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3,531 questions
You are admitting a 35-week gestation newborn to the neonatal intensive care unit for respiratory distress at 4 hours of age. She requires assisted ventilation. The resident working with you asks what test of pulmonary function is preferred in your initial assessment of this newborn. Of the following, the BEST response is
The pediatric resident at the emergency department notifies you that one of your patients, an 18-montb-old boy, has been admitted to the hospital for observation after being found with an open bottle of lemon-scented furniture polish. On arrival at the emergency department, the child had lemon-scented polish on his clothing, and his breath smelled of the substance. His mother stated that he had vomited once, but there has been no choking, gagging, or coughing since the ingestion. Of the following, the MOST appropriate management includes:
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
An 18-month-old child has been brought to your urgent care clinic for evaluation. He and his mother are in town visiting his grandmother. His mother tells you that she fo11nd him playing with an open bottle of his grandmother's medication. On physical examination, he is sleepy but arousable, pale, mildly diaphoretic, and afebrile. His respiratory rate is 20 breaths/min, heart rate is 60 beats/min, and blood pressure is 65/40 mm Hg. His lungs are clear, there are no murmurs, and his pulses are weak. Of the following, the MOST likely cause for this patient's presentation is ingestion of
A 15-month-old boy presents to the emergency department following the acute onset of nausea, vomiting, and abdominal pain. He appears agitated. His heart rate is 160 beats/min, but other vital signs are normal. His mother, who has asthma, reports finding her theophylline bottle lying empty on the floor in her bedroom. His capillary blood gas measurement is normal, and his USMLE Pediatry2e/Management blood glucose concentration is 190 mg/dL (10.5 mmol/L). Of the following, the MOST appropriate management of this patient is
You are evaluating a 6-hour-old male infant who was born after a term pregnancy and normal delivery and weighs 4 kg. The infant is comfortable but exhibits mild tachypnea, with a respiratory rate of 50 breaths/min. His heart rate is regular at 150 beats/min. His oxygen saturation is 60% in all extremities and does not increase significantly with the administration of oxygen by face mask. His lungs are clear, and there are no murmurs, gallops, or rub. You suspect transposition of the great arteries. Of the following, the BEST management strategy is
A 13-month-old boy presents to your office after his mother called for an urgent appointment because he had a bad cough and noisy breathing. He has been previously healthy and is fully immunized. On physical examination, his temperature is 100.9°F (38.3°C), pulse rate is 142 beats/min, respiratory rate is 36 breaths/min (crying), and pulse oximetry reading is 98o/o on room air. The mother states that he went to sleep normally with only mild symptoms of an upper respiratory tract infection and awakened at 4 am with noisy breathing. He tolerated sips of juice this morning and has had no vomiting, diarrhea, or high fever. After the boy settles down from having his vital signs measured, he has a ''barking cough,'' and on auscultation, you notice stridor with every breath. Mild suprasternal retractions are visible on examination of the chest. He prefers to sit up and looks slightly anxious. Of the following, the treatment MOST likely to provide improvement is
A 3-year-old boy is brought in by ambulance fitting. You are assigned to get the history from the father. Harry is normally fit and well with no significant past medical history or allergies. He is up to date with his immunizations and has been growing and developing normally. His behaviour has been difficult for the past 2 weeks since the birth of his little sister. Mum has been unwell as she developed HELLP syndrome and was in hospital for a week foilowing the delivery. Yesterday, he was quite unwell with a tummy bug, vomiting and had black diarrhoea. That evening they found a mess he had made in the bathroom with all of his mum's things strewn over the floor including her tablets from the hospital. By that time, Harry was getting better so they did not think anything of it. Today he has been acting strangely and has been difficult to understand, he then became lethargic at about 4 pm and started fitting 15 minutes ago. What is the most likely diagnosis?
A 2-month-old exclusively breast-fed infant presents to your office because his mother thinks that he is irritable. His mother reports that the infant has been passing loose stools and cries when he has a bowel movement. He is generally happy at other times. Physical examination demonstrates a healthy, afebrile, vigorous infant who has normal skin color. Cardiac, pulmonary, and abdominal examination findings are all normal. Anal inspection demonstrates no fISsures. A stool specimen has reddish flecks, and the guaiac test is positive. Of the following, the BEST next step is to
The following are the treatment options available for the management of the patient with severe head injury. Which of the following does not have an effect on reducing intracranial pressure?
During an open repair of an abdominal aortic aneurysm, the consultant asks you to discuss the openings in the diaphragm. You discuss the structures that pass through the three main openings as well as the several smaller ones. Which of the foilowing structures does not pass through one of the three main diaphragmatic openings?
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)
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
Just before clinic starts, you find your two visiting medical students talking about a movie they saw over the weekend in which some of the characters suffered from the ''black death'' or bubonic plague. They involve you in the conversation and ask you what you know about this disease of antiquity. They are astounded to hear that plague still exists in the world today. You decide to use this time to make a teaching point and query them about the appropriate antimicrobial therapy for plague. Of the following, the MOST appropriate antimicrobial agent I•S
A 5-year-old girl presents after having a brief generalized seizure. Her mother reports that the child has had a 3-day history of fever, tenesmus, and bloody diarrhea. On physical examination, you find a mildly toxic-appearing child who has a temperature of 104°F (40°C) and diffuse abdo1ninal tenderness. The rectal examination produces significant pain. Stool from her rectum is guaiac-positive. You tell her mother that you believe the diarrhea has an infectious cause. Of the following, the MOST likely pathogen is
A 4-year-old girl presents to the emergency department with a 3-day history of left-sided weakness. On physical examination, she has a temperature of 99°F (37.2°C), pulse of 50 beats/min, respiratory rate of 24 breaths/min, and blood pressure of 118/78 mm Hg. She cannot abduct her right eye, but has normal funduscopic examination results. Strength on the left is 4/5 in the upper and lower extremity and on the right is normal. Of the following, the MOST appropriate next step in the evaluation of this child 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
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 1-day-old baby is on the post-natal ward. You are asked to review her as she is febrile and lethargic. On examination she is tachycardic, has a capillary refill time of 3 seconds centrally and reduced urine output. Her blood culture 24 hours later grows Gram-positive cocci. Which is the most likely causative organism?
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