Question bank

A 5-year-old boy was diagnosed with asthma aged 3 years. He presented to accident and emergency with shortness of breath, increased work of breathing and a 1-week history of coryzal illness and fever. On examination he is tachypnoeic 60/ min, tachycardia 160 bpm and has minimal air entry bilaterally. He has intercostal recession, tracheal tug and is too breathless to complete a sentence. Oxygen saturation is 90 per cent in air. What is the initial management of this boy?

A 10-month-old baby boy is brought to accident and emergency with inconsolable crying. His mother says he is a miserable baby and even after feeding he does not settle. He has recently started to cruise around furniture, but is not yet walking. His crying has been worse today and both his parents had been awake all night due to his incessant crying. On examining the baby, you note that he is more upset when being handled and is a bit better when lying on his front. You do a chest x-ray which shows three posterior rib fractures; his mother states he fell down some steps yesterday. What is the likely diagnosis and appropriate management strategy?

A 14-month-old girl is brought to the emergency department with a 12-hour history of fever and rash. Her mother became frightened when it was difficult to arouse the girl after her nap. Findings on physical examination include a temperature of 104°F (40°C), a heart rate of 164 beats/min, a respiratory rate of 42 breaths/min, and a blood pressure of 75/45 mm Hg. There are petechiae and purpura (Item Q156A) on the chest, arms, and legs. As you are establishing intravenous access and drawing blood for initial laboratory evaluations, you request an immediate dose of antibiotics. Of the following, the MOST appropriate therapy is

A 12-year-old boy who was born with multicystic dysplastic kidneys. He had a renal transplant when he was 7 years old due to chronic kidney disease stage V after having peritoneal dialysis for 1 year. Which of the following would you not expect him to be taking?

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 14-year-old girl was diagnosed with idiopathic thrombocytopenic purpura (ITP) last week after she attended the children's assessment unit with recurrent epistaxis. She had a platelet count of 16 x109/L last week and now re-presents to accident and emergency with further episodes of epistaxis, haematemesis and petechiae. She had a heart rate of llObpm and her blood pressure is 100/70 mmHg. What is the next best management step?

You are evaluating a 2-year-old boy in your office for recurrent cellulitis of his right thigh. The patient has had three episodes in the last 4 months. According to his mother, all the episodes start with a ''red bump'' that progressively enlarges and, in most cases, drains spontaneously. He has received two courses of cephalexin in the past, but there was no clinical improvement until the abscess spontaneously drained. On one occasion, an incision and drainage procedure had to be performed. Except for pain with walking, the patient has been afebrile and experienced no other systemic symptoms. On physical examination, you note a 6x6 cm area of induration and erythema on the lateral right thigh that is warm, firm, and tender to palpation. There is no active drainage from the site. Of the following, the MOST appropriate antibiotic for treatment of this patient is

A 4-year-old boy presents for a health supervision visit, and in the course of the visit, his mother discloses that ever since the birth of his 2-month-old sister, the boy has resumed bedwetting, which had ceased to be a regular occurrence. He is dry during the day and has no stool incontinence. Past medical history reveals that the child has never been hospitalized, had a negative urine culture at age 9 months associated with a fever, and was toilet trained completely at age 3, with only episodic bedwetting about once every month. Physical examination reveals a happy, playful child whose growth and developmental parameters are normal for age and who has a circumcised penis and normal findings on scrotal examination. Urinalysis of a specimen obtained via clean catch urination shows normal results. Of the following, the next BEST step in the management of this boy is to

During a sports physical, you note that a 14-year-old boy has thoracic kyphosis. He cannot pull his shoulders back to correct the curvature in the standing position. The kyphosis persists in the prone position. A standing lateral radiograph reveals a kyphotic curve of 50 degrees between T3 and T12, with anterior wedging of vertebrae at T7 and TS and T9. The patient is at Risser stage 4. Of the following, the MOST appropriate management plan for this patient is to

A 35-year-old female has suffered a road traffic accident while coming off her motorbike at 25 mph during a head-on collision with a car. On arrival to the emergency department, she is found to have a pneumothorax following review of her trauma series imaging. You assist the Surgical Registrar in siting a chest drain. Which of the following structures does not form part of the layers encountered when inserting a chest drain?

A 45-year-old man undergoes emergency laparotomy for suspected intraabdominal trauma. A large liver laceration is detected during laparotomy and the bleeding is difficult to control. The Consultant locates the free edge of the lesser omentum and performs Pringle's manoeuvre to control the haemorrhage. From the list below, which structures are found within the free edge of the lesser omentum?

During a ward round, you are asked to review a chest radiograph of a 45-yearold female who experienced difficulty breathing 1 day post laparoscopic cholecystectomy. You are quizzed about USMLE Surgery2e/Basic the contents of the mediastinum. From the list below, which structure does not form part of the contents of the mediastinum?

You are in the endoscopy unit observing an endoscopic retrograde cholangio pancreatogram for a patient with deranged liver function tests also presenting with jaundice. The Consultant explains to you that he must get to the part of the duodenum where the duodenal papilla is located. From the list of answers below, which part of the duodenum is the Consultant referring to?

A 16-year-old male suffers a head injury and subsequent loss of consciousness while playing rugby. The site of impact was the right temporoparietal region and a CT scan of the head reveals a right-sided extradural haematoma with minimal midline shift. The Radiologist suspects that a branch of the middle meningeal artery is the cause of the extradural haematoma. USMLE Surgery2e/Basic The patient is taken urgently to theatre to evacuate the haemorrhage. From the list below, select the skull foramina through which the middle meningeal artery passes?

A 56-year-old lady is having a total thyroidectomy for Graves' disease. During the operation she develops thyroid storm and the anaesthetist informs you that the patient has developed a tachycardia. From the list below, please choose a feature not likely to be associated with thyroid storm?

You are reviewing the blood test results of a SO-year-old man who has been admitted following a crush injury to his right leg. His serum potassium is found to be low at 2.9mmol/L foilowing earlier correction of hyperkalaemia. You request an ECG for this patient. Which one of the following ECG changes is not characteristic of hypokalaemia?

During a health supervision visit for a 16-year-old boy, you learn that he has experienced chest pain twice with intense exercise during practice for his high school varsity soccer team. Each time the pain felt like pressure, radiated to his left shoulder, and was associated with lightheadedness. He did not seek medical attention after either episode. His father, who is age 49 years, has hypertension and uses lipid-lowering medication. Results of the boy's physical examination are normal, including his blood pressure and cardiovascular examination. Of the foilowing, the BEST management plan is

A 2-year-old boy presents to the emergency department and requires intubation due to apnea. Subsequent tests reveal a diagnosis of meningococcal meningitis. Because of the emergent nature of the intubation, you were not able to put on a mask prior to performing this task. Therefore, you will need to take prophylactic medications to prevent transmission of the organism to you. Of the following, the MOST appropriate antimicrobial agent for prophylaxis is

You are observing a 45-year-old female being prepared for induction of anaesthesia for a laparoscopic cholecystectomy. You discuss the stages of anaesthesia with the Consultant anaesthetist. From the list below, select the answer corresponding to the correct number of stages of anaesthesia?

A 6-month-old infant has been receiving high-dose amoxicillin therapy for bilateral otitis media. After 48 hours of therapy, she continues to be febrile, with a temperature of 102°F (38.9°C), and is irritable. Physical examination reveals erythematous, dull, and bulging tympanic membranes, with no movement on insufflation. Of the following, the MOST appropriate antibiotic to change this patient to is