents with fever, night sweats, weight loss, fatigue, anorexia, and painless, rubbery, cervical lymphadenopathy. What is the most common presentation of Hodgkin disease?
Painless, rubbery, cervical LNs
A 14-year-old girl is brought to your office by her mother because she is complaining of "seeing double." The history is significant for headaches that waken the patient from sleep in the morning but are relieved by vomiting. On physical examination, you note that she is unable to abduct either eye. Lower extremity reflexes are slightly exaggerated. Which of the following physical signs is most likely to be present in this patient?
Papilledema
You see a 4-year-old child for declining school performance and behavior problems. His mother notes that he is a poor sleeper. He snores loudly and often gasps in his sleep. Sometimes she sleeps with him because she is afraid he will stop breathing. You note a slight fall off the growth curve and very large tonsils. A neck film demonstrates large adenoids as well. The child's insurance company will not pay to have the tonsils and adenoids removed unless you can prove they are causing him significant health problems. Which test is the most likely to give you that information?
Polysomnography
Which of the following is considered a RF for neonatal RDS?
Poorly controlled maternal diabetes
A 4-week-old male infant born at term presents with emesis, dehydration, and poor weight gain. The pediatrician evaluating the child palpates an olive-sized mass in the child's epigastrium. She believes the infant may have pyloric stenosis. Which of the following clinical presentations is most consistent with pyloric stenosis?
Projectile non-bilious emesis
A 17-year-old young girl on oral contraceptive therapy for regulation of her menstrual periods presents with a 1-week history of left leg pain and swelling. Evaluation with a Doppler ultrasound reveals absence of flow in the left fem-oral and popliteal veins. The clot extends proximally to the left external iliac vein. The most important potential complication that one should be cautious about in this girl is:
Pulmonary Embolism
An 8-year-old boy is referred to the ED by his pediatrician for a chief complaint of weakness. The weakness has been slowly progressive over the last several weeks. A ROS reveals a Hx of constipation, polyuria, and polydipsia. The child is on no meds, and PMH is noncontributory. In the PCP's office, the patient had a serum potassium measurement of 2.8 mEq/L. A blood pressure measurement in the emergency department is normal forage, height, and gender. Urine electrolyte studies reveal an elevated urine potassium value. Which of the following conditions is the most likely cause of this patient's hypokalemia?
Renal tubular acidosis
You are offering preventive counseling to the parent of a 12-month-old child at a health maintenance visit. The child weighs 18 lbs. You would be correct in informing the parent that this child should be:
Restrained in a rear facing infant car seat in the back seat of a car until he has reached 20 lbs
A child in the emergency department has point tender-ness over the proximal tibia and an appropriate history of trauma. The radiograph shows a fracture through the growth plate that extends into the epiphysis and joint space. This type of fracture would be characterized as:
Salter Harris type III
A 13-year-old male presents to the office with short stature. Growth data demonstrates that he has been growing between the 3rd and 5th percentile at a steady rate since age 4 years. His father started shaving at age 17 and completed his growth at age 19 years. What examination and workup would support the diagnosis of constitutional delay of growth and puberty?
Scant axillary hair, tanner II pubic hair, testicular volume 5 cc, bone age 11 years, TSH 2.1 (0.5-4.8), IGF-I 420 (152-540)
A 3-year-old girl periodically experiences swelling around her lips and breaks out in hives when she eats the snacks provided at daycare. Which of the following is the most appropriate for determining whether the child's symptoms are due to food allergies?
Skin prick testing to foods followed by double-blind placebo-controlled food challenges
An adolescent comes to you with a chief complaint of painless vaginal discharge. You note projection of the breast areola as a secondary mound above the contour of the breast and pubic hair of adult texture and color with no spread to the medial surface of the thighs. This patient's examination is most consistent with which Tanner stage of development?
