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3,531 questions
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 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
You are seeing a 6-week-old infant who was born with trisomy 21 and a large atrioventricular septa] defect. Over the previous week, she has tired with feeding and has not gained weight. Her respiratory rate is 60 breaths/min and heart rate is 150 beats/min. Auscultation reveals mild retractions and a 2/6 systolic murmur with a gallop rhythm. The liver is palpable at 2 cm below the costal margin, and the perfusion is good. You decide to increase the caloric content of the formula to 24 kcal/oz, and you contact her pediatric cardiologist to discuss referral for surgical repair. Of the following, the BEST therapeutic option while awaiting surgical repair is
A 3-week-old baby attends accident and emergency with bloody diarrhoea. Mum says he has been having diarrhoea for the past 2 days since she started using formula milk. He was previously breastfed and mum was not having any dairy products due to lactose intolerance. He also has eczema on his cheeks and a strong family history or asthma and eczema. Mum is concerned that he may be allergic to milk too. What is the most likely diagnosis?
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 16-year-old boxer presents to your office 2 hours after a blow delivered to one ear during sparring. The ear is swollen and painful. On physical examination, you note a 2-cm diameter USMLE Pediatry2e/Management area of bruising and fluctuance along the upper aspect of the pinna anteriorly. Of the following, the MOST appropriate next step in the management of this patient is to
A 7-year-old boy presents with a 3-year history of seasonal rhinorrhea and nasal congestion. He states that ''as soon as the weather warms up,'' he experiences daily nasal symptoms that are often severe enough to limit his outdoor activity. On physical examination, you note infraorbital swelling, a transverse nasal crease, boggy turbinates, and clear rhinorrhea. A nasal smear demonstrates numerous eosinophils. You decide to treat him with a nasal spray. Of the following, the MOST effective long-term treatment for this boy is a nasal spray containing a(n)
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 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 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
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 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
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 12-year-old child is struck in the right eye by a baseball. He now complains of double vision when he looks to the left. On physical examination, you note marked swelling and bruising circumferentially around the boy's right eye. His pupillary reflexes are normal, he has no blood in the anterior chamber of the eye, and his optic disc margins are sharp. He has dysconjugate gaze to the left but not to the right. His vision is 20/20 out of the left eye and 20/30 out of the right eye. Other findings on his neurologic examination are normal. Of the following, the MOST likely diagnosis is
A 14-year-old girl presents with complaints of lower abdominal cramps that have occurred on days 1 and 2 of her menstrual cycle for the past year. The cramps usually are associated with bloating and loose bowel movements. The symptoms have caused school absences on the first day of the past three periods. Use of acetaminophen has provided no relief. Menarche was at age 12 years. Her menstrual cycle is regular; menses last 5 days and are characterized by moderate flow. Of the following, the MOST appropriate management of these symptoms is the use of
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
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 mother brings her 12-month-old boy to you because he holds his head tilted to the right. She tells you that he periodically draws up both his legs and cries. The child has developed normally, but does not yet walk or cruise. On physical examination, he has mildly increased deep tendon reflexes in the upper and lower extremities, but other findings are normal. Of the following, the study MOST likely to establish this boy's diagnosis is
A 12-year-old boy is suspected to have a right-sided testicular torsion and is taken urgently to theatre for a scrotal exploration. Which of the foilowing structures is not encountered during a scrotal exploration?
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