Question bank

An 18-month-old child has been brought to your urgent care clinic for evaluation. He and his mother are in town visiting his grandmother. His mother tells you that she fo11nd him playing with an open bottle of his grandmother's medication. On physical examination, he is sleepy but arousable, pale, mildly diaphoretic, and afebrile. His respiratory rate is 20 breaths/min, heart rate is 60 beats/min, and blood pressure is 65/40 mm Hg. His lungs are clear, there are no murmurs, and his pulses are weak. Of the following, the MOST likely cause for this patient's presentation is ingestion of

An 18-year-old boy presents to the emergency department 30 minutes after eating at a seafood restaurant. He states that approximately 10 minutes into his meal he developed generalized hives, pruritus, and difficulty breathing. He has a history of shellfish food allergy, although he had ordered steak and denies eating any crab, lobster, or shrimp. On physical examination, the patient appears to have labored breathing, audible wheezing, and diffuse raised erythematous USMLE Pediatry2e/Management lesions (Item QlSA) on his trunk and extremities. His vital signs include a temperature of 98.5°F (37°C), heart rate of 100 beats/min, respiratory rate of 22 breaths/min, blood pressure of 110/60 mm Hg, and pulse oximetry of 92% on room air. Of the following, the MOST appropriate immediate action is:

A worried grandmother brings her 2-year-old grandchild to the emergency department immediately upon finding the boy with an open bottle of 81-mg chewable aspirin (which is used by the grandfather for coronary artery disease prophylaxis). She is unsure of the number of tablets in the bottle prior to ingestion, but the original number was 30, and there are now three remaining. The child has vomited once and is fussy and lethargic. Physical evaluation reveals a 12-kg child who has tachypnea and tachycardia. Laboratory results include a pH of 7.45, carbon dioxide of 25 mEq/L (25 mmol/L), and bicarbonate of 18 mEq/L (18 mmol/L). A salicylate measurement result is pending. Of the foilowing, the next BEST step in the management of this child is to:

A mother brings her 10-month-old son to the emergency department because he has been vomiting for the past 10 days. The child has not experienced any diarrhea. On physical examination, he is lethargic and has dry mucous membranes, reduced tears, a full anterior fontanelle, and 2-second capillary refill. After a second intravenous bolus of 20 ml,/kg of normal saline, the boy extends his arms and legs forcefully for 10 seconds. Of the following, the MOST appropriate next step in the management of this child is administration of:

A 3-year-old child is rushed to the emergency department after the mother found her with an open and empty bottle of acetaminophen. The mother has no idea how many tablets were in the bottle. She estimates that no more than 1 hour has passed since the child ingested the tablets. The child began to vomit during the trip to the emergency department, and has vomited three times more since her arrival. The child is awake and alert but clearly unhappy, crying even in her mother's arms. She appears pale and diaphoretic. Her heart rate is 110 beats/min, respiratory rate is 26 breaths/min, temperature is 98.6°F (37°C), and blood pressure is 90/60 mm Hg. Of the following, the MOST appropriate statement about acetaminophen toxicity is that:

You are asked to evaluate two children, ages 3 and 9 years, on the pediatric hematologyoncology inpatient unit who have developed fever, cough, increased work of breathing, and nodular lesions on their chest radiographs. The children are isolated in private rooms and have different nurses and doctors caring for them. The children's rooms are located adjacent to an area where a new playroom is being constructed. Of the following, the MOST likely pathogen causing these patients' pneumonia is

A 7-year-old girl presents to your clinic with a 2- to 3-day history of a nonproductive cough, malaise, and temperature to 101°F (38.3°C). On physical examination, you note that the girl does not appear ill and are surprised to hear widespread crackles in the lungs bilaterally. Chest radiography demonstrates bilateral diffuse infiltrates. Of the following, the MOST appropriate antimicrobial agent to treat this girl's infection is:

A 14-year-old girl presents with complaints of lower abdominal cramps that have occurred on days 1 and 2 of her menstrual cycle for the past year. The cramps usually are associated with bloating and loose bowel movements. The symptoms have caused school absences on the first day of the past three periods. Use of acetaminophen has provided no relief. Menarche was at age 12 years. Her menstrual cycle is regular; menses last 5 days and are characterized by moderate flow. Of the following, the MOST appropriate management of these symptoms is the use of

The pediatric resident at the emergency department notifies you that one of your patients, an 18-montb-old boy, has been admitted to the hospital for observation after being found with an open bottle of lemon-scented furniture polish. On arrival at the emergency department, the child had lemon-scented polish on his clothing, and his breath smelled of the substance. His mother stated that he had vomited once, but there has been no choking, gagging, or coughing since the ingestion. Of the following, the MOST appropriate management includes:

You are called to evaluate an 18-month-old infant who was found playing with a medication bottle. The top was open, and many of the pills were on the floor. The prescription was for a tricyclic antidepressant used by the patient's older brother. On physical examination, the boy appears clumsy but awake and flushed. He has a heart rate of 150 beats/min, a respiratory rate of 28 breaths/min, and dilated pupils. He is breathing easily and has strong pulses. Of the following, the MOST important next step in this patient's management is