Stage IV
A 9-year-old boy diagnosed with pneumonia 2 days ago presents to the emergency department via ambulance in respiratory distress. His past medical history is noncontributory. He is hypoxic and requires oxygen. A STAT portable CXR reveals large right-sided pleural effusion, which shifts in decubitus position. Fluid is obtained via thoracentesis for Gm stain and culture. Which of the following is the most likely pathogen responsible for this boy's pneumonia?
Staph aureus
A 6-year-old boy presents with a newly appreciated heart murmur. He is asymptomatic, with normal growth and development and normal exercise tolerance. On examine- S1 and S2 are normal; a II/VI LOW-frequency MID-systolic murmur is heard at the left lower sternal border. His pulses are normal. The most likely diagnosis is:
Still's Murmur
16-year-old male is brought to your office by his mother, who insists that you perform a urine drug screen on her son. You begin by interviewing the mother and the young man together, but explain to the parent that you will also be conducting part of the interview and the PE without her present in the room. She states that she will only agree to let you speak with him alone if you agree to discuss with her any high-risk behaviors that he admits to engaging in. Concerning patient confidentiality in regard to adolescents, you are required by law to inform the parent of this minor of which of the following?
Suicidal ideation
A parent brings her 12-week-old child to your office because he has a scaly facial rash. The boy was exclusively breastfed for 8 weeks but was switched to cow milk-based formula about a month ago when his mother went back to work. She has been putting lotion on the rash, but it has not helped. The child's birth weight was at the 50th % but has now dropped toward the 25th % line. The PE reveals an eczematous rash over both cheeks. The stool is guaiac+ but not grossly bloody. Based on the H&P, you suspect allergy to cow milk protein. Which of the following is the best next step in the management of this patient?
Switch the pt from cow milk-based formula to a protein hydrolysate formula
At the health maintenance visit for a 12-year-old male, you note that he has entered his pubertal height growth spurt. The patient's mother asks about what changes her son should be expecting in his body over the next several years. As part of your review, you mention that the most typical sequence of pubertal events in males is which of the following?
Testicular enlargement, Pubarche, penile enlargement, peak high velocity
You are called to evaluate a newborn with an apparent foot deformity. On close examination, you note adduction of the forefoot, inversion of the foot, and plantar flexion at the ankle that is relatively fixed. Which of the following is true of this patient's condition?
This deformity may be associated with other congenital malformations
A 3-month-old infant presents with a history of abnormal movements that his parents think might be seizures. You observe an episode of recurrent rhythmic flexor-extensor spasms that repeat about 30 times before subsiding. The EEG shows hypsarrhythmia, and a Wood lamp exam is positive for several flat, hypopigmented macules scattered over the skin surface. This child's infantile spasms are most likely a result of which of the following underlying disorders?
Tuberous sclerosis
A 16-year-old female patient presents with short stature and no secondary sexual characteristics. What diagnosis must be considered?
Turner Syndrome
A child presents with lymphedema of the hands and feet, shield-shaped chest, widely spaced hypoplastic nipples, short stature, and multiple pigmented nevi. In addition, she had a coarctation of the aorta that was repaired and has renal disease. Which of the following chromosomal disorders is most likely in this child?
Turner Syndrome
A 5-year-old boy presents with painful swelling of the hands and feet since the day before. Since earlier today, he has palpable purpura on the lower extremities, and also developed intermittent, colicky midabdominal pain. Prior to these events, he had a cold for 1 week. He did not have fevers, and overall is well appearing. On physical examination, he has normal vital signs. He has palpable purpura on the lower extremities and buttocks. He has scrotal swelling. His hands and feet are puffy, and he has pain with movement of the ankle joints. His abdominal examination is unremarkable. A complete blood count shows normal results with a platelet count of350,000/mm3. Which of the following laboratory tests is most often abnormal in this disease process?
UA
A 3-month-old infant presents with cyanosis and an echocardiogram reveals that the child has tetralogy of Fallot. What four associated lesions describe Tetralogy of Fallot?
