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205 questions
A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination, you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is high for a certain condition. You presumptively diagnose the child with which of the following?
A 4-year-old child presents to his pediatrician with a complaint of a mild rash and fevers. His travel history is positive for a camping trip 2 weeks prior. The parents do not recall a tick bite on the child and do not remember if there were ticks in the area. No other members of the family complain of similar symptoms and the child does not attend day care. Physical examination is positive for a temperature of 100.9°F with an erythe matous rash noted over the child's trunk. Which of the following factors would significantly increase the possibility that the child has Lyme disease?
A mother brings her 4-year-old son to your office, relating that he fell earlier that morning while at the playground. She says that the boy tripped over another child and landed on his outstretched hands. On examination, the boy has some mild swelling around his left wrist, and he says that it hurts when you palpate it. What is the most appropriate next step?
You see a 31/2-year-old child in the emergency department who has had fever for the past week. The parents relate that their son has some swollen glands, fever, and now seems to be getting a rash on his arms. On examination, you find an uncomfortable appearing young boy whose vital signs are normal with the exception of a temperature of 104°F. You note t hat he has a red posterior oropharynx with dry, cracked lips. His TMs are normal. He has mild conjunctival injection bilaterally without any discharge. His chest is clear, and his heart sounds are normal. He does not have any hepatosplenomegaly. His has a lacy, confluent macular rash on his chest and upper arms, with mild peeling of the tips of his fingers. Which laboratory result would be most consistent with the diagnosis?
In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking ("seal" like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F. What is the most common x-ray finding in this illness?
A 14-year-old boy is brought to the emergency department for evaluation of fever and headache. The mother relates that her son has had a worsening headache for 56 days. She says that she took him to a walk-in clinic, and he was put on amoxicillin for a sinus infection. His headaches have been getting worse and that he is now having fevers as high as 103.6°F. The mother says that he normally is very active and that he currently has a summer job at a local park clearing out underbrush. Since he has become ill, he has had such a decrease in energy that he cannot go to work. He has had a decrease in his appetite and has been sleeping more. He denies any sore throat, abdominal pain, chest pain, dysuria, vomiting, or diarrhea. On examination, he is an uncomfortable young man whose vital signs are: temp 101.9°F, RR 26, HR 124, and BP 79/56. is head, ear, eye, nose, and throat examination reveals normal TMs, a mildly erythematous hypopharynx, and some shotty cervical lymphadenopathy. His lungs are clear. His cardiac examination is normal. His liver edge is palpable just below the right costal margin and is mildly tender. His spleen is not palpable. His skin examination is normal with the exception of scattered petechiae around his ankles and wrists. A CBC reveals WBC 13,000 with 65% segs and 22% lymphs, hematocrit of 35, and platelet count of 95,000. His electrolytes reveal a Na 125, K 5.1, Cl 102, and bicarbonate 21. His BUN and Cr are normal. What additional testing would be warranted at this point?
A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child's arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000. After discussing various options with a regional pediatric hematologist and the patient's parents, your most appropriate initial management would be which of the following?
An 18-month-old boy presents with a history of fever to 39.0°C for 5 days. He has also been irritable and has not been drinking well. Associated symptoms include red eyes, a rash, and some trouble walking. On physical examination, he has a temperature of 39.5°C. H e has bilateral bulbar conjunctivitis, a strawberry tongue, an inflamed oral pharynx, edema of the hands and feet, a morbilliform rash, and cervical lymphadenopathy. He is very irritable. His CBC shows a WBC of 15,000/ mm3 with 60% neutrophils, 35% lymphocytes, and 5% monocytes. His hemoglobin is 12.0 g/dL and platelet count is 500,000/ mm3. Which of the following is the most likely diagnosis? erythema infectiosum (fifth disease)
A 10-year-old boy presents with red discoloration of the urine since the morning. He is healthy and otherwise asymptomatic. He denies dysuria, frequency, urgency, flank, or abdominal pain. His BP is normal. His examination is within normal limits including abdomen and genitourinary system. There is no rash or edema. His urine is pink in color; urinalysis is negative for hemoglobin or protein. No white cells, red cells, or bacteria are noted. Which of the following is the most appropriate next step?
A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child's arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000. Following your initial evaluation and treatment, you see the child for follow-up in 1 week. She continues to appear well but still has obvious purpura and her platelet count is now 17,000. All other cell lines are normal. Of the options listed below, what is your most appropriate management at this time?
A 12-year-old girl presents with chest pain when she plays basketball. The pain is substernal, is associated with dyspnea, and occurs after she has been playing vigorously. The pain does not radiate. The pain and dyspnea resolve with rest. She does not have palpitations or any lightheadedness associated with the pain. She does not have pain or dyspnea at other times. There is no history of early cardiac deaths or unexplained deaths of young people in her family. Her physical examination is normal, except for a grade 2/6 systolic vibratory murmur heard at the left lower sternal border. The same patient now complains of palpitations and dizziness with the chest pain. Which of the following tests should be ordered for this patient? chest x-ray
A 12-year-old girl presents with chest pain when she plays basketball. The pain is substernal, is associated with dyspnea, and occurs after she has been playing vigorously. The pain does not radiate. The pain and dyspnea resolve with rest. She does not have palpitations or any lightheadedness associated with the pain. She does not have pain or dyspnea at other times. There is no history of early cardiac deaths or unexplained deaths of young people in her family. Her physical examination is normal, except for a grade 2/6 systolic vibratory murmur heard at the left lower sternal border. Which of the following is the most likely cause of her symptoms?
An athletic 12-year-old boy complains of left knee pain when he runs and plays sports. The pain resolves when he rests. He has otherwise been well. His physical examination is normal, except for swelling and increased prominence over the left tibial tubercle. Aradiograph of the left knee is normal. Which of the following is the most likely diagnosis?
Jehovah's Witnesses usually refuse to consider a recommended blood transfusion. A 5-yearold child with hemophilia and dangerously low hemoglobin levels needs such a transfusion, but the Jehovah's Witness parents refuse to accept the recommendation. How are principles of autonomy best resolved?
A 4-year-old girl is brought in to the office by her mother. She developed chicken pox about 6 days ago. She appeared to be recovering well but mother became concerned because she was persistently scratching at several of the lesions and they were not healing. On examination, the child is afebrile and generally well appearing. On examination of her skin you see the following image What is the most likely responsible agent?
A 5-year-old male is admitted to the hospital following a 3-week history of spiking fevers and fatigue. Your examination reveals pale mucous membranes and skin. You also find splenomegaly. This child has an extensive evaluation by the Hematology-Oncology consultants. Their evaluation excludes the presence of a malignancy. The extensive evaluation did reveal that the child has a WBC count of 22,000 with 41% monocytes and 12% "atypical" lymphocytes. His hematocrit is 28% and erythrocyte sedimentation rate (ESR) is 5. This child likely has which of the following diseases?
An 18-month-old boy has received 5 days of amoxicillin for otitis media. He continues to have fever, and on physical examination, the right tympanic membrane is bulging with purulent fluid behind it. Which of the following is the best antibiotic to use?
A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination, you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is high for a certain condition. Upon further imaging, what associated finding would be expected?
During a routine yearly checkup, a 10-year-old boy is found to have 2 + proteinuria on urinalysis. Which of the following would be the most appropriate diagnostic test?
A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child's arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000. What is the most likely cause of this child's bleeding and bruising?