Part 7 (1762-1784)(1530-1784) Pogba KH 8
326) A 17-year-old boy comes to medical attention because of recurrent sinusitis and pneumonia, and persistent watery diarrhea due to Giardia lamblia. His parents and a sister are in excellent health. Physical examination reveals enlarged lymph nodes in cervical, axillary and inguinal regions. A lymph node biopsy shows hyperplastic follicles with an absence of plasma cells. Laboratory investigations show: Hematocrit44%, Leukocyte count9, 800/mm3, Neutrophils55%, Lymphocytes30%, Monocytes5%, CD4 T-cell count1000 cells/mm3, Proteins, serum6.2 g/dL, Albumin5.0 g/dL, Globulin1.2 g/dL. Additional studies demonstrate severely depressed levels of serum IgG, with slightly below-normal levels of IgM and IgA. Which of the following is the most likely diagnosis?
Common variable immunodeficiency
Acquired immunodeficiency syndrome (AIDS)
. Hodgkin disease
. Isolated IgA deficiency
X-linked agammaglobulinemia of Bruton
327) An 8-year-old boy presents with a 2-day history of rash. The rash started on the head and spread downward to his trunk and extremities. He also complains of a fever, cough, and a runny nose for the past 5 days. On physical examination, his temperature is 38.2 C (100.7 F), blood pressure is 88/56 mm Hg, pulse is 76/min, and respirations are 16/min. There is a small, irregular red spot with a central gray color on his buccal mucosa. The rash on his body is erythematous and maculopapular in quality. Which of the following is the most likely diagnosis?
327) An 8-year-old boy presents with a 2-day history of rash. The rash started on the head and spread downward to his trunk and extremities. He also complains of a fever, cough, and a runny nose for the past 5 days. On physical examination, his temperature is 38.2 C (100.7 F), blood pressure is 88/56 mm Hg, pulse is 76/min, and respirations are 16/min. There is a small, irregular red spot with a central gray color on his buccal mucosa. The rash on his body is erythematous and maculopapular in quality. Which of the following is the most likely diagnosis?
. Rubella
. Roseola infantum
Hand-foot-mouth disease
Erythema infectiosum
328) A 3-year-old child presents in clinic with marked erythema of the cheeks, with no prior symptoms. The rash soon involves the arms and has a reticular erythematous maculopapular appearance. The patient has been previously healthy and is not on any medications. He has not been exposed to any other ill individual. Which of the following is the most likely diagnosis?
Fifth disease (erythema infectiosum)
Measles
Roseola
Rubella
Varicella
329) The mother of a 6-month-old infant is concerned that her baby may be teething. You explain to her that the first teeth to erupt in most children are which of the following?
. Mandibular central incisors
Maxillary lateral incisors
Maxillary first molars
Mandibular cuspids (canines)
First premolars (bicuspids)
330) A 6-month-old previously health child is brought to the doctor's office because of sudden onset of lethargy, constipation, generalized weakness and poor feeding. He has been meeting all development milestones and his immunization schedule is up to date. On further questioning, his parents mention that his diet was recently advanced to a homemade formula of evaporated milk and honey. On physical examination, he has stable vital signs, clear lungs, normal skin turgor and full fontanelles. Which of the following is the most likely explanation for the patient's presentation?
Botulism
Hirschsprung disease
Hypernatremia
Hyponatremia
Hypothyroidism
331) A 15-year-old girl presents to the emergency department with the sudden onset of watery diarrhea tinged with blood. The girl was previously healthy. Her only medications are topical benzoyl peroxide and oral clindamycin for acne vulgaris. Physical examination reveals a slightly distended abdomen that is diffusely tender. Her temperature is 38.1 C (100.5 F). She has not been exposed to any uncooked meat and has not eaten any unusual foods. Which of the following is the most likely diagnosis?
