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205 questions
In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking ("seal" like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F. What is the most likely diagnosis?
A 6-year-old girl has a low-grade fever, headache, and nasal congestion. She has a flushed face and has developed a lacy reticular rash on the trunk and extensor surface of her arms and legs. Palms and soles are spared. Her mother has been ill with a low-grade fever and some joint stiffness and pain. Which of the following is the most likely diagnosis?
A 5-year-old febrile child presents with swelling of the right eyelid. Proptosis and limitation of ocular movements is noted. Which of the following is the most likely diagnosis?
A 4-week-old, previously healthy male presents with projectile emesis after feeds. His mother states that he has had 2 weeks of postprandial emesis, which became projectile in the past 2 days. She states that it looks like formula and has never been bilious. Which of the following statements is true?
A full-term newborn develops cyanosis a few hours after birth. Oxygen administration does not improve color or oxygen saturations. Which of the following is the most likely diagnosis?
A 4-year-old child was brought in for evaluation of sleep problems. He cried and screamed within an hour of falling asleep. He seemed disoriented and confused; he did not seem aware of his parents' presence. They were unable to arouse him to comfort him. This resolved spontaneously, and he had no recollection of the event the next morning. You informed the parents that he was most likely experiencing which of the following?
A 3-year-old boy was bitten while teasing a neighborhood cat. On examination, there are two puncture wounds on the right hand and some superficial scratch marks. There is erythema, warmth, and induration around the puncture sites. Which of the following organisms most likely caused the infection?
A 7-year-old boy presents with a rash. His mother states that he was well until 3 days ago when he developed fever and malaise. The next day, the rash started as papules on the trunk, which rapidly changed to vesicles. The lesions have spread all over the body. On physical examination, he has no fever and seems well. You note numerous vesicles all over the body, some of which have crusted over. Which of the following is the most likely diagnosis?
An 18-month-old girl is brought to the hospital with a history of 6 days of bloody diarrhea. She has been drinking well but has not been wetting her diaper. She has been irritable. On physical examination, she has periorbital edema. She appears pale and is tachycardic. Her CBC shows a hemoglobin of 6 g/dL and a platelet count of 100,000/mm3. Her blood urea nitrogen (BUN) is 50 mg/dL and creatinine is 5.5 mg/dL. Her urinalysis shows gross hematuria. Which of the following is the most likely causative organism for her clinical problem?
An infant is due for her first dose of polio vaccine.Her parents have heard that there are two different types of vaccine for polio. They want to know why their daughter needs to get another shot rather than just taking the oral form of the vaccine. You tell the parents the major advantage of the injectable vaccine is which of the following?
A 7-year-old child is scheduled for an elective tonsillectomy. The most important instruction to the parents should be to make sure that the child does which of the following?
During a well-child visit, the grandmother of an 18-month-old patient is concerned because the child's feet turn inward. She first noticed this when her grandson began to walk. It does not seem to bother the child. On examining his gait, his knees point forward and his feet turn inward. Which of the following is the most likely cause of this condition?
A 13-year-old girl presents with parental concerns of poor posture. She has not had any back pain. On examination, she has unequal shoulder height, asymmetric flank creases, and a forward- bending test that shows rib asymmetry. The physical examination is otherwise normal. Which of the following is the most likely cause of her condition?
After 10 days of nasal congestion and rhinorrhea, a 3-month-old infant develops a severe hacking cough during which he repeatedly turns dusky and appears to choke on or to vomit profuse thick, clear nasopharyngeal mucus. For 7 days, the coughing continues unabated. On physical examination, he is afebrile and his lungs are clear. His chest x-ray is normal. His WBC count is 24,000/mm3, with 15% polymorphonuclear cells, 82% lymphocytes, and 3% monocytes. Which of the following antibiotics should be used to treat this patient? amoxicillin
A 2-month-old infant is brought to the emergency department with irritability and lethargy. The parents state that he was well until he rolled off the couch on to the floor yesterday. On examination, he is inconsolable and afebrile. The fontanels are full and tense. He has a generalized tonic-clonic seizure. Which of the following is the most important initial diagnostic study to order?
A 7-year-old girl presents with hives, which developed after a bee sting. She has no other symptoms. The hives resolve with diphenhydramine. Which of the following is the most appropriate management?
A 12-year-old boy comes to the clinic for a sports physical. He is new to your practice. He comes with his foster mother, who states that he was recently placed in her care because of his mother's problems with drug abuse. Although a complete medical history is not available, she knows that he has not received regular care. He does not have any chronic medical problems. She also knows that his father died of heart disease when he was 35. On physical examination, the boy's height is greater than the 95th percentile. His arm span exceeds his height. As you continue your physical examination, you remember that congenital heart disease is common in this particular syndrome. Which of the following is the most likely congenital heart defect in patients with this syndrome? supravalvular aortic stenosis
A 2-year-old boy has had a purulent drainage from the right nostril for a week. He is afebrile and has had no associated symptoms, such as cough. Which of the following is the most likely diagnosis?
A 5-year-old boy has a history of bed-wetting about four to five times a week. He has recently begun to attend kindergarten. He was toilet trained (dry during the day) by age 3 but has never been consistently dry at night. He denies any dysuria or frequency. There is no history of increased thirst or frequent urination. The urinalysis is negative for blood, protein, glucose, or ketones; there are no white cells or bacteria; the specific gravity is 1.020. Which of the following is the most likely diagnosis?
Amother brings in her 3-year-old girl because she felt a smooth mass on the left side of her belly when she was giving her a bath. Which of the following is the most likely diagnosis?