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3,531 questions
A 14-year-old girl presents to your office with complaints of a red and ''irritated'' eye for the past 12 hours. She wears contact lenses, but has not worn them since the previous evening. Her pain and inflammation have continued to worsen despite removing the contact lenses. On physical examination, you note diffuse moderate injection of the bulbar conjunctiva of the lefteye. Her extraocular motions and pupillary reflexes are normal. Results of funduscopic examination are normal. There is no discharge. Fluorescein examination reveals diffuse uptake of stain but no evidence of corneal abrasion. Of the following, the MOST appropriate next step in the management of this child is to
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
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 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 12-year-old girl presents to your office for the first time with a swollen, painful, erythematous right knee joint. She tells you that her left knee felt and looked similar yesterday, but now feels normal. She also is easily fatigued and has had fever. On physical examination, she has a temperature of 101.7°F (38.7°C), a heart rate of 125 beats/min, a respiratory rate of 24 breaths/min, and a blood pressure of 120/78 mm Hg. Her lungs are clear. On auscultation, you note a 3/6 holosystolic murmur (Item Q87A) at the cardiac apex with radiation to the axilla. Of the following, the BEST plan for management of this patient's joint swelling includes
You are examining a 2-day-old term newborn prior to discharge. On physical examination, you note a 5 x 5 cm mass in the right abdomen. The remainder of her physical examination findings are normal. Of the following, the MOST likely diagnosis is
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 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
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
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
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 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 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?
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 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 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
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
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 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: