Pediatrics IMLE – All Subjects

The finding in the picture is revealed during a neonatal examination. The mother has encountered a febrile illness abroad during the first trimester.
The mother has not received routine immunization and had no prenatal follow up.

Which of the following findings is likely in this newborn, now or further in life?

A 10-day-old newborn presents with significant tremor in 4 limbs. He was born at 40 weeks of gestation, to a mother with gestational diabetes mellitus. Examination reveals a generally well, not dysmorphic newborn, with significant tremor and restlessness. Laboratory results are presented in the table.

Which of the following is the most likely diagnosis?

A 6-hour-old neonate presents with frothing from the mouth and nose, and difficulty in breathing during eating. On examination he is generally well, and cries without respiratory distress.

Which of the following is the next diagnostic test?

A 5-year-old boy with cystic fibrosis presents with recent respiratory deterioration, including exercise intolerance, and exacerbated cough and sputum. Auscultation reveals wheezing and pulmonary function tests reveal deterioration compared to the previous test. There is no evidence of viral disease. He is treated with steroids, and laboratory results include increased IgE and eosinophils.

Which of the following, in addition to steroids, is the most appropriate treatment at this stage?

A 9-months old infant was born at a weight of 3000 gr, and now weighs 6000 gr. He has been admitted due to his second episode of pneumonia. Examination is positive for cervical lymphadenopathy and hepatosplenomegaly. Blood work is presented in the table 

Which of the following test will most likely promote the diagnosis?

A 2-months-old infant with failure to thrive is brought for a developmental assessment. Pregnancy was positive for polyhydramnios, and the parents are first degree cousins. Blood pressure is normal, and blood work is positive for metabolic alkalosis, hypokalemia, and hypochloremia. Urine analysis reveals hypercalciuria.

Which of the following is the most likely diagnosis?

A 3-year-old male is followed up for being under the 3rd height percentage. He has polydipsia and polyurea, with high serum sodium and normal glucose. Examination reveals the finding in the photo below, and MRI reveals an ectopic posterior hypophysis.

Which of the following is the most likely diagnosis?

A 3-year-old boy presents with polydipsia and polyurea, with no glucosuria.
Blood osmolarity is increased and urine osmolarity is decreased.
Which of the following is the most likely diagnosis?

A 1-month-old infant female is referred for workup of significant hypotonia, respiratory distress, and feeding difficulties. Laboratory results are positive for elevated CPK, and an echocardiogram reveals hypertrophic cardiomyopathy.

Which of the following is the most appropriate treatment for this disease?

A 2-year-old male presents with the finding in the photo below. Abdominal ultrasound reveals an abdominal mass.

Which of the following is the most typical for the toddler’s most likely diagnosis?

Which of the following pathogens is associated with congenital sensoneuronal hearing loss?

The 4-year-old child in the picture is developmentally delayed. Examination reveals an early systolic ejection click, and he has

hypercalcemia, failure to thrive, and hypothyroidism.

Which of the following is the boys’ most probable heart defect?

A 17-year-old boy, who is having unprotected sex, presents with itching in the urethral meatus.

Examination reveals irritation of the meatal area and purulent discharge.

Which of the following pathogens is the most likely causative agent for his condition?

A 2-month-old infant is evaluated for apathy and poor feeding. On examination – tachycardia and mild extremity tremor. Labs – glucose 35 mg/dl, urinary ketones negative.

Which of the following is the most likely diagnosis?

Which of the following is an etiology for early eruption of teeth in infants?

 A 1-week-old newborn’s examination reveals the skin finding in the photo.

Follow-up shows growth of the lesion. The rest of the examination is unremarkable, and there are no additional lesions.
Which of the following is the most recommended treatment?

A two-week-old male is brought to the clinic due to a lesion on his shoulder (shown in the image).

The lesion was observed already after birth. Other than this finding, his examination is normal. What is the recommended treatment for this case?

You hear shouting at the beach and see a gathering of people. When you approach them, you see a child of about 5 years old lying on the sand, fully wet, unresponsive, and not breathing. You are the only qualified medical specialist around. What is the first immediate action required for you to take?

A 16-year-old male referred to the ER due to increase in temperature, cough, stabbing chest pain that are exacerbated during inspirium and relieved by sitting. On auscultation, distant heart sounds and pericardial friction rub heard. X-ray image below.

What is most likely to be found in an ECG in this case?

An 8-year-old girl presents with a 12-day febrile disease, and shortness of breath over the last day. Examination is significant for inspiratory dyspnea, 92% saturation in room air, mild hepatosplenomegaly, and the finding in the attached picture. Laboratory findings include leukocytosis with atypical lymphocytes, a sterile pharyngeal culture, and the findings in the table attached.