VD, over-riding aorta, pulmonary stenosis, right ventricular hypertrophy
A mother brings her 5-year-old son to your office in New Mexico for his regular health maintenance visit. A quick review of the patient's chart reveals that he and his family are strict vegans (i.e., they eat no animal products of any kind). Their house is very small, so all the children spend a good deal of time outside. The mother states that her son eats plenty of dark green vegetables and iron-fortified grains. She does not believe in providing supplemental vitamins and minerals. This child is most at risk for which nutritional deficiency?
Vitamin B12
A 4-year-old boy was seen by his pediatrician for fever and abdominal pain. The pain began after a sledding accident the day before his visit in which he fell on his right side. His mother noticed that his abdomen appeared distended today, particularly on the right side. In the pediatrician's office, he is noted to be hypertensive and has gross hematuria. What is the most likely diagnosis?
Wilms tumor
A young couple is in your office for their prenatal visit, and you are discussing infant feeding. The father states that he prefers that the mother breastfeed the baby. The mother is hesitant to commit to breastfeeding because she plans on returning to full-time employment 6 weeks after the child is born. Neither her mother nor her sisters chose to breastfeed. She is concerned that human breast milk may not provide all the nutrients that the child needs, and she believes formula is a more complete nutritional source for infants. She is willing to consider exclusive breastfeeding based on the American Academy of Pediatrics recommendation. If her baby is exclusively breastfed, when should the child begin receiving oral vitamin D supplementation?
Within the first month of life
You are examining a 3-year-old girl at her well-child visit. While she is staring at her stuffed cow in your hands, you quickly cover her right eye with an index card. Cover/Uncover shows the right eye "drifts" back toward the center. This reaction in response to the cover test indicates what abnormal condition?
strabismus
Galactosemia, a disorder of carbohydrate metabolism, is inherited in an autosomal recessive fashion. What is the risk of galactosemia in a child whose parents are both carriers for the disorder?
25%
You are seeing a new patient for a health maintenance visit. The child is able to tell you his age and gender and speaks in five to eight word sentences. His grandmother tells you that he is able to pedal a tricycle. He can perform a broad jump when the behavior is modeled and is able to copy a circle. However, he cannot yet balance on one foot or copy a cross. You record that the patient's developmental achievement is consistent with his age. Which of the following most closely correlates with this child's age in years?
3 years
A 14-year-old patient in your practice with anorexia nervosa has fallen to 80% of her ideal body weight for heightened gender. She has not menstruated in 9 months. She has postural hypotension and a low heart rate. Which of the following murmurs is most likely to be present on this patient's cardiac examination?
A MID-systolic click, followed by a murmur
A 7-year-old girl presents with a 3-week history of dozens of asymptomatic red, scaly 5 to 10 mm plaques appearing on the trunk. When the scales are pulled off, they bleed. Her nails are pitted. The most appropriate lab test is:
A throat culture
A 3-month-old female infant presents to your emergency department unresponsive and with fever, tachypnea, bradycardia, and hypotension. What order should you follow in your initial assessment?
AIRWAY, breathing, circulation, disability, exposure
A 14-year-old girl presents with several weeks of profound fatigue, intermittent low-grade fevers, a facial rash, and joint pain. The rash recently worsened markedly after sun exposure. On physical examination, she has a malar rash extending over the bridge of the nose, but sparing the nasolabial folds, painless oral ulcers, and painful limitation of movement in her wrists and finger joints. On laboratory testing, her WBC is 3,500/mm3, Hgb 9.5 g/dL, platelet count 120,000/mm3. A urinalysis shows 15 to 19 RBC/hpf and an elevated protein of 100 mg/dL. Which of the following tests will most likely be positive?
ANA antibody
A 3-year-old boy presents to the pediatrician with fever, pallor, anorexia, joint pain, petechiae, and hepatosplenomegaly. Which of the following is the most likely diagnosis?
