Question bank

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?

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 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?

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)

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 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 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 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?

While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall. You obtain the following x-ray What is your interpretation of the x-ray?

While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall. You obtain the following x-ray What is the mechanism that likely resulted in this injury?

An 8-month-old boy is brought to the clinic by his mother because he has been lethargic, fussy, and not feeding well over the past several days. The mother has been working two jobs so the baby has been cared for by her boyfriend for the past month. She is very worried because he has not been smiling and vocalizing as much as he normally does and he has not been able to lift his head. What is the most common cause of injury in the first year of life?

An 8-month-old boy is brought to the clinic by his mother because he has been lethargic, fussy, and not feeding well over the past several days. The mother has been working two jobs so the baby has been cared for by her boyfriend for the past month. She is very worried because he has not been smiling and vocalizing as much as he normally does and he has not been able to lift his head. Which of the following findings on physical examination is suggestive of child abuse?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. Which of the following signs is associated with Down syndrome?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. After confirming that the child does indeed have Down syndrome, the parents ask you what problems their baby may have in the future. With which of the following is the infant most likely to have problems?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. The infant begins to have progressively large amounts of bilious emesis. The infant feeds well and has only a small amount of abdominal distention. What is the most likely diagnosis?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. If you were to perform an abdominal x-ray, what is the most likely finding that would be seen?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. What is the most common central nervous system (CNS) complication of Down syndrome?

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. You are concerned about a possible malignancy. What is the most common malignancy of childhood?

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. The best course of care for this young man would be which of the following?