Which of the following treatments may improve the girl’s condition now?

A 14-year-old girl has lost 10 kg over the last months. Examination reveals a very thin girl, heart rate of 55/min (normal values 60-80). Laboratory results include low serum potassium, and elevated liver function tests and cholesterol.

Which of the following is the most likely diagnosis?

A 4-year-old girl has had 5 episodes of wheezing and shortness of breath over the last year. She has been treated with bronchodilators and inhaled steroids as an outpatient. Her recent chest x-ray is normal.

Which of the following predicts continuous symptoms into adulthood?

A 3-year-old boy was born at term, with a normal birth weight after an uneventful pregnancy and labor. He has passed his first stool at 72 hours of age. He is followed up for failure to gain weight, soft stool, steatorrhea, and has had an episode of pancreatitis.

Which of the following tests will promote the diagnosis?

The toddler in the photo below has been born at term. He was diagnosed with VSD shortly after birth, and the defect was surgically treated. In addition, he has been diagnosed with congenital hypothyroidism by newborn screening , and is treated with L-thyroxin.

Which of the following has increased incidence in this boy’s condition?

Below is the blood count of a healthy 1-year-old boy:

Which of the following is the most likely cause of anemia?

A 1-year-old male is referred for anemia workup. Examination reveals pallor

of the skin and conjunctivas. Blood smear and laboratory results are below

Which of the following is the most likely diagnosis?

An 8-year-old boy presents with a limp over the last week, with no history of trauma. Over the last two days he has high systemic fever. Examination reveals a temperature of 38.5oC, refusal to bear weight on the right leg, and significant tenderness in external rotation of the right hip. Laboratory results include leukocytosis and elevated inflammatory markers, and ultrasound demonstrates a large quantity of turbid fluid in the right hip joint.

Which of the following is the most likely causative agent?

A 13-year-old boy has been hit by a ball during a soccer game, two days prior to his arrival. He has been complaining of epigastric pain since, fever, and vomiting. His examination is positive for significant abdominal epigastric tenderness.

Which of the following tests will most probably promote diagnosis?

A 2-year-old generally well boy, who has been treated in the past with inhalations, presents with acute stridor. Examination reveals stridor, as well as good and equal breath sounds.

Which of the following is not an appropriate treatment for his condition?

A 17-month-old unimmunized infant, who was born via vaginal delivery, presents with 2 days of rhinorrhea, non-purulent conjunctivitis, fever, cough, and the rash seen in the picture.

Otitis media was diagnosed in the emergency room.

Which of the following describes the required isolation in his condition?

A 16-year-old boy is referred for work-up of incidental proteinuria. Which of the following supports a diagnosis of orthostatic proteinuria?

A 13-year-old girl is referred for work up due to fatigue, malaise, and elevated liver enzymes over the last 3 months. Examination is positive for a palpable, tender liver, 3cm below the rib cage. Laboratory results include total bilirubin 3.5, direct bilirubin 2, ALT 90, AST 80, GGT 25, ALKP 145, albumin 3.5, total protein 8.

Which of the following will most likely be found in this patient?

3-days-old newborn has not passed stools and is evaluated due to distended abdomen and vomiting. Below is his abdominal X-ray.

Which of the following is the most likely diagnosis?

A 30-month-old health toddler, with divorced parents is sent for evaluation due to mastication with
evidence of stomach content at 1-2 hours after a meal, for the last 2 months. There are no additional
complains, and there weren’t any similar complaints in the past
Which of the following is the most recommended treatment?

Which of the following most accurately fits the description of transient tachypnea of newborn?

A 14-year-old female, presented at the clinic due to lameness and pain in the groin area on the right side for about a month. Physical examination: lame with limitation in internal rotation of left leg.
In imaging, the following finding was demonstrated.

Which of the following is a risk factor for her disease?

A 3-month-old male, hospitalized for investigation of suspected convulsions. On examination – findings are demonstrated in the image (below). Brain imaging (CT) showed subependymal nodules.

Which of the following findings is typical of the probable diagnosis in this case?

A 16-year-old male arrives at the pediatric emergency room unconscious; on initial examination, he responds to pain, a temperature of 38.4°C, and tachycardia. In physical examination, the appearance of individual lesions on the back does not disappear when pressed. Cerebrospinal fluid culture demonstrated gram-negative diplococci growth. For whom of the following prophylactic treatment is recommended?

