Question bank

A 3 year old is brought to see the GP with multiple pearly raised papules with central umbilications. They have been there for more than a month on his torso and upper legs. His mother is worried he has warts. What is the most likely diagnosis?

You are notified by the newborn screening program that a 2-week-old infant in your practice has an elevated phenylalanine level, which is confirmed by repeat testing. The mother reports that the baby is healthy and breastfeeding well. Of the following, the MOST important first step in management of this infant is to

A female infant is born with unilateral cleft lip and palate. Findings on the remainder of the physical examination are normal, and you inform the parents that this apparently is an isolated birth defect. During counseling of the family about their risk for having another similarly affected child, the statement that you are MOST likely to include is that

A 15-year-old boy comes to see you, complaining of recurrent abdominal and back passage pain relieved by passage of diarrhoea. He is also complaining of low back and knee pain and last week there was blood mixed into his stool. He has been losing weight recently. On examination he is slim and looks pale. His abdomen is soft but tender in the left iliac fossa with no masses. What is the most likely diagnosis?

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

An older mother books in to see you after attending the health visitor for a weight check at 2 months for her first child. She and her husband have had a hard time coming to terms with their daughter's diagnosis of Down's syndrome. She is relieved th.at the appointment with the cardiologists went well and the heart is normal. However they have a lot of trouble getting her to take the whole bottle, she was slow to regain her birth weight and looking at the plotted weight yesterday she is not growing along her birth centile and the mother is worried she is not doing a good enough job. She is not vomiting except for small possets after feeds, is passing urine and opening her bowels. The red book growth chart shows the weight to be falling off centiles. What is the most appropriate management?

You are observing an open carpal tunnel decompression in theatre. Which of the following structures is not at risk during this procedure?

A term male infant is born to a woman who has known multiple drug abuse problems. Her urine drug screen was positive for barbiturates, benzodiazepines, and opioids upon admission to the labor and delivery unit. The infant is delivered vaginally without complications. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. His birth weight is 3,500 g. You are asked to evaluate the infant for early discharge at 23 hours of age. Findings on physical examination are normal, with the exception of jitteriness, and the infant is not breastfeeding well. Of the following, the BEST reason to keep this infant in the hospital is that

A 15-month-old boy presents to the emergency department following the acute onset of nausea, vomiting, and abdominal pain. He appears agitated. His heart rate is 160 beats/min, but other vital signs are normal. His mother, who has asthma, reports finding her theophylline bottle lying empty on the floor in her bedroom. His capillary blood gas measurement is normal, and his USMLE Pediatry2e/Management blood glucose concentration is 190 mg/dL (10.5 mmol/L). Of the following, the MOST appropriate management of this patient is

You are performing a presedation physical examination in a 3-year-old female who is scheduled to have a repeat computed tomography (CT) scan with contrast. The mother mentions that her daughter experienced diffuse hives and facial swelling 10 minutes after the contrast administration during her first CT. Of the following, the BEST way to prevent future contrast reactions is to:

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

Upon entering your examination room, you find a father who is visibly upset. He has brought his 1-month-old and 2-year-old daughters to see you today because his wife was recently diagnosed with tuberculosis. As you question him further, he tells you that his wife's physician told him that his wife's chest radiograph was abnormal and she was ''smear-positive.'' He hands you results from the health department stating that he and his daughters all had negative skin tests and chest radiographs. His wife is at the health department today to start medicines against tuberculosis, and he wants to know if there is anything that should be done for the children. Of the following, the MOST appropriate treatment is to

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 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:

A 9-year-old girl develops daily daytime enuresis for 3 weeks. You notice her sitting in a chair in your office waiting room with her legs crossed and squirming. About 20 minutes later, upon entering the examination room, she runs to the bathroom to urinate. You are able to obtain a urine sample, and results of analysis are normal. Her vital signs and findings on history and physical examination are all unremarkable. Of the following, the MOST appropriate next step in.her management is to

You are evaluating a 2-year-old boy because he bangs his head on his bed before he goes to sleep. His mother has no other concerns about his behavior. There have been no recent changes in the family or stresses that she can identify. Physical examination findings are normal except for excoriated skin on the boy's forehead and minimal ecchymosis. Of the following, the MOST likely diagnosis is

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 7-month-old male infant adopted from a Somalian orphanage has been in the United States for 3 weeks. Ten days after arrival, the infant is hospitalized with a fever to 104°F (40°C), increased irritability, and decreased oral intake and activity. Results of a blood culture are positive for Haemophilus influenzae type b. Since arriving in the United States, he has been attending the home child care that his adoptive mother operates, which includes six other children between 12 and 18 months of age, each of whom has been fully immunized. Of the foilowing, the MOST appropriate recommendation for chemoprophylaxis for child care attendees and staff is

A 2,700-g male infant born at 36 weeks' gestation is being treated for suspected neonatal sepsis following the development of respiratory distress shortly after birth. His mother had a fever to 102°F (38.9°C) during labor and delivery but reports that she had no illnesses during pregnancy. Of the following, the MOST appropriate antibiotic regimen for this infant is

A 4-year-old child has been losing weight recently and has been vomiting for the past 24 hours, unable to eat anything. His mother has brought him into accident and emergency out of concern as he seems confused. The triage nurse has taken him to the resuscitation room and asked for your help. On examination he is drowsy, has a heart rate of 150, respiratory rate of 60 and a central capillary refill of 5 seconds. He has subcostal recessions and good air entry bilaterally with no added sounds. He moans when you examine his abdomen but there are no masses. You put in a canula and take bloods. The venous blood gas shows: pH 7.12, PC02 2.3 kPa, P02 6.7 kPa, HC03-15.3 mmol/L, BE-8.6, Glucose 32.4 mmol/L. What is the most likely diagnosis and what is the first management step?