Pseudomembranous enterocolitis
Irritable bowel syndrome
Gastroenteritis
. Salmonella infection
Ulcerative colitis
332) A 22-year-old woman has just delivered a male infant at 41 weeks of gestation. Her medical history is normal and her pregnancy was uncomplicated. She is an assistant in a veterinary clinic. Examination of the infant reveals jaundice, hepatosplenomegaly, and generalized lymphadenopathy. During the examination, he suddenly begins to have tonic-clonic seizures. The CT scan reveals active inflammatory lesions, hydrocephalus and intracranial calcifications. What is the most likely diagnosis of this patient?
Congenital toxoplasmosis
Congenital rubella
Congenital syphilis
Congenital herpes simplex
Congenital hepatitis B
333) A 5-year-old girl is brought to the physician's office for a follow-up visit after recovering from an episode of acute bacterial meningitis. Five weeks ago, she developed pneumococcal meningitis, and was admitted to the hospital, where she underwent lumbar puncture, CT scan of the head, and ceftriaxone therapy. She was discharged in a stable condition. According to the mother, the child has not been performing well in school since her illness. She also noticed that the child has forgotten how to copy figures such as triangles and squares, and is unable to identify colours accurately. What is the most likely cause for the regression of milestones in this patient?
Meningitis
Drug reaction
Lumbar puncture
Alexia
Amnesia
334) You are seeing a 2-year-old boy for the first time. His father denies any past medical or surgical history, but does note that the child’s day care recently sent a note home asking about several episodes, usually after the child does not get what he wants, when he “breathes funny” and sits in a corner with his knees under his chin for a few minutes. The day-care staffers think this “self-imposed time-out” is a good thing, but they worry about the breathing. One teacher even though he once looked blue, but decided that it was probably because of the finger paints he had been using. On examination, you identify a right ventricular impulse, a systolic thrill along the left sternal border, and a harsh systolic murmur (loudest at the left sternal border but radiating through the lung fields). His chest radio- graph and ECG are shown. Which of the following congenital cardiac lesions would you expect to find in this child?Right ventricular outflow obstruction
Patent ductus arteriosus
Atrial septal defect (ASD)
Transposition of the great vessels with a patent foramen ovale
Hypoplastic left heart
335) A 5-year-old boy is brought to the physician because of a malodorous discharge coming from his right nostril. His parents report that the child developed frequent sneezing and mucus discharge for one week. They thought it was a common cold. The child is afebrile and in apparent good health. There is no history of allergic diseases or recurrent infections. Examination reveals obstruction of the right nasal fossa with associated purulent discharge from the right nostril. Which of the following is the most likely diagnosis?
Nasal foreign body
Juvenile angiofibroma
Allergic rhinitis
Nasal polyp
Rhinitis medicamentosa
336) A 4-year-old girl is brought to your office by her mother for recent onset of fever and rash. For the past 4 days, she has had headaches, fever, and sore throat. She was apparently normal 4 days ago, and upon presentation of the symptoms, her mother thought that she was having a simple viral fever which would go away with time; however, she then developed a pale pink maculo-papular rash, first on the face and neck, and then it rapidly spread onto the trunk and limbs. On examination, the child is afebrile and doesn't appear ill, but there are few palpable suboccipital and posterior auricular lymph nodes. What is the most likely cause of this patient's condition?
Rubella virus
Group A beta- hemolytic streptococci
Measles virus
Varicella virus
Human parvovirus
337) For the past year, a 12-year-old boy has had recurrent episodes of swelling of his hands and feet, which has been getting worse recently. These episodes occur following exercise and emotional stress, last for 2 to 3 days, and resolve spontaneously. The last episode was accompanied by abdominal pain, vomiting, and diarrhea. The results of routine laboratory workup are normal. An older sister and a maternal uncle have had similar episodes, but they were not given a diagnosis. He presents today with another episode as shown in the photographs on the next page. Which of the following is the most likely diagnosis?Hereditary angioedema
Systemic lupus erythematosus
Focal glomerulosclerosis
Congenital nephrotic syndrome
Henoch-Schönlein purpura
338) During a regular checkup of an 8-year-old child, you note a loud first heart sound with a fixed and widely split second heart sound at the upper left sternal border that does not change with respirations. The patient is otherwise active and healthy. Which of the following heart lesions most likely explains these findings?