A 2-year-old boy presents with speech difficulties. His history is positive for multiple ear infections.
Examination now reveals bilateral turbid ear drums, and middle ear effusion.
The boy is well, calm, and afebrile.

Which of the following is the most appropriate next step?

A 7-year-old boy presents with 2 days of hematuria, several weeks after having an episode of pharyngitis. His examination is significant for hypertension. Laboratory results include low serum C3, proteinuria, and microscopic examination of the urine revealed red blood cell casts.

Which of the following is the most appropriate treatment?

A 3-year-old boy is undergoing work up due to failure to thrive. History is positive for several large smelly stools per day, and several episodes of pneumonia and cough necessitating inhalation therapy.

Which of the following tests will contribute the most to diagnosis?

In which of the following conditions administration of 100% oxygen during an hyperoxic test will increase the saturation from 72% to 79%?

A 2-months-old infant has been somnolent for the last few hours, and has difficulty feeding. Examination reveals tachycardia, mild tremor of the legs, and hepatomegaly 3 cm below the rib cage. Serum glucose levels are 35 mg/dl, urine is positive for ketones, a serum lactate is increased.

Which of the following is the most likely diagnosis?

A 7-months-old boy presents with restlessness, alternating fevers, and failure to gain weight over the last month. Examination is positive for an abdominal mass, and the finding in the photo below 

Which of the following is the most likely diagnosis?

A 12-year-old boy presents with the physical findings in the photos below

Which of the following will most likely be found in this patient?

A 3-months-old infant presents with stridor, episodes of spitting up and vomiting, with arching of the back and neck. The mother reports the stridor is improved while arching. Thickening of the feeds was unhelpful.

Which of the following tests is most appropriate for the most likely diagnosis?

A term, few hours old newborn, with a history of a normal pregnancy and delivery, presents with respiratory distress. Examination reveals dyspnea and grunting, use of accessory muscles, and abdominal breathing.

Auscultation to the lungs reveals bowel sounds. X-ray is below.

Which of the following is the most likely diagnosis?

A 7-year-old girl presents with the ocular finding in the attached picture.

She has no fever, blurred vision, or swelling around the eye.

Denies entry of foreign body or use of creams / makeup

Which of the following is the most recommended initial treatment?

A 2-day-old small for gestational age newborn has the features demonstrated in the picture.
Prenatal ultrasound was not performed. Echocardiography reveals a bicuspid aortic valve.

Which of the following symptoms is common in the newborn’s most likely diagnosis?

A 3-year-old boy is in intensive care, ventilated and sedated, deteriorates on the 3rd day.

Chest x-ray is attached. Pleural drainage revealed pH 7.3, protein 2.5 gr/dl, WBC 5000/m2, LDH 150 IU/L, glucose 72 mg/dl.

Which of the following is the most likely diagnosis?

A 1-year-old boy presents with weakness and apathy for an hour. On admission he is pale, grunting, and with a weak cry. His heart rate is 245 bpm, saturation is 97% with an oxygen mask. Capillary fill is 7 seconds and blood pressure is unmeasurable on several attempts.
A picture from the monitor is attached.

Which of the following is the next step in managing this patient?

A 4-year-old boy is evaluated for repeat dyspnea episodes, abdominal pain, vomiting, and diarrhea. He has swelling and non-pitting edema around his ankles. There is no erythema, rash, or systemic fever. These episodes last for 2-3 days and spontaneously resolve.

Which of the following is the most appropriate treatment?

A 3-year-old girl presents to the clinic with recurrent urinary tract infections and a single episode of pyelonephritis.
On voiding cystourethrogram (VCUG) the finding below is demonstrated.

Which of the following is the most appropriate treatment?

A 1-month-old infant is referred to the ER due to prolonged seizure. History is positive for significant
bleeding after the umbilical cord detachment. Normal pregnancy and normal home delivery. He is fed
with breast milk and formula and gains weight appropriately. Glucose is 60 mg/dl on glucometer.
Which of the following is the most appropriate treatment?

Which of the following conditions will require treatment with progesterone-only birth control pills?

A two-month-old male presented in the ER following a fever and a cough. On examination, he has a cleft palate. A chest x-ray demonstrated opacity at the base of the left lung and the absence of the thymus. Which of the following laboratory tests would advance the presumed diagnosis?

When examining a newborn in the delivery room, pallor reacts to irritation of the nostrils with a cough. The limbs are slightly flexed without active movement, the newborn cries and breathes well, and the pulse – is 120. What is his Apgar score?

A 9-months-old baby with atopic dermatitis develops the extensive rash demonstrated in the picture.

Which of the following is the most recommended treatment?

