Question bank

A 4 year-old-boy presents to your clinic with anal itching of 2 weeks' duration. His mother denies itching in other family members. Tape applied to his perianal skin shows oval structures. Of the following, the most appropriate management of this patient is

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

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

You are evaluating a 10-year-old boy who has behavior problems. He hits his younger brother, talks back to his parents, and refuses to perform his assigned household chores. He does well in school, but is oppositional in the classroom. His parents ask what they can do to improve his behavior. Of the following, your BEST response is that

A 15-month-old infant has been breastfed since birth. He eats finger foods (eg, peas, carrots) and occasionally some cereal. His mother adheres to a vegan diet and plans the same for her child. A USMLE Pediatry2e/Basic complete blood count documents anemia. Of the following, the MOST likely cause of this infant's anemia is a deficiency of:

An 11-year-old girl was brought to accident and emergency in December with pain in her left leg. She is known to have sickle cell disease and her baseline haemoglobin is 7.0 g/dL. She has been admitted in the past with painful leg and chest crises. She has a cough and coryza. Today her blood results show: haemoglobin 6.8, white cell count (WCC) 12 x109/L, platelets 209 x109/L, C-reactive protein (CRP) 20 mg/L. What is not part of the appropriate initial management?

As part of your clinic responsibilities, you supervise allergy shots for patients who have allergic rhinitis. The nurse calls you about a 12-year-old girl who received her allergy shot 30 minutes ago and now is experiencing warmth and erythema over the injection site. On physical examination, the patient appears healthy and in no distress. Vital signs include a temperature of97.5°F (36.4°C), heart rate of 90 beats/min, and respiratory rate of 18 breaths/min. At the injection site, there is a 4 x 4 cm raised, erythematous, warm area. There is no edema of the tongue or uvula, and findings on her pt1lmonary, cardiovascular, and skin examinations are otherwise normal. Of the following, the NEXT most appropriate action is to

A sexually active adolescent male presents with the primary complaint of pubic and perianal pruritus. Careful examination reveals pubic or "crab" lice infestation. Of the following, the MOST characteristic feature of this infestation is that the lice:

A father carries his 5-year-old child into the emergency department after a motor vehicle crash in which his vehicle rolled over several times. The accident occurred 1 minute away. The boy was restrained by lap and shoulder belts. He did lose consciousness. In his father's arms, the USMLE Pediatry2e/Emergency child moans softly but does not open his eyes. Of the following, the MOST dangerous consequence of transporting this injured child to the emergency department in this manner is

A 6-year-old girl presents with a 1-year history of periumbilical, nonradiating abdominal pain. The pain occurs at least three times per week and lasts up to 30 minutes. There is no history of heartburn, constipation, or diarrhea. Physical examination, complete blood count, erythrocyte sedimentation rate, and urinalysis yield normal results. A Helicobacter pylori serology (immunoglobulin G antibody) is positive. Of the following, a TRUE statement regarding this patient is that:

An adolescent male presents with a hypopigmented eruption composed of multiple oval macules arrayed across the upper trunk in a yoke distribution. Of the following, the PREFERRED management course consists of

You see a baby for the first baby check at 6 weeks. Mum reports no problems and he is feeding well. On examination you are unable to palpate the testicles on either side or do not feel any lumps in the groin area. He has a normal penis with no hypospadias and the anus is patent. He is otherwise a normal baby on examination. What is the most important diagnosis to rule out?

A 3-year-old boy who has spina bifida has a history of recurrent urinary tract infections (UTis). He is currently being treated for a UTI. Monitoring laboratory evaluation shows a blood urea nitrogen of 23 mg/dL (8.2 mmol/L) and a creatinine concentration of 1.1 mg/dL (97.2 mcmol/L). Of the following, the class of antibiotics that is MOST commonly associated with renal toxicity is

Retinopathy of prematurity (ROP) is the leading neonatal cause of blindness in the United States. Of the following, the population at GREATEST risk for severe ROP comprises infants

A 3-year-old boy who recently was adopted is brought to you for the first time. The adoptive mother explains that the biologic mother had a history of intravenous drug use, and the child is hepatitis C-positive. On physical examination, the happy, active child has no evidence of an enlarged liver or spleen. You discuss with the mother the possibility of referral to a specialist for antiviral therapy. Of the following, a TRUE statement about treatment of hepatitis C is that

A 2-year-old who has a history of repaired biliary atresia presents to your office with fatigue and intermittent dark stools. On physical examination, he is afebrile and pale but active. His heart rate is 110 beats/min, liver and spleen are both enlarged, and abdomen is distended, with prominent abdominal veins. The hematocrit is 22% (0.22). Of the following, the MOST appropriate next step is to

You inserted an endotracheal tube into a 2-year-old child who had severe head trauma after a motor vehicle crash. Initially, she had good chest rise, with oxygen saturations of 99% on 100% inspired oxygen delivered via bag-valve mask, but 10 minutes later, she suddenly deteriorates. Her oxygen saturation now is 60%, and her heart rate is 50 beats/min and falling rapidly. You note poor breath sounds on both sides of her chest and poor chest rise. Of the following, the BEST initial management of this patient is to

An 11-year-old child is brought to the emergency department with massive trauma after a motor vehicle crash. His Glasgow Coma Scale score is 3. Rapid assessment reveals marked bruising of the face and blood from the mouth, nose, and ears. In addition, the child has large areas of bruising and abrasions across the chest, abdomen, and pelvis as well as bright red blood from the urethral meatus and a deformity of the left femur. Among the initial major interventions are insertion of an endotracheal tube and establishment of two large-bore intravenous lines. Of the following, the MOST appropriate next step is to

An 18-month-old boy presented to the GP with a history of eating soil. He had been in the garden this afternoon as his mother put the washing out. She found him eating the soil and took him straight inside. On examination, he is well and alert but has pale conjunctivae. He is not tachycardic or tachypnoeic. His diet consists of predominantly of breast milk. What is the most likely result of his haemoglobin and haematin.ics?

A 9-year-old girl presents to accident and emergency with fever, vomiting and dysuria. She is wearing a steroid bracelet and has a steroid card stating she is on daily prednisolone for severe USMLE Pediatry2e/Paraclinic asthma and eczema and is therefore at risk of adrenal suppression. She is tachycardic at 140 bpm and you are concerned that her blood pressure is low. Her capillary glucose is 3.0 mmol/L. What is the single most important investigation?