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Isolated tricuspid regurgitation
Tetralogy of Fallot
Mitral valve prolapse
339) A 2-year-old child with minimal cyanosis has an S3 and S4 (a quadruple rhythm), a systolic murmur in the pulmonic area, and a middiastolic murmur along the lower left sternal border. An ECG shows right atrial hypertrophy and a ventricular block pattern in the right chest leads. Which of the following is the most likely diagnosis?
Ebstein anomaly
Wolff-Parkinson-White syndrome
Atrioventricular canal
Pulmonic stenosis and a VSD (tetralogy of Fallot)
Pid regurgitation and pulmonic stenosis
340) An 18-year-old male undergoes elective hernia repair. During the operation, he suffers considerable blood loss, and receives a blood transfusion. He then experiences an anaphylactic transfusion reaction. He is resuscitated and further hospital course is uncomplicated. His past medical history is significant for recurrent sinopulmonary infections and intermittent episodes of diarrhea since childhood. Which of the following is the most likely cause of his symptoms?
IgA deficiency
DiGeorge Syndrome
X linked agammaglobulinemia
Wiskott-Aldrich syndrome
. Cystic fibrosis
341) A 2-hour-old male neonate has developed worsening cyanosis over the past few minutes. The infant was vaginally delivered (assisted with forceps) at full term and weighed 4.1 kg (9 lb). The Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Oxygen is administered by mask but does not relieve the cyanosis. Further examination reveals tachypnea, subcostal retractions, a normal first heart sound, a single and loud second heart sound (S2), and no murmur. Which of the following is the most likely cause of the infant's cyanosis?
Transposition of the great vessels
Atrial septaI defect
Coarctation of the aorta
Ventricular septal defect
Patent ductus arteriosus
342) A 5-year-old girl presents to the emergency department with acute onset of muscle weakness. The mother carried the girl to the examination room and states that the muscle weakness started in her daughter's legs yesterday. The weakness became worse today and progressed to the trunk and both arms. She was also complaining difficulty of breathing earlier today. She has been otherwise healthy but had a common cold about 10 days ago. On examination, her respirations are 26/min and shallow. She has profound muscle weakness in her lower extremities, and moderate weakness in her upper extremities. Her deep tendon reflexes are absent. A lumbar puncture is performed, which shows increased protein concentration but no pleocytosis. Which of the following is the most likely diagnosis?
. Guillain-Barré syndrome
. Dermatomyositis
. Botulism
Myasthenia gravis
Toxic neuropathy
343) A 4-year-old previously healthy but unimmunized boy presents with sudden onset of high fever, inspiratory stridor, and refusal to drink. Of the following causes of inspiratory stridor, which best fits this clinical scenario?
Epiglottitis
Vascular ring
Croup
Foreign body aspiration
Laryngeal tumor
344) A week-old infant presents blood in his stools. He was born at home, with the father assisting in the delivery; no physician or midwife was present. He has been breast-fed and has been nursing well. On examination, you also note some blood in his nose. He is not jaundiced; a rectal examination and guaic test of the stool confirms that blood is present. His examination is otherwise normal. He is on no medications. Which of the following is the most likely diagnosis?
Vitamin K deficiency
Child abuse
Breast milk allergy
Sepsis
Liver disease
345) A 12-year-old American boy comes to you with the complaints of abdominal pain and dark urine. On examination he has normal vitals, icteric sclerae, and abdominal tenderness with a mass palpable in right upper quadrant. His laboratory report shows bilirubin: 6.5 mg/di, negative viral serologies and mild elevations of amylase and lipase. Ultrasonography shows a cystic extra hepatic mass and a gall bladder separated from the mass. What is the most likely diagnosis in this patient?
Choledochal cyst
Caroli's syndrome
Biliary abscess
. Biliary atresia
Pseudo pancreatic cyst
346) A 10-year-old boy has been having “bellyaches” for about 2 years. They occur at night as well as during the day. Occasionally, he vomits after the onset of pain. Occult blood has been found in his stool. His father also gets frequent, nonspecific stomachaches. Which of the following is the most likely diagnosis?
