A 2 yr old boy is seen for his routine checkup, 4 weeks after an episode of bilateral acute otitis media that resolved uneventfully with antibiotic treatment. He seems generally well, but his mother reports that he is not hearing as well as usual. On pneumatic otoscopy, both his eardrums appear amber, opaque, and retracted, and both are immobile. Otherwise his ENT examination is unremarkable. Which of the following treatment regimens is the most appropriate to institute at this time?
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Question 2 of 46
2. Question
A 7-day-old infant is found to have a significantly elevated total bilirubin, but is otherwise well. The fractionated bilirubin reports a direct bilirubin of 3.0 mg/dL, and the indirect bilirubin is 6.0 mg/dL. Which one of the following should be considered in your differential diagnosis?
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Question 3 of 46
3. Question
A newborn infant spends about 40 min with the mother but then falls asleep and does not respond to the mother’s voice.
Which of the following statements regarding this lack of activity is true?
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Question 4 of 46
4. Question
Conductive hearing loss (CHL) is:
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Question 5 of 46
5. Question
A newborn develops sepsis and shock. The pathogen that most commonly causes systemic and focal infections in the newborn is:
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Question 6 of 46
6. Question
A 4-yr-old boy is noted to have stereotypic body movements and poor verbal and nonverbal communication, with absence of empathy. At daycare, he has not made any friends.
The most likely diagnosis is:
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Question 7 of 46
7. Question
A 2 mo old girl has a rapidly growing hemangioma involving the perioral region bilaterally, with symmetric extension onto the chin and anterior neck. She was born 8 wk premature with an otherwise benign medical history, although her parents wonder if she may be developing asthma. The most appropriate next step in patient management is:
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Question 8 of 46
8. Question
Which of the following is associated with a poorer prognosis for persons presenting with meningococcal disease?
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Question 9 of 46
9. Question
The probable age of a child who rolls back to front, has a thumb-finger grasp, self-inhibits to “no” and bangs two cubes is:
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Question 10 of 46
10. Question
A 6-mo-old infant is presented for evaluation of a tuft of thick black hair located on the sacrum. The child’s mother states that the lesion has been present since birth and seems to be asymptomatic, and the child is otherwise healthy. The most appropriate next step in management is:
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Question 11 of 46
11. Question
A previously healthy 18-month-old child has been in a separate room from his family. The family notices the sudden onset of coughing, which resolves in a few minutes. Subsequently, the patient appears to be normal except for increased amounts of drooling and refusal to take foods orally. Which of the following is the most likely explanation for this toddler’s condition?
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Question 12 of 46
12. Question
A 1-month-old boy presents to your clinic with feeding intolerance, poor weight gain, and a large tongue. On exam, you notice a large posterior fontanelle and umbilical hernia.Your next step in making the diagnosis would be:
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Question 13 of 46
13. Question
A blonde, blue-eyed girl was admitted at 2.5 mo of age with severe emesis to rule out pyloric stenosis. She had poor development, eczema, and a musty odor. The most likely diagnosis is:
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Question 14 of 46
14. Question
You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about nausea and a funny feeling in his chest. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis?
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Question 15 of 46
15. Question
Small mandible on x-ray no thymos:
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Question 16 of 46
16. Question
A previously healthy 2 wk old now has progressive lethargy. Physical examination reveals muscle rigidity, opisthotonos posture, periods of hypertonicity, and flaccidity. Laboratory data reveal hypoglycemia, metabolic acidosis, and cerebral edema. Plasma levels of leucine, isoleucine, and valine are elevated. The most likely diagnosis is:
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Question 17 of 46
17. Question
A 15-year-old girl with short stature, neck webbing, and sexual infantilism is found to have coarctation of the aorta. A chromosomal analysis likely would demonstrate which of the following?
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Question 18 of 46
18. Question
A mother brings her 3-year-old son with Down syndrome to the clinic because his gums have been bleeding for 1 week. She reports he has been less energetic than usual. Examination reveals that the child has a temperature of 100F orally, pallor, splenomegaly, gingival bleeding, and bruises on the lower extremities. Which of the following is most likely?
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Question 19 of 46
19. Question
Which of the following cancers has the highest incidence in young children (<7 yr of age)?
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Question 20 of 46
20. Question
A 5 yr old is noted by the parents to snore at night. The child also has had problems staying awake in preschool and has had behavioral problems. The father also snores. Physical examination of the child reveals large, pink, nonexudative tonsils.
The most appropriate next step is:
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Question 21 of 46
21. Question
A 30 hour-old full term infant has face and chest jaundice,he is breast feeding well. And has an otherwise normal exam.his bilirubin level is 16.5mg/dl. which is the following is the most appropriate course of action?
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Question 22 of 46
22. Question
Which of the following cancers is most closely associated with Epstein Barr virus?
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Question 23 of 46
23. Question
A 4-year-old boy is in the office for a routine health maintenance evaluation. His examination is normal except for multiple deep dental cavities. You plan on referring him for dental evaluation and possible dental extraction. His mother reminds you that he has a “heart condition.” Which of the following cardiac conditions requires antibiotic prophylaxis against endocarditis?
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Question 24 of 46
24. Question
Cystic Fibrosis (CF) vitamin supplement?
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Question 25 of 46
25. Question
An adolescent girl who is a cheerleader comes to you with a painful bump below her right knee. She denies fever or trauma. Which of the following is the most likely diagnosis?
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Question 26 of 46
26. Question
A 4 yr old white girl has had joint swelling in multiple joints for over 6 mo.She is slow to move in the morning and moves as if stiff for the 1st hours of theday. Thereafter, she is a very active child. She has no rash and very littlelimitation of range of motion. Her erythrocyte sedimentation rate (ESR) is 4mm/hr.