Acute lymphoblastic leukemia
You are moonlighting in the pediatric emergency department when a 10-year-old male arrives by ambulance with lethargy, confusion, dizziness, and a severe headache. His parents and maternal grandmother are in the adult emergency department with less severe but similar symptoms. The emergency medical technicians report that they were called by the police who found the family sleeping in their car with the engine running at their Christmas tree stand. Carbon monoxide poisoning is suspected. Which of the following should be the first step in the evaluation and management of this patient?
Administer 100% o2
A 5-year-old boy is brought to your office complaining of progressive fatigue, weakness, and nausea over the past few months. He was a model student, but he is now having trouble in school and displaying frequent outbursts, the last of which resulted in his being sent home for hitting another child. Initial lab results show mild hypoglycemia, hyponatremia, and hyperkalemia. The child is diagnosed with adrenal insufficiency and treated appropriately; however, his behavior continues to worsen, and he begins to have difficulty walking and speaking. Which of the following is the most likely etiology of his behavior problems?
Adrenoleukodystrophy
During a routine annual physical examination, a 9-year-oldpreviously healthy girl has a blood pressure of 140/75 mmHg in all four extremities. The physical examination is otherwise completely normal, except for obesity. The family history is positive for hypertension in the father and paternal uncle. The blood pressure remains in the 140/70 mmHg range on two repeat examinations performed 1 week apart, using a cuff that is appropriate for her obesity. THE urinalysis, serum electrolytes, and serum creatinine levels are normal. Which of the following is the most appropriate next step in for this patient?
Advise a regimen of weight reduction and regular exercise
A 3-year-old boy presents with violent episodes of intermittent colicky pain, emesis, and blood per rectum. =Intussusception. A tubular mass is palpated in the right lower quadrant. THE abdominal radiograph reveals a dearth of air in the right lower quadrant and air-fluid levels consistent with ileus. Which of the following procedures is good for diagnosis and treatment?
Air contrast or double contrast enema
Which of the following scenarios is consistent with abuse rather than accidental injury?
All of the above (a 30-month child with a bucket handle fracture, a 12-month old infant with a rib fracture, a 6-month old infant with retinal hemorrhages without head trauma, abdominal bruises in a 9-month old infant)
A 4-year-old child with known asthma presents to the emergency department with a chief complaint of wheezing for the past 8 hours. On examination he is alert and cooperative, mildly tachypneic, has diffuse loud expiratory wheeze, and has a pulse oximetry reading of 89% while breathing room air. He has already taken 3 albuterol aerosols at home in the past hour. He is unchanged after receiving another albuterol inhalation treatment in the emergency department. Appropriate next management would include:
All of the above (supplemental O2, albuterol inhalation ipratropium bromide inhalation, oral corticosteroids)
A 20-month-old boy who was treated with high-dose amoxicillin (90 mg/kg per day) for acute otitis media 3 weeks ago now presents with acute-onset ear pain, a bulging, erythematous right tympanic membrane, and decreased mobility on pneumatic otoscopy examination. Which of the following is the most appropriate ABx choice for this child?
Amoxicillin-clavulanate= AUGMENTIN
An 18-month-old female child presents with blood-streaked stool. The stool is GROSSLY positive on occult blood testing. Which of the following diagnoses is most likely?
Anal fissure
A 2-year-old female child presents with VT, severe ventricular dysfunction, hypotension, and metabolic acidosis. The patient is cardioverted into ventricular fibrillation which degenerates into asystole. What is the most appropriate indication for using IV EPI in this patient?
Asystole
A 2-year-old child is brought to the emergency department following a brief (2 minutes) generalized seizure. Initial vitals include a temperature of 102.9°F. Following the history, physical examination, and laboratory studies, you determine that the patient has had a febrile seizure. You would be correct in telling the parents which of the following?