A 2-year-old boy presents with a 3-day history of diarrhea and vomiting. He has been able to tolerate small amounts of fluids. He is moderately dehydrated, with dry mucous membranes and a heart rate of 145 beats/min. Of the following, the BEST management for this patient's fluid status is:

A 16-year-old boy is brought to your office by his parents because be wants medicine to help him grow and develop muscles. He has been working out for 1 year without much effect. On physical examination, his height is 63 in (adjusted mid-parental height, 73 in), he weighs 106 lb, and he has testes that are 8 mL in volume. He appears healthy but very young. His father says that he was very small as a boy but was given three injections of growth hormone when he was 16 and grew to his present height of 71 in during late high school and college. Laboratory test results for the boy are normal, including a complete blood count, erythrocyte sedimentation rate, electrolytes, blood urea nitrogen, creatinine, prolactin, insulin-like growth factor-I, tissue transglutaminase antibody, quantitative immunoglobulin A, free thyroxine, and thyroid-stimulating hormone. A bone age radiograph is reported to resemble that of a 13-year-old. Of the foilowing, your BEST approach is to

A 2-month-old exclusively breast-fed infant presents to your office because his mother thinks that he is irritable. His mother reports that the infant has been passing loose stools and cries when he has a bowel movement. He is generally happy at other times. Physical examination demonstrates a healthy, afebrile, vigorous infant who has normal skin color. Cardiac, pulmonary, and abdominal examination findings are all normal. Anal inspection demonstrates no fISsures. A stool specimen has reddish flecks, and the guaiac test is positive. Of the following, the BEST next step is to

A 3-year-old boy is brought in by ambulance fitting. You are assigned to get the history from the father. Harry is normally fit and well with no significant past medical history or allergies. He is up to date with his immunizations and has been growing and developing normally. His behaviour has been difficult for the past 2 weeks since the birth of his little sister. Mum has been unwell as she developed HELLP syndrome and was in hospital for a week foilowing the delivery. Yesterday, he was quite unwell with a tummy bug, vomiting and had black diarrhoea. That evening they found a mess he had made in the bathroom with all of his mum's things strewn over the floor including her tablets from the hospital. By that time, Harry was getting better so they did not think anything of it. Today he has been acting strangely and has been difficult to understand, he then became lethargic at about 4 pm and started fitting 15 minutes ago. What is the most likely diagnosis?

Just before clinic starts, you find your two visiting medical students talking about a movie they saw over the weekend in which some of the characters suffered from the ''black death'' or bubonic plague. They involve you in the conversation and ask you what you know about this disease of antiquity. They are astounded to hear that plague still exists in the world today. You decide to use this time to make a teaching point and query them about the appropriate antimicrobial therapy for plague. Of the following, the MOST appropriate antimicrobial agent I•S

A 9-year-old girl is stung on the left leg by a hornet while playing outside. Within 10 minutes, she experiences diffuse pruritus, and a large area of erythema develops at the sting site. Five minutes later, extensive raised welts appear on her trunk and extremities. Her parents rush her to the emergen.cy department, where intravenous antihistamines and steroids are administered. During this episode, she denies difficulty breathing or swallowing. No tongue or uvula edema is USMLE Pediatry2e/Management evident during examination, and her symptoms gradually resolve over 4 hours. Of the following, the NEXT recommended step in her management is to

You diagnose tinea capitis in a 7-year-old girl. She is otherwise healthy and has no known allergies to medications. You plan to prescribe oral griseofulvin. Of the following, it is MOST appropriate to prescribe the drug

A 7-year-old boy presents with a 3-year history of seasonal rhinorrhea and nasal congestion. He states that ''as soon as the weather warms up,'' he experiences daily nasal symptoms that are often severe enough to limit his outdoor activity. On physical examination, you note infraorbital swelling, a transverse nasal crease, boggy turbinates, and clear rhinorrhea. A nasal smear demonstrates numerous eosinophils. You decide to treat him with a nasal spray. Of the following, the MOST effective long-term treatment for this boy is a nasal spray containing a(n)

A 13-month-old boy presents to your office after his mother called for an urgent appointment because he had a bad cough and noisy breathing. He has been previously healthy and is fully immunized. On physical examination, his temperature is 100.9°F (38.3°C), pulse rate is 142 beats/min, respiratory rate is 36 breaths/min (crying), and pulse oximetry reading is 98o/o on room air. The mother states that he went to sleep normally with only mild symptoms of an upper respiratory tract infection and awakened at 4 am with noisy breathing. He tolerated sips of juice this morning and has had no vomiting, diarrhea, or high fever. After the boy settles down from having his vital signs measured, he has a ''barking cough,'' and on auscultation, you notice stridor with every breath. Mild suprasternal retractions are visible on examination of the chest. He prefers to sit up and looks slightly anxious. Of the following, the treatment MOST likely to provide improvement is

A 16-year-old boxer presents to your office 2 hours after a blow delivered to one ear during sparring. The ear is swollen and painful. On physical examination, you note a 2-cm diameter USMLE Pediatry2e/Management area of bruising and fluctuance along the upper aspect of the pinna anteriorly. Of the following, the MOST appropriate next step in the management of this patient is to