Question bank

A 1-week-old infant presents for his first newborn evaluation. He had been discharged apparently well and thriving at 48 hours of age. He now exhibits grouped vesicles on an erythematous base that were not present at birth. Wright stain of scrapings from the floor of the vesicles reveals multinucleated giant cells and balloon cells. Of the following, the MOST likely diagnosis is

A 16-year-old Caucasian girl from the northeastern United States presents for a health supervision visit. She drinks three to four diet sodas a day and describes herself as ''a couch potato.'' She has a history of asthma and had been hospitalized for administration of intravenous methylprednisolone twice in the past year. Physical examination findings are normal. She is at Sexual Maturity Rating 4 and has had normal menses for 3 years. A year ago, she fell while walking and fractured her ulna. You are considering therapy for suspected osteopenia. Of the following, the MOST appropriate therapy for this patient at this time is

A 10-year-old child is brought to your office for evaluation of a 1-day history of fever, vomiting, diarrhea, and abdominal pain. His mother states that he has vomited five times, and the emesis has been clear. He has had four episodes of nonbloody diarrhea. He describes his abdominal pain as crampy but cannot localize it to any specific part of his abdomen. He denies any symptoms of dysuria. On physical examination, the child is in no acute distress, his temperature is 99.2°F (37.3°C), heart rate is 102 beats/min, respiratory rate is 26 breaths/min, and blood pressure is 105/70 mm Hg. Results of examination of the head, neck, chest, and heart are normal. His abdomen is soft, and there is no guarding. There is no rebound tenderness. He complains of mild discomfort on deep palpation of his entire abdomen. He has hyperactive bowel sounds on auscultation, and he has no flank tenderness. Of the following, the MOST appropriate next step in the management of this patient is to

A 10-year-old child is brought in by ambulance with seizure activity. ffis mother reports it starting 30 minutes ago in his right arm and quickly became generalized tonic clonic jerking. She gave him his buccal midazolam after the first 5 minutes and called an ambulance when he did not respond after another 5 minutes. The ambulance crew gave him rectal diazepam on arrival at 15 minutes into the seizure. He is receiving high flow oxygen via a face mask and continues to convulse. The mother tells you that he was weaned from his long-term seizure medication, phenytoin, 2 weeks ago and that he has had a cold for the past 2 days. What is the next step in management?

On a newborn baby screening examination, you see a baby girl born by elective caesarean section for breech presentation. This is her mother's frrst child. The examination is normal except for a clunk felt on Barlow's test and a relocation click on Ortolani's manoeuvre on the right side. What is the next step in management?

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

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:

You are speaking to the mother of a child who attends a junior high school where one of the students was diagnosed with meningococcal disease 24 hours ago. Her child does not have any classes with the index patient and, except for passing him in the hall during lunch 3 days ago, has had no other contact with the patient. The child's mother is frantic because the school sent home a notice asking parents to bring their children to the public health department or their private physician to receive antibiotic prophylaxis. Of the following, the MOST appropriate advice for this parent is that her child:

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 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:

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:

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

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:

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 16-year-old girl presents with the complaint of right upper quadrant pain, right shoulder pain, and nausea. She is afebrile. She has been taking combined oral contraceptive pills for 6 months. Results of ultrasonography of the gallbladder performed after an emergency department visit 2 days ago are normal. Of the following, the most appropriate NEXT step in the evaluation of this patient's pain is

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 are evaluating a 12-year-old boy who recently moved to your community. His family history reveals that his father, who is 36 years old, suffers from extremely high blood cholesterol levels (>500 mg/dL [12.9 mmoVL]). The boy's mother states that her husband's brother has the ''same problem.'' Findings on the boy's physical examination are normal. Of the following, the BEST next step for your patient is to

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

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 assisting a bypass grafting procedure in theatre. Your senior colleague asks you to show him from where the common femoral artery arises. From the list below, choose the statement that best describes the anatomical landmark and course of the common femoral artery?