. Peptic ulcer
Appendicitis
Meckel diverticulum
Functional abdominal pain
Pinworm infestation
347) 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?
Medial tibial torsion
Metatarsus adductus
Legg-Calvé-Perthes disease
Femoral anteversion
Adducted great toe
348) Two weeks after a viral syndrome, a 9-year-old boy presents to your clinic with a complaint of several days of weakness of his mouth. In addition to the drooping of the left side of his mouth, you note that he is unable to completely shut his left eye. His smile is asymmetric, but his examination is otherwise normal. Which of the following is the most likely diagnosis?Bell palsy
Guillain-Barré syndrome
Cerebral vascular accident
Botulism
Brainstem tumor
349) A 4-year-old girl is noticed by her grandmother to have a limp and a some-what swollen left knee. The parents report that the patient occasionally com- plains of pain in that knee. An ophthalmologic examination reveals findings as depicted in the photograph. Which of the following conditions is most likely to be associated with these findings?Juvenile rheumatoid arthritis
Slipped capital femoral epiphysis
Henoch-Schönlein purpura
Osgood-Schlatter disease
Legg-Calvé-Perthes disease
350) A 1-month old boy is brought to the emergency department by his mother, who states that he has been having what she describes as "projectile vomiting" for the past several days. She states that he vomits every time she feeds him, and the situation seems to be getting worse, although he does not seem to be in pain. She describes the vomitus as non-bilious, and he has had normal stools with no blood in them. On examination, the infant appears to be mildly dehydrated, his abdomen is soft, and there is a palpable, olive-sized, firm moveable mass in the right upper quadrant. Which of the following is the most likely diagnosis?
Pyloric stenosis
Midgut volvulus
Hirschsprung disease
Intussusception
Duodenal atresia
351) A pediatrician examines a 2-month-old infant who had been born at term. The pediatrician hears a continuous murmur at the upper left sternal border. The peripheral pulses in all extremities are full and show widened pulse pressure. Which of the following is the most likely diagnosis?
Patent ductus arteriosus
Coarctation of the aorta
. Peripheral pulmonic stenosis
Persistent truncus arteriosus
Ventricular septal defect
352) A 3-week-old infant is being evaluated for hematochezia. His mother states that the infant passed stools j that contain both blood and mucus. There were no complications during her pregnancy, and the infant has been otherwise healthy. On physical examination, his temperature is 37.1 C (98.9 F), pulse is 110/min, and respirations are 18/min. He appears well, and his fontanelle is flat and level. Abdominal examination reveals normal active bowel sounds; his abdomen is nontender to palpation and there is no mass. His diaper contains stool that has bright red blood on it with mucus. Which of the following is the most likely explanation of his hematochezia?
Food allergy-induced colitis
Meckel diverticulum
Necrotizing enterocolitis
Rectal fissure
Ulcerative colitis
353) A 7-year-old boy is brought to the physician because of a persistent mucopurulent nasal discharge for 2 weeks following a common cold. The mother also reports that the child has had frequent cough during the day and occasional temperatures up to 38.0 C (100.5 F). The child does not appear critically ill, but he complains of mild pain in the maxillary region and nasal obstruction. Rhinoscopic examination reveals a rivulet of purulent fluid coming from the inferior meatus. The rest of the physical examination is normal. Which of the following is the most likely diagnosis?
Acute bacterial sinusitis
Acute otitis media
Acute viral rhinitis
Allergic rhinosinusitis
Asthma
354) A 9-year-old boy presents with a several-day history of progressive arm and leg weakness. He has been well except for an upper respiratory infection 2 weeks ago. The patient is alert and oriented. On repeated examination, the heart rate varies between 60 and 140 beats/min, and the blood pressure (BP) varies between 90/60 and 140/90 mmHg. Respirations are shallow, with a rate of 50/min. There is symmetric weakness of the face and all four extremities. Deep tendon reflexes are absent. Sensation is intact. Which of the following is the most likely diagnosis?
