Question bank

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

A 2,700-g male infant born at 36 weeks' gestation is being treated for suspected neonatal sepsis following the development of respiratory distress shortly after birth. His mother had a fever to 102°F (38.9°C) during labor and delivery but reports that she had no illnesses during pregnancy. Of the following, the MOST appropriate antibiotic regimen for this infant is

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 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

A 12-year-old boy presents to his GP with left-sided unilateral breast development stage III. He is very upset as he is being bullied at school. His mother is worried as her friend's sister bas just been diagnosed with breast cancer and wants to know if he could have breast cancer? What is the management?

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 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 accident and emergency triage nurse asks you to look at a 3-year-old child with a short history of waking up this morning unwell with a cough and fever. She looks unwell, heart rate is 165, respiratory rate 56, saturations of 96 per cent in air, temperature of 39.3°C and central capillary refill of 4 seconds. She has a mild headache but no photopbobia or neck stiffness and you notice a faint macular rash on her torso and wonder if one spot is non-blanching. You ask the triage nurse to move her to the resuscitation area and call your senior to review her. Fifteen minutes later your senior arrives and the spot you saw on the abdomen is now non-blanching and there is another spot on her knee. What are the three most important things to give her immediately?

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 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?

A term male infant is born to a woman who has known multiple drug abuse problems. Her urine drug screen was positive for barbiturates, benzodiazepines, and opioids upon admission to the labor and delivery unit. The infant is delivered vaginally without complications. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. His birth weight is 3,500 g. You are asked to evaluate the infant for early discharge at 23 hours of age. Findings on physical examination are normal, with the exception of jitteriness, and the infant is not breastfeeding well. Of the following, the BEST reason to keep this infant in the hospital is that

A 13-year-old girl is on the ward having a bone marrow transplant for acute leukaemia. She is noted to be profoundly anaemic with haemoglobin 5.9 g/dL and she is doe to receive a transfusion of one unit of red blood cells. You are called to see her 5 minutes after starting the transfusion. She has come out in a rash, is looking frightened, with a heart rate of 120 bpm and respiratory rate of 30. As you arrive, you can see she has swollen lips and tongue and her blood pressure is measured as 90/45 mmHg. What is the best initial management step?

A preterm baby is now 25 + 7 weeks corrected gestation. He is on the neonatal unit being cared for while his mother recovers on ITU after he was born secondary to an eclamptic seizure. He has been receiving formula milk as the parents have not consented to donor breast milk. He has been having bilious aspirates from his nasogastric tube and today his abdomen in very distended and tense. He has had one episode of bloody stools. You are going to treat him for nectrotizing enterocolitis (NEC). What is the best initial management plan?

You are on elective in Uganda and spending the day on the paediatric ward. You are told that it is the rainy season and malaria is now becoming increasingly problematic. Almost all the children on the ward are suffering with the effects of malaria. The irrst child is a 5-year-old boy with a cyclical fever, abdominal pain and a 4cm splenomegaly. He has 2 per cent parasitaemia on blood film. You are asked how you would treat this child. What is the best initial management step?

You are reviewing the blood test results of a SO-year-old man who has been admitted following a crush injury to his right leg. His serum potassium is found to be low at 2.9mmol/L foilowing earlier correction of hyperkalaemia. You request an ECG for this patient. Which one of the following ECG changes is not characteristic of hypokalaemia?

You are observing an elective right hip replacement. The lead surgeon is accessing the hip joint via the posterior approach. From the list below, choose the correct order (from superficial to deep) and correct structures that are cut through during the posterior approach to the hip?

A 5-year-old boy was diagnosed with asthma aged 3 years. He presented to accident and emergency with shortness of breath, increased work of breathing and a 1-week history of coryzal illness and fever. On examination he is tachypnoeic 60/ min, tachycardia 160 bpm and has minimal air entry bilaterally. He has intercostal recession, tracheal tug and is too breathless to complete a sentence. Oxygen saturation is 90 per cent in air. What is the initial management of this boy?

A 10-month-old baby boy is brought to accident and emergency with inconsolable crying. His mother says he is a miserable baby and even after feeding he does not settle. He has recently started to cruise around furniture, but is not yet walking. His crying has been worse today and both his parents had been awake all night due to his incessant crying. On examining the baby, you note that he is more upset when being handled and is a bit better when lying on his front. You do a chest x-ray which shows three posterior rib fractures; his mother states he fell down some steps yesterday. What is the likely diagnosis and appropriate management strategy?

A 12-year-old boy who was born with multicystic dysplastic kidneys. He had a renal transplant when he was 7 years old due to chronic kidney disease stage V after having peritoneal dialysis for 1 year. Which of the following would you not expect him to be taking?

You see a 46-year-old man who has presented to accident and emergency with an acute onset of shortness of breath. Your registrar has high clinical suspicion that the patient is suffering from a pulmonary embolism and tells you that the patient's ECG bas changes pointing to the suspected diagnosis. From the list below, which of the foilowing ECG changes are classically seen?