A 3-year-old boy presents with facial and limb edema. Urinalysis reveals significant proteinuria and blood work results are presented in the table.

Which of the following is a possible complicate his most likely disease?

A 3-month-old baby presents with severe restlessness with no additional symptoms. Examination reveals an afebrile infant, with normal oxygen saturation in room air, heart rate of 240/min, blood pressure of 80/40. The rest of the physical examination is normal.

Which of the following will contribute the most to diagnosis?

A 5-months-old infant presents with respiratory distress especially during feeds, stridor, and dysphagia with arching of the back during swallowing. Echocardiography reveals right aortic arch.

Which of the following is the most appropriate treatment?

 A 14-year-old boy presents with developmental delay and learning difficulties. Examination reveals elongated face, micropenis, and large testicles.

Which of the following is the most likely diagnosis?

A 6-year-old boy presents with multiple short episodes of staring and detachment from his surrounding occurring at all hours of the day for the last few weeks. Hyperventilation worsens the episodes. EEG demonstrates general bursts of slow spikes and waves pattern.

Which of the following describes the appropriate treatment for this condition?

On routine examination of a 1-month old infant, you notice asymmetrical lower limb folds. Barlow and Ortolani tests are positive.

Which of the following is a risk factor of this condition?

A 7-year-old girl’s parents and teachers report recent episodes of unawareness and stillness, occurring a few times a day and lasting 5-10 seconds. EEG is below.

Which of the following is the most likely diagnosis?

14-year-old girl presents with weight loss, nervousness, excessive sweating, heat intolerance, and tremor. Laboratory results include undetectable TSH and increase FT4. A facial photo is below

Which of the following is the most likely explanation for the findings in the picture?

A 3-day-old newborn presents with apathy, vomiting, and reduced feeding.

Examination is positive for signs of dehydration, micropenis, and testicular hyperpigmentation.

Laboratory results reveal hyponatremia and hyperkalemia.

Which of the following is typical of the newborn’s most likely diagnosis?

A 19-month-old infant is brought to the clinic by his mother, who is concerned since he has not begun walking yet. He did not sit until 14 months of age. Pregnancy and delivery were normal.

Which of the following would you recommend?

A 2-months-old baby, with parents who are first degree relatives, presents with weakness upon moving his limbs, and difficulty raising his head when in the prone position. Examination reveals an alert baby, which follows well with his eyes. No reflexes were obtained, there were tongue fasciculations, and the finding in the attached picture.

Which of the following is the most likely diagnosis?

In which of the following is the finding in the photo below most likely to be found?

A 16-year-old girl presents with a few weeks of palpitations, heat intolerance, hyperhidrosis, tremor, increased appetite, and weight loss. Examination reveals heart rate of 140 bpm and a tender fulness on the anterior aspect of the neck.

Which of the following is a typical laboratory finding in her most likely disease?

A 12-year-old boy who swims on the school’s team, complains of pain in his right ear for the last 2 days.
Examination reveals significant tenderness when the otoscope is inserted to the ear canal,
thick yellowish discharge, and an edematous and sensitive auditory canal.
Which of the following supports the most likely diagnosis?

A 6-year-old boy is admitted due to skin ecchymosis, anemia, thrombocytopenia, hepatosplenomegaly, and bone pain.

Which of the following is the most appropriate treatment ?

A 5-year-old male began walking at the age of 1.8 years; his parents report clumsy gait, difficulty going up and down stairs, and difficulty transitioning from sitting to standing. On physical examination – bilateral calf hypertrophy. In laboratory tests, CPK values around 3000 in several tests. Family history – brother with a similar history.

Which of the following findings is common in the toddler’s diagnosis?

In a brain ultrasound (US) of a premature baby born at week 32 weighing 1400 grams, the finding described in the image was observed.

Which of the following complications is common in the context of the presumed diagnosis?

A 4-year-old male has been suffering for the last week from abdominal pain, loss of appetite, diarrhea, and emesis. On the last day, the parents have noticed periorbital edema. In a blood test, electrolyte levels are within the norm, and albumin levels are 2.6 g/dL (norm above 3.5). Urinalysis with no evidence of protein. What is the standard treatment in this case?

A 17-year-old boy presents with shortness of breath and nausea starting a few minutes after being stung by a bee. His examination includes blood pressure of 65/40, and a heart rate of 140 per minute. He improved after been treated with an adrenaline injection. He has been stung by bees twice before without a systemic reaction.
His blood test is significant for increased anti bee venom IgE levels.

Which of the following is the best approach?