At least 50% of patients w/ febrile seizure will experience seizures with subsequent episodes of fever
The mother of a 30-month-old boy is concerned that the child's speech is "garbled." The child uses "ma-ma" and "da-da" appropriately. He uses about 30 other words, but most of them are mispronounced (for instance, "boo" in-stead of "blue"). The boy's aunt, uncle, and cousins came to visit for a weekend and were unable to understand more than half of what he said. Examination of the ears reveals normal canals with translucent, mobile tympanic membranes, and visible landmarks. Which of the following evaluations for speech delay should be performed first?
Audiologic (hearing) assessment
You are seeing an 18-month-old boy who is new to your practice. His father is concerned about his child's development in relation to his two older brothers. The boy avoids eye contact and does not respond to efforts to engage him in reciprocal play such as peek-a-boo and patty cake games. He does not generate spontaneous language but can repeat certain words if spoken to him over and over. He spends a lot of time by himself rocking back and forth and becomes very agitated if this activity is interrupted. Which of the following conditions is most consistent with this child's reported behaviors?
Autism
A mildly febrile 6-year-old patient presents to your office with dysuria and urinary frequency and urgency. She has a history of one prior UTI about 8 months ago. You obtain a dipstick urinalysis and send a urine culture. The dipstick is positive for nitrites and leukocyte esterase. Which of the following is the most appropriate course of action at this time?
Begin empiric amoxicillin and schedule a renal U/S and voiding cystourethrogram within 6 weeks
A newborn infant has a slight hip click on hip examination. Which of the following risk factors would most strongly support further evaluation?
Breech presentation or family history of developmental dysplasia of the hip
An 8-year-old boy presents with growth failure and vague abdominal pain. The abdomen is distended. There is no perianal disease, abdominal mass, or tenderness. The next set of diagnostic tests should include:
CBC, CRP, tissue transglutaminase assay
A woman with a seizure disorder under medical management wants to conceive a child. Her risk of having a child with a neural tube birth defect is greatest if her current medical regimen includes which of the following?
Carbamazepine
Which of the following statements about acute myeloid leukemia (AML) is true?
Chemotherapy used for AML is more intense than that used for ALL
You are called to the delivery room for a routine birth. The infant cries when the cord is cut. You examine the child under the warmer and notice that when he stops crying, his chest heaves, and he turns blue. You are unable to pass the NG tube through the nose for suctioning. Which condition is likely causing this infant's respiratory distress?
Choanal atresia or stenosis
A 2-year-old girl presents with a swollen left knee, limp-ing, and morning stiffness in the left knee of 3 months 'duration. On physical examination, there is a left knee joint effusion, synovial thickening, and limitation of movement. In addition, the left leg is longer than the right and there is atrophy of the quadriceps. The remain-der of the review of systems and physical examinations is normal. On laboratory testing, a complete blood count is normal. An antinuclear (ANA) antibody test is positive ata titer of 1:320. This child is at most risk for which of the following sequelae/complications?
Chronic, non-granulomatous anterior uveitis (iridocyclitis)
A very tired mother brings her 6-week-old infant to your office because "he screams for hours and hours a day and nothing makes him stop." His parent describes the crying spells as occurring daily and lasting several hours, usually through the late afternoon and early evening. Nothing seems to console the child during these episodes. While he's crying, the infant often pulls his knees to his abdomen as if he is in pain. Other than the crying spells, the child is asymptomatic. He feeds well and moves his bowels regularly. The child's weight, length, and head circumference are normal, and his physical examination is normal. This patient's history and physical examination are most consistent with which of the following conditions?
Colic
No red reflex is seen on fundoscopic examination of anew-born. Which of the following is the most likely diagnosis?
Congenital cataract
A 10-year-old girl presents with a linear streaks of thickened and indurated skin on the right arm and trunk. The linear streak on the right arm has a longitudinal orientation and extends from the upper arm to the dorsal aspect of the hand, whereas the linear streak on the trunk is transversely oriented. The lesions are surrounded by a halo of erythema with a violaceous appearance. The central portion is hyperpigmented and thickened. Which of the following complications is this child most likely to develop?
Contracture of the right elbow.
