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205 questions
An 11-month-old girl presents to your office with a fever of 39°C she has had for 2 days. She has also vomited frequently and had decreased fluid intake. She looked tired and ill but on examination, had no apparent source of infection. She appeared to be 510% dehydrated. You decide to obtain a urine specimen for analysis and culture. Which of the following is the best method?
A 10-year-old boy comes to your office in the winter with a sore throat he has had for 2 days. In addition, he has had fever, headache, and abdominal pain. He does not have any allergies to medications. On examination, he has a temperature of 38.6°C, an erythematous pharynx, and tender cervical adenopathy. Arapid screening test for group Astreptococcus is performed and is positive. Which of the following would be the most appropriate antimicrobial agent?
An 8-year-old girl presents for a checkup. She is new to your practice. The mother states that she has always been small for her age; otherwise, she has been well. She is short and has a height age of 4 years, 4 months. You note some abnormalities in her general appearance as shown in the figure. Which of the following is the most likely diagnosis?
An 11-year-old girl has her first menses. Both ovaries contain approximately how many oocytes?
A 12-year-old boy comes to the clinic for a sports physical. He is new to your practice. He comes with his foster mother, who states that he was recently placed in her care because of his mother's problems with drug abuse. Although a complete medical history is not available, she knows that he has not received regular care. He does not have any chronic medical problems. She also knows that his father died of heart disease when he was 35. On physical examination, the boy's height is greater than the 95th percentile. His arm span exceeds his height. Which of the following is the most likely cause of his tall stature?
A 14-year-old boy complains of breast enlargement on the left side. He denies pain, discharge, or any drug use. He is on no medications and is otherwise healthy. On physical examination, his sexual maturity rating (Tanner) is stage II for both genitalia and pubic hair growth. Initial management should include which of the following?
An 11-month-old girl presents to your office with a fever of 39°C she has had for 2 days. She has also vomited frequently and had decreased fluid intake. She looked tired and ill but on examination, had no apparent source of infection. She appeared to be 510% dehydrated. Her urine culture is positive at 24 hours. Which of the following is the most likely organism? Klebsiella
A 1-year-old African American infant is in for well-child care. He is primarily breast-fed. His parents do not give him much solid food because he has no teeth. He receives no medications or supplements. His parents are concerned about his bowed legs. On examination, you note some other bony abnormalities including frontal bossing, enlargement of the costochondral junctions, a protuberant sternum (pigeon chest), and severe bowing of the legs. You obtain x-rays to confirm your clinical diagnosis and also note a healing fracture of the left femur. Which of the following is the most likely diagnosis?
A 3-year-old boy has had fever for 4 days. On physical examination he has bilateral cervical lymphadenopathy, injected pharynx, and dry cracked lips. A throat swab is done and the rapid strep test is negative. The child is sent home and advised to follow-up if symptoms worsen. The child is brought back 2 days later with all previous findings including a maculopapular rash, swollen hands, and conjunctivitis. Which of the following is the most likely diagnosis?
A 10-month-old male presents with a 12-hour history of episodes of crying, holding his stomach, and bending over in pain. The parents report one "reddish" stool. He has no past medical history or episodes of similar events. He did have 24 hours of viral symptoms, which resolved a few days ago. The following study was obtained. Which of the following statements is true?
A 4-year-old girl presents to the emergency department with fever and a petechial rash. A sepsis workup is performed, and IV antibiotics are administered. Gram-negative diplococci are identified in the CSF. Which of the following is true of this condition?
The mother of a 3-year-old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication. Which of the following is the most appropriate next diagnostic step?
The mother of a 3-year-old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication The tests you ordered are normal for a prepubertal girl. Which of the following is the most likely diagnosis?
The mother of a 3-year-old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication Which of the following is the most appropriate management of this girl? pituitary suppression with a gonadotropin-releasing hormone (GnRH) agonist
An 11-month-old girl presents to your office with a fever of 39°C she has had for 2 days. She has also vomited frequently and had decreased fluid intake. She looked tired and ill but on examination, had no apparent source of infection. She appeared to be 510% dehydrated. After the infection has been treated, which one of the following tests should be considered?
A pediatrician asks you to see a 13-year-old girl who has not begun to menstruate and has a 6-month history of pelvic and lower abdominal pain at approximately month interval. She has Tanner stage 3 pubic hair and breast development. Her growth spurt occurred about 1 year ago and her current height is 65 in. (165 cm). She has never had sexual intercourse. On examination of her external genitalia the presence of Tanner stage 3 pubic hair is confirmed. The labia are normal. There is no obvious vaginal opening and there is bulging between the labia minora. Which one of the following is the most likely diagnosis?
A 4-year-old child presents to your office in July with a history of a low-grade fever (38.1°C) and "s ores" in his mouth for 2 days. He has been refusing to eat but has been drinking an adequate amount of liquids. On examination, he is afebrile and seems well hydrated. He has ulcers on his tongue and posterior pharynx, which are 4 mm in diameter. You also note a few vesicles on his hands and feet, which are 34 mm in size and mildly tender. Which of the following is the most likely diagnosis?
A pediatrician asks you to see a 13-year-old girl who has not begun to menstruate and has a 6-month history of pelvic and lower abdominal pain at approximately 1-month interval. She has Tanner stage 3 pubic hair and breast development. Her growth spurt occurred about 1 year ago and her current height is 65 in. (165 cm). She has never had sexual intercourse. On examination of her external genitalia the presence of Tanner stage 3 pubic hair is confirmed. The labia are normal. There is no obvious vaginal opening and there is bulging between the labia minora. Which one of the following laboratory tests is increased in women with gonadal dysgenesis? serum FSH concentrations
While visiting a neighbor, a 14-year-old girl is bitten on the left hand by the neighbor's pet cat. The cat is an indoor pet and has had all of the required routine vaccinations. You see the girl in the office approximately 1 hour after the injury. On the dorsum of the left hand you see two shallow puncture wounds that are not actively bleeding. She has full range of motion of her hand, normal capillary refill, and sensation. You see in the chart that the patient had a diphtheria/tetanus (dT) booster vaccine last year. What is the most appropriate management at this time?
An 8-year-old African American boy is brought in for evaluation of a mass on the scalp. On examination, he is afebrile and nontoxic. There is a boggy mass on his scalp with alopecia. His posterior cervical lymph nodes are enlarged but nontender. Which of the following is the most appropriate treatment?