A 1-year-old infant is admitted for urinary tract infection and treated accordingly. She had responded to treatment and improved after 48 hours. Renal ultrasound is normal.

Which of the following represents the recommended approach?

A 2-hour-old newborn is evaluated for central cyanosis. Oxygen saturation in room air is 60%, heart rate is 160 per minute, breath sounds are good and equal, and there is no murmur. Hyperoxia test revealed low PaO2.

Which of the following describes the next step in this newborn’s care?

A 7-year-old deaf boy presents with several episodes of syncope during exertion. ECG is below.

Which of the following is the most appropriate treatment?

A 2-day-old newborn, born at home presents with seizures. Head CT demonstrated a recent brain bleed.
Coagulation function tests are disrupted (INR 2.3).

Which of the following routine newborn care would have prevented this condition?

A 13-year-old complains of double vision and has been seen holding his eye open with his fingers to prevent it from intermittently closing. The symptoms are worse in the evenings. Recently he has been exhibiting difficulties in swallowing food.

Which of the following test will promote the diagnosis?

A few-hours-old newborn develops the finding in the photo below

Which of the following is a common complication of this condition?

A 5-year-old boy is brought to the ER following a motor vehicle accident. On arrival he seems in pain but fully conscious. Vital signs – pulse 55/min, room air saturation 98%, blood pressure 140/90 mmHg. Neurological examination is normal. In light of the above, which of the following is the most important test?

A child is diagnosed with atopic dermatitis. He is referred for examination due to the rash in the photos.

Which of the following is the most appropriate treatment?

Which of the following presents an indication for kidney biopsy in patients with nephrotic syndrome?

An 8-year-old with known epilepsy for about 2 months. Presents with an itching rash and fever of 38°C.

He has been treated for seizures with lamotrigine (lamictal) over the last 4 weeks, with a good response. Examination reveals the rash seen in the picture, erythema in the pharynx, and enlarged cervical lymph nodes.

Laboratory tests are positive for elevated liver enzymes and eosinophilia of 700.

Which of the following steps is correct in managing this patient?

An 8-year-old, generally healthy boy, presents with right axillary swelling for 14 days, with no fever, weight loss, or night sweats. Examination reveals tender right axillary swelling with no significant erythema of the skin, and no rash or hepatosplenomegaly. The parents report adopting a kitten a few months back.

Which of the following is the most appropriate recommendation?

An 18-months-old boy presents with fever for two days and left knee pain.Several other infants at his day care had oral lesions and fever two weeks ago.

On examination – appears well, temperature 38.2 oC, swelling and local warmth of the left knee, decreased range of motion. Labs are below:

Which of the following is the most appropriate treatment?

A 30-month-old, healthy and vaccinated toddler, presents with high fever, torticollis, dysphagia and drooling. Other vital signs are normal.

Laboratory results reveal elevated inflammatory markers. Cervical CT is attached.

Which of the following is the most appropriate treatment?

A 3-year-old girl is diagnosed with neurofibromas, skin hyperpigmented lesions, scoliosis, iris tumors,
and learning disabilities. Her brother who is 6-month-old has skin hyperpigmented lesions (more than 5) without any other signs. Genetic testing is positive for neurofibromatosis type 1 with the same NF1 gene mutation in both of them.
Which genetic principle is demonstrated is this case?

Maternal blood work of a term infant, born via a spontaneous vaginal delivery with a birth weight of 3100gr,
are presented in the table:

Which of the following is the most appropriate recommendation?

A 3-year-old female, normally healthy, was discharged about 10 days ago from hospitalization due to pneumonia, treated with intravenous penicillin, referred due to edema and erythema of the hand in the infusion area, accompanied by fever up to 38.7°C, evidence of enlarged lymph nodes and joint pain. What is the best treatment in this case?

A 6-year-old male, usually healthy, under follow-up due to lack of eye contact in conversations, lack of social smiling, rarely speaking, poor language, rarely plays with his peers and prefers to watch screens. He has been referred due to sleep disorders.

Which of the following recommendations is the most likely in this situation?

A 7-year-old was brought into the ER in a stupor. Not talking. Opens eyes in response to pain stimulation and reaches out towards pain area; what is the child’s GCS (Glasgow coma scale) score?

A 13-year-old boy presents to the emergency room due to ankle and calf pain, dizziness and pharyngeal pain, that started 20 minutes before, while walking in the forest.
Examination reveals flushing, blood pressure 70/40, heart rate of 130/min, respiratory rate of 30/min, saturation 95% in room air, and the finding in the picture attached.

Which of the following is the mandatory immediate treatment in this case?