Guillain-Barré syndrome
Viral encephalitis
Transverse myelitis
Myasthenia gravis
Polymyositis
355) A previously healthy 4-year-old child pictured below presents to the emergency room (ER) with a 2-day history of a brightly erythematous rash and temperature of 40°C (104°F). The exquisitely tender, generalized rash is worse in the flexural and perioral areas. The child is admitted and over the next day develops crusting and fissuring around the eyes, mouth, and nose. The desquamation of skin shown in the photograph occurs with gentle traction. Which of the following is the most likely diagnosis?Staphylococcal scalded skin syndrome
Epidermolysis bullosa
Erythema multiforme
Drug eruption
Scarlet fever
356) A 6-year-old boy is brought to the emergency department (ED) by the paramedics due to nausea, vomiting, diarrhea and abdominal pain over the past hour. His mother found an open multivitamin supplement bottle and some pills scattered on the kitchen floor. After his admission to the ED, he starts hyperventilating and experiences hematemesis. His blood pressure is 90/60 mmHg, pulse is 130/min, respirations are 50/min and temperature is 37.2 C (99F). Abdominal plain x-ray reveals several small opacities in the stomach and duodenum. Lab results are: Hb 13.5 g/dL, Ht 42%, WBC 10,000/mm3, Platelets 300,000/mm3, Blood Glucose 118 mg/dL, Serum Na 135 mEq/L, Serum K 34 mEq/L, Chloride 102 mEq/L, Bicarbonate 16 mEq/L, BUN 16 mg/dL, Serum Creatinine 1.0 mg/dL, pH 7.30, P02: 90 mm Hg, PC02: 29 mm Hg. What is the most likely diagnosis?
Iron poisoning
Vitamin K poisoning
Vitamin D poisoning
Vitamin A poisoning
. Riboflavin poisoning
357) A 3-year-old boy is brought to the office by his mother because he has been having painless passage of black stools for the past few days. Otherwise, his bowel habits are normal. He has no other medical problems. He takes no medication. His vital signs are within normal limits. The physical examination is unremarkable. What is the most likely diagnosis of this patient?
Meckel's diverticulum
Inflammatory bowel disease
Intussusception
Anal fissure
Peptic ulcer disease
358) A 2-week-old Caucasian male presents with constipation since birth. He was born full term via a normal vaginal delivery. He did not pass meconium till his 3rd day of life, after he was given a glycerin suppository. He has since stooled every 3–4 days, only with the help of a suppository. The stools are pellet like. He has had increasing abdominal distention. On rectal examination, tone appears normal and the ampulla contains no stool. Which of the following is the most likely cause?
Hirschprung disease
Cystic fibrosis
Anal stenosis
Functional constipation
Hypothyroidism
359) A 44 year old woman delivers a 3120 g (6 lb 14 oz) newborn male. Her pregnancy was normal except that she noted decreased fetal movement compared to her previous pregnancies. She declined an amniocentesis offered by her obstetrician. Physical examination of the newborn reveals an infant with facial features suggestive of Down syndrome. The infant then has bilious vomiting. An x-ray film showing the kidneys, ureters, and bladder (KUB) is performed, which shows a "double bubble" sign. Which of the following is the most likely cause of the abdominal signs and symptoms?
Duodenal atresia
Hirschsprung Disease
. Malrotation
Meconium ileus
Pyloric stenosis
360) A 9-year-old Caucasian male complains of fever, sore throat and difficulty swallowing. Small tender lymph nodes are palpated in the cervical region. The symptoms subside quickly on penicillin therapy. Ten days later, the patient presents again with fever, skin rash and fleeting joint pain in the lower extremities. Physical examination reveals scattered urticaria and palpable lymph nodes in the cervical, axillary and inguinal regions. Which of the following is the most likely cause of this patient's current complaints?
