Question bank

While in the emergency department you see a 3-week-old infant. The mother says that the child felt warm earlier in the day and has not been eating very well. The infant has a temperature of 100.9°F and has mildly decreased tone. What is the most appropriate initial management?

A 4-year-old is brought to your office by his mother for evaluation. She is concerned because the child has been spiking fevers and pulling on his left ear. Your examination reveals a bulging and erythematous tympanic membrane (TM). Which of the following is most likely to be the cause of his illness?

You see a 2-month-old infant in the emergency department for vomiting. The mother says that the baby has been spitting up more over the past few days and has become more irritable. She denies any fever, diarrhea, or change in formula. The mother tells you that there is a family history of "heartburn" and that her other children have all spit up. The infant has some emesis in the emergency department that seems to be formula mixed with some bile. The infant is intermittently irritable and sleepy. What is the most concerning diagnosis that this could be?

You see a 2-month-old infant in the emergency department for vomiting. The mother says that the baby has been spitting up more over the past few days and has become more irritable. She denies any fever, diarrhea, or change in formula. The mother tells you that there is a family history of "heartburn" and that her other children have all spit up. The infant has some emesis in the emergency department that seems to be formula mixed with some bile. The infant is intermittently irritable and sleepy. Which of the following would be the most appropriate initial test?

On a Monday morning you see a 12-year-old otherwise healthy boy in the emergency department. The parents brought the boy in because they noticed that he started to have an abnormal gait in the past few days. He seems to be shuffling his feet. The boy complains that his legs feel heavy and are tingling. He relates that his arms feel fine. His past history is significant for attention deficit/hyperactivity disorder (ADHD) for which he is taking methylphenidate. He denies trauma or taking any other medicines or drugs. On examination, he is afebrile with normal vital signs. His entire physical examination is normal with the exception of the examination of is lower extremities. He has 3/5 strength throughout both of his lower extremities with a normal muscle mass. His all joints have a full range of motion, without any pain or swelling. His reflexes are absent and he describes some paresthesias of his feet and ankles. What is the most likely diagnosis?

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 would be the most appropriate treatment?

A 4-year-old is brought to your office by his mother for evaluation. She is concerned because the child has been spiking fevers and pulling on his left ear. Your examination reveals a bulging and erythematous tympanic membrane (TM). You determine that the child should receive antibiotics. The initial antibiotic of choice should be?

You are working in the emergency department and are called to perform a lumbar puncture on a 3- month-old infant who presented with fever and lethargy. The spinal fluid that you obtain is turbid. The laboratory reports that there are 200 WBCs and 5 RBCs per high-power field (HPF). Ninety-five percent of the WBCs in the spinal fluid are neutrophils. Which of the following is the most probable cause of this illness?

You are working in the emergency department and are called to perform a lumbar puncture on a 3-month-old infant who presented with fever and lethargy. The spinal fluid that you obtain is turbid. The laboratory reports that there are 200 WBCs and 5 RBCs per high-power field (HPF). Ninety-five percent of the WBCs in the spinal fluid are neutrophils If the laboratory result showed that 98% of the WBCs in the spinal fluid were lymphocytes, what would be the most likely etiology of the infection?

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?

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?

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 4-year-old child is brought to your office because of a sudden onset of irritability, weakness, and pallor. The mother tells you that both of her children have been experiencing episodes of vomiting and diarrhea. Your physical examination reveals a blood pressure of 115/80, dry mucus membranes, petechiae, and diffuse abdominal pain. The following laboratory work is obtained: Urinalysis: microscopic hematuria and proteinuria Blood urea nitrogen (BUN)/creatinine (Cr): 20/1.0 mg/dL Hemoglobin: 7 g/dL Peripheral blood smear: fragmented RBCs Prothrombin time (PT), partial thromboplastin time (PTT): normal Coombs' test: negative What is the most likely diagnosis?

A mildly mentally retarded 9-year-old girl is brought to your office for acne. On examination, she does not actually have acne but has small flesh colored papules along her nasolabial fold. Her past history is significant for having had a first (afebrile) seizure last year. The mother reminds you that she has a faint birthmark on her hip that is pale and becomes more prominent in the summer, when the child's skin tans. Examination of this area reveals a 5-cm oval patch that is hypopigmented. Which condition would she most likely have?

A 10-month-old infant has a dysplastic right external ear, some preauricular tags, and a small notch (coloboma) in the iris and lower lid. Which condition does he likely have?

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. What is the most likely diagnosis?

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?

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. What is the most appropriate treatment at thispoint?

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. What is the most worrisome complication of this disease?