The most likely diagnosis is:
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Question 27 of 46
27. Question
A 14-year-old healthy girl has a urinalysis as part of her well child visit. Urine dipstick testing shows specific gravity 1.014, pH 6.0, and 2+ proteinuria and is negative for blood. Microscopic examination of the urine is unrevealing. The most appropriate next step in diagnosis is to:
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Question 28 of 46
28. Question
A 9-mo-old boy is brought to the emergency room in a limp andunresponsive state. Initial examination shows a pulse rate of 35/min and occasionalirregular breaths. After initiation of CPR (including tracheal intubation), delivery ofoxygen via positive pressure breaths, and chest compressions, multiple attempts toinsert an IV line fail. The most appropriate next step in management should be to:
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Question 29 of 46
29. Question
Of the following signs of cancer, the most likely to occur in children is:
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Question 30 of 46
30. Question
An 8-year-old girl is brought in to the hospital while actively seizing. She has been hospitalized many times before for status epilepticus. She is receiving valproic acid at home to control the seizures. The first step in the management of this patient is to:
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Question 31 of 46
31. Question
A 12-yr-old girl experienced diarrhea, which lasted for 3 days, 2 wk before manifesting progressive weakness and inability to walk. She has intermittent tingling of her fingers and toes. Physical examination reveals marked peripheral muscle weakness without atrophy or fasciculations. The deep tendon reflexes are absent in her ankles and 1+ at her knees. Findings on the sensory examination are normal. Motor involvement is symmetric. The most likely diagnosis:
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Question 32 of 46
32. Question
A 12-yr-old white girl presents with arthralgias of the knees and elbow and swollen hands of 6 months’ duration. She has had intermittent fever and has lost 15 lb. Other than swollen joints, findings on physical examination are normal. Three years earlier, she was found to have thrombocytopenia and was diagnosed with idiopathic thrombocytopenic purpura (ITP). In addition,one summer she had severe sunburn, and 2 yr ago she had mouth sores.Today she has a hematocrit of 25% and a positive result on a Coombs test,and the urinalysis shows multiple red blood cells.
The most likely diagnosis is:
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Question 33 of 46
33. Question
You are seeing a 10-year-old boy for his wellchild checkup and notice that he is hypertensive. He has otherwise been doing well. When looking back through his old chart, you realize that his previous blood pressures were normal. What would be your next course of action?
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Question 34 of 46
34. Question
A 10 yr old girl has had diplopia and ptosis and weakness of her neck flexors for 2 mo. Symptoms are worse in the evening and are usually less severe on awakening in the morning. She has no fasciculations or myalgias, and her deep tendon reflexes are 1-2+. The most likely diagnosis is:
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Question 35 of 46
35. Question
A 13-year-old boy develops fever, malaise, sore throat, and a dry, hacking cough over several days. He does not appear to be particularly sick, but his chest examination is significant for diffuse rales and rhonchi. The chest radiograph is shown below. Which of the following is the most likely pathogen?
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Question 36 of 46
36. Question
Which of the following autoantibodies is most specific for SLE?
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Question 37 of 46
37. Question
A 12 yr old boy with cystic fibrosis experiences an acute exacerbation andis admitted for intravenous antibiotic therapy. Sputum culture revealsPseudomonas aeruginosa. The antibiotic recommended for treatment is:
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Question 38 of 46
38. Question
A 9-year-old girl with asthma is brought to the office for the first time. On average, she uses her albuterol inhaler three times per week, but for the past 10 days, she has been wheezing both day and night and is using the inhaler three to four times per day. On examination, you note diffuse wheezing and moderate subcostal retractions. Which of the following is the next step in management?
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Question 39 of 46
39. Question
A 14 yr old girl presents with vaginal bleeding that is more prolonged andprofuse than her usual periods, which are irregular and first started 13 moago. She has pallor and tachycardia. The next step in her evaluation is to:
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Question 40 of 46
40. Question
All of the following are features of scarlet fever except:
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Question 41 of 46
41. Question
A 12-month-old female infant with failure to thrive is brought to the office. Her parents note that she is very fussy and often spits up after feedings. She also has two loose foul-smelling stools each day. Serologic testing reveals elevated serum tissue transglutaminase antibody. Which of the following foods can she eat safely without aggravating or inducing her symptoms?
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Question 42 of 46
42. Question
A 12-month-old boy is brought to your clinic because he is refusing to walk. His mother states that he began walking at 10 months of age, and has been doing well until this point. His vital signs are remarkable for a temperature of 39.2°C and a physical examination that reveals a moderately ill infant, with an extemally rotated, left hip with limitation to passive and active motion. The most likely causative organism for this illness is:
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Question 43 of 46
43. Question
A 6 yr old girl underwent removal of a craniopharyngioma 3 mo previously. She is on a thyroid replacement regimen, but her mother reports she is very fatigued. The next step would be to:
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Question 44 of 46
44. Question
A 5-mo-old infant develops signs of respiratory distress after coughing and sneezing for 3 days. He has marked subcostal and intercostal retractions and a respiratory rate of 80 breaths/min. Breath sounds are markedly diminished on both sides. Diffuse crackles can be heard bilaterally. There is no stridor. Arterial oxygen saturation in 100% oxygen by non-rebreather mask is 80%. The skin is pale and peripheral arterial pulses are weak. Which of the following is the most appropriate immediate course of action?
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Question 45 of 46
45. Question
Sickle cell anemia become asplenic infection risk?
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Question 46 of 46
46. Question
A 10 yr old boy receiving vincristine for treatment of a malignancy has developed the syndrome of inappropriate antidiuretic hormone secretion(SIADH), a known complication of this therapy. All of the following parameters would be decreased in this patient EXCEPT: