Question bank

A 7-year-old girl presents to your clinic with a 2- to 3-day history of a nonproductive cough, malaise, and temperature to 101°F (38.3°C). On physical examination, you note that the girl does not appear ill and are surprised to hear widespread crackles in the lungs bilaterally. Chest radiography demonstrates bilateral diffuse infiltrates. Of the following, the MOST appropriate antimicrobial agent to treat this girl's infection 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 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?

The pregnant mother of a 3-year-old girl in your practice is concerned because her obstetrician just told her that her serum alpha-fetoprotein value is markedly increased. Of the following, the MOST appropriate advice to give to this woman is that she should consider

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

A 4-year-old boy presents to your clinic with a 4-day history of fever. Over the past 24 hours, he developed swelling over the left side of his face, and his left eye is starting to close. On physical examination, his temperature is 102°F (38.9°C), and his left cheek and lower eyelid are swollen but not red or warm. On oral examination, you note a severe decay of the second maxillary molar and elicit pain when you tap on this tooth. Of the following, the MOST appropriate therapy is

A term newborn is delivered by emergent cesarean section because of intrauterine growth restriction, oligohydramnios, and nonreassuring fetal heart rate monitoring in labor. Delivery room resuscitation includes endotracheal intubation and assisted ventilation with 100% oxygen, chest compressions, intravenous epinephrine, and volume expansion. Apgar scores are 1, 2, and 3 at 1, 5, and 10 minutes, respectively. An umbilical cord arterial blood gas measurement documents a pH of 6.9 and a base deficit of 20 mmoVL. At 12 hours of age, the infant demonstrates tonic-clonic convulsive activity of the arms and legs with a concomitant decrease in heart rate and bedside pulse oximetry saturation. Of the following, the MOST likely cause for this infant's seizure 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

A 15-year-old girl is rushed to the emergency department after slipping off a diving board and striking her head on cement. On physical examination, her mental status evaluation results are completely normal. She can abduct her upper extremities at the shoulder, but cannot flex or extend her arms and minimally moves her imgers. She cannot move her limp lower extremities. You order emergent magnetic resonance imaging of the brain and spine. Of the following, the MOST important therapy to implement before the patient is sent for imaging 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

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?

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 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

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

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 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

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

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 15-year-old boy presents with melena and anemia. Endoscopy demonstrates a nodular gastritis of the antrum and an ulcer. Biopsies of the antrum demonstrate spiralshaped organisms consistent with Helicobacter pylori. You prescribe amoxicillin, clarithromycin, and lansoprazole for 2 weeks. At a follow-up visit, the family asks whether the treatment has been successful in USMLE Pediatry2e/Basic eradicating the organism. Of the following, the PREFERRED noninvasive test to evaluate whether the pathogen has been eradicated 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