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3,531 questions
An infant is delivered by cesarean section at 34 weeks' gestation because of preterm labor. There is no history of ruptured membranes, maternal fever, or abnormalities in fetal heart rate monitoring. The infant requires assisted ventilation with a bag-mask device and 100% oxygen in the delivery room. His Apgar scores are 5 and 7 at 1 and 5 minutes, respectively. An umbilical cord arterial pH is 7.23 and base deficit is 3 mmol/L. He is admitted to the newborn nursery, but transferred to the neonatal intensive care unit (NICO) within 1 hour for respiratory distress manifested by tachypnea and grunting. His arterial blood gas results (obtained on room air) upon admission to the NICO are: pH, 7.20; Pco2, 70 mm Hg; Po2, 50 mm Hg, and base deficit 10 mmol/L. Of the following, the MOST common cause for this infant's respiratory distress is
A 12-year-old child who recently emigrated from southeast Asia has beta-thalassemia for which she has required frequent transfusions. She presents today with polyuria and polydipsia. On your initial evaluation, you detect a grade II/VI systolic murmur with a gallop rhythm, palpate the liver 4 cm below the costal margin, and determine that the girl is well below the 5th percentile for height. Of the following, the MOST likely diagnosis is
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 are assisting with a total thyroidectomy for a patient who has a goiter and is experiencing compressive symptoms. The Surgical Registrar asks you to name the artery supplying the thyroid gland, which originates from the external carotid artery. From the list below, choose the most likely answer?
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 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 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
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 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:
You are seeing a 6-year-old girl whose mother is concerned about the girl masturbating. For the past several months, the girl has touched her genitals while watching television with her mother. The parents have been divorced for 2 years, and the girl spends weekends with her father. You question her mother further. Of the following, the response that MOST increases your suspicion for behavior that is out of the norm is
Yon are asked to give your opinion on an abdominal plain film radiograph of a patient with bowel obstruction. The ftlm shows distended loops of large bowel which form a 'U' shape, giving the appearance of a big coffee bean. Select the most likely reason for the large bowel obstruction?
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 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:
The mother of an infant born at 34 weeks' gestation asks you whether any of the medications she was given prior to delivery will have any effect on her daughter's growth and development. Of the following, the MOST correct statement concerning drugs commonly used in labor is that
A 15-year-old girl who has juvenile rheumatoid arthritis has been treated with ibuprofen 30 mg/kg per day for 3 months. She has had epigastric abdominal pain for 1 month that has been unresponsive to empiric therapy with omeprazole 20 mg/day. You are considering adding misoprostol 100 mcg four times daily to her current treatment regimen. Of the following, a TRUE statement regarding misoprostol is that the drug
A 12-year-old girl presents to the emergency department with abdominal pain. Her parents report that she awakened with a temperature of 101°F (38.4°C) this morning, complained of abdominal pain, and has vomited twice. There is no diarrhea, and there are no sick contacts. She reports nausea and no interest in food or drink. She was previously entirely healthy. Urinalysis reveals a specific gravity of 1.015 and is otherwise normal. Of the following, the finding that MOST indicates the need for immediate surgical intervention is
You receive a call from a teenage patient, who tells you that she is having palpitations and feels somewhat lightheaded. You refer her to your local emergency department, where no symptoms are discerned and physical examination findings are normal. The emergency department sends a copy of the patient's electrocardiogram by facsimile to your office for you to review. Of the following, the BEST interpretation of the girl's electrocardiogram is
A 16-year-old male was involved in a brawl with other teens. He was struck a number of times with fists and clubs, and he admits to punching some of his adversaries as well. He presents 6 hours later with complaint of pain in his wrist. Physical examination reveals moderate swelling and tenderness on the dorsum of the hand in the region of the base of the thumb and index finger. A radiograph of the hand reveals a fracture. Of the following, the fracture that is associated with the POOREST prognosis for healing is a
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
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?