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3,531 questions
A mother brings her 10-month-old son to the emergency department because he has been vomiting for the past 10 days. The child has not experienced any diarrhea. On physical examination, he is lethargic and has dry mucous membranes, reduced tears, a full anterior fontanelle, and 2-second capillary refill. After a second intravenous bolus of 20 ml,/kg of normal saline, the boy extends his arms and legs forcefully for 10 seconds. Of the following, the MOST appropriate next step in the management of this child is administration of:
A worried grandmother brings her 2-year-old grandchild to the emergency department immediately upon finding the boy with an open bottle of 81-mg chewable aspirin (which is used by the grandfather for coronary artery disease prophylaxis). She is unsure of the number of tablets in the bottle prior to ingestion, but the original number was 30, and there are now three remaining. The child has vomited once and is fussy and lethargic. Physical evaluation reveals a 12-kg child who has tachypnea and tachycardia. Laboratory results include a pH of 7.45, carbon dioxide of 25 mEq/L (25 mmol/L), and bicarbonate of 18 mEq/L (18 mmol/L). A salicylate measurement result is pending. Of the foilowing, the next BEST step in the management of this child is to:
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 16-year-old boy is brought to your office by his parents because be wants medicine to help him grow and develop muscles. He has been working out for 1 year without much effect. On physical examination, his height is 63 in (adjusted mid-parental height, 73 in), he weighs 106 lb, and he has testes that are 8 mL in volume. He appears healthy but very young. His father says that he was very small as a boy but was given three injections of growth hormone when he was 16 and grew to his present height of 71 in during late high school and college. Laboratory test results for the boy are normal, including a complete blood count, erythrocyte sedimentation rate, electrolytes, blood urea nitrogen, creatinine, prolactin, insulin-like growth factor-I, tissue transglutaminase antibody, quantitative immunoglobulin A, free thyroxine, and thyroid-stimulating hormone. A bone age radiograph is reported to resemble that of a 13-year-old. Of the foilowing, your BEST approach is to
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
A 10-year-old child is brought in by ambulance with seizure activity. ffis mother reports it starting 30 minutes ago in his right arm and quickly became generalized tonic clonic jerking. She gave him his buccal midazolam after the first 5 minutes and called an ambulance when he did not respond after another 5 minutes. The ambulance crew gave him rectal diazepam on arrival at 15 minutes into the seizure. He is receiving high flow oxygen via a face mask and continues to convulse. The mother tells you that he was weaned from his long-term seizure medication, phenytoin, 2 weeks ago and that he has had a cold for the past 2 days. What is the next step in management?
You are called to evaluate an 18-month-old infant who was found playing with a medication bottle. The top was open, and many of the pills were on the floor. The prescription was for a tricyclic antidepressant used by the patient's older brother. On physical examination, the boy appears clumsy but awake and flushed. He has a heart rate of 150 beats/min, a respiratory rate of 28 breaths/min, and dilated pupils. He is breathing easily and has strong pulses. Of the following, the MOST important next step in this patient's management is
A 14-year-old girl comes to see you as she has not had her periods yet. You note that her breasts are stage II and her nipples are set lateral to the mid-clavicular line. She has no pubic hair. Her weight is on the 50th centile but height is on the 9th centile. Her parents are both of average height. What is the most likely diagnosis?
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 9-year-old girl is stung on the left leg by a hornet while playing outside. Within 10 minutes, she experiences diffuse pruritus, and a large area of erythema develops at the sting site. Five minutes later, extensive raised welts appear on her trunk and extremities. Her parents rush her to the emergen.cy department, where intravenous antihistamines and steroids are administered. During this episode, she denies difficulty breathing or swallowing. No tongue or uvula edema is USMLE Pediatry2e/Management evident during examination, and her symptoms gradually resolve over 4 hours. Of the following, the NEXT recommended step in her management is to
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
You are evaluating a 12-year-old boy who recently moved to your community. His family history reveals that his father, who is 36 years old, suffers from extremely high blood cholesterol levels (>500 mg/dL [12.9 mmoVL]). The boy's mother states that her husband's brother has the ''same problem.'' Findings on the boy's physical examination are normal. Of the following, the BEST next step for your patient is to
A 14-montl1-old infant who is breastfed with bottle supplementation presents with early evidence of dental caries. Of the following, the MOST appropriate practice to disrupt this process is to
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 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
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 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 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