Drug-induced reaction
Rheumatic fever
Lymphoproliferative disorder
Henoch-Schonlein purpura
. Infective endocarditis
361) A 28-month-old female has been living with her mother in a shelter for homeless women and children. She is brought to the Emergency Department in status epilepticus, which is stopped with intravenous lorazepam. She is placed on a cardiac monitor and a wide complex tachycardia is noted. The ventricular tachycardia reverts to sinus tachycardia after defibrillation is performed. Her temperature is 38.5 C (101.3 F), blood pressure is 120/80 mm Hg, pulse is 195, and respirations are 26. Physical examination reveals a lethargic, pale toddler with dilated and reactive pupils, dry mucous membranes, shallow respirations, diaphoresis and brisk deep tendon reflexes. A urine toxicology screen is most likely to detect which of the following substances?
Cocaine
Barbiturates
Heroin
Marijuana
PCP
362) A 4-year-old girl is brought to the office due to seizures that occurred 2 hours ago. This is her first episode. Her parents are also concerned because she is not able to carry on activities that children of her age are expected to do. On examination, there is a red flat lesion covering the left eye area and adjacent facial skin, which does not blanch on pressure, and which the parents say has been present since birth. Other pertinent findings are hemianopia, hemiparesis, and hemisensory disturbances. An x-ray of the skull shows tramline intra-cranial calcifications. What is the most likely diagnosis?
Sturge-Weber syndrome
Tuberous sclerosis
Capillary hemangioma
Epilepsy
Neurofibromatosis
363) A term neonate is small for date and has a small head. Further physical examination of the infant demonstrates small eyes with short palpebral fissures, a flattened nose, and abnormal palmar creases. With which of the following maternal conditions is this presentation most likely associated?
Alcohol abuse
Cirrhosis
Cocaine abuse
Diabetes mellitus
Hypothyroidism
364) A 10-day-old infant is brought to the office by her mother for the evaluation of purulent discharge from both eyes. The discharge appeared three days ago, after which the child developed a cough. On examination, the infant's eyes appear normal, except for the presence of purulent discharge. Auscultation reveals diffuse rales without wheezing. Chest radiograph shows a hyperinflated thorax. What is the most likely diagnosis?
Congenital chlamydial infection
Gonococcal conjunctivitis
. Chemical conjunctivitis
Congenital rubella infection
Adenovirus infection
365) A 2-month-old girl presents to her pediatrician's office for well-child care. Her mother complains of excessive tearing of the baby's left eye for the past 4 weeks. Each morning, a yellow crusty discharge is noted along the lashes of the left eye. The conjunctiva appears uninflamed. The right eye is not affected. On physical examination, the infant is otherwise well and achieving adequate weight gain on an exclusive breast milk diet. She is developmentally appropriate, including visually tracking 180 degrees. Which of the following is the most likely diagnosis?
Dacryostenosis
Gonococcal conjunctivitis
Normal infant eye
Viral conjunctivitis
Vitamin A deficiency
366) A 3-week-old female infant born at 38 weeks' gestation through an uncomplicated vaginal delivery, presents to the emergency department with 2-day history of fever. The infant had been healthy since birth. Her temperature in the emergency department is 40.0 C (104.0 F). She appears to be quite lethargic. A culture taken from the infant grows group B Streptococcus (GBS) in 24 hours. Which of the following infections is most consistent with this presentation?
. Meningitis
Endocarditis
Gastroenteritis
Pneumonia
Pyelonephritis
367) A 10-year-old boy is brought to clinic because of increasing weakness and dyspnea over the past 6 months. He has been previously healthy and is on no medications. There is no significant family history of illness. On examination, he appears pale. His hematocrit is 20%, mean corpuscular volume (MCV) is 60/mm3, and iron level is normal. Smear reveals basophilic stippling. Hemoglobin electrophoresis is consistent with the absence of one beta-globin gene. Which of the following is the most likely diagnosis?
Thalassemia
Sickle cell disease
Porphyria
Hemoglobin S-C disease
EUiptocytosis
368) The child shown below presents with a 3-day history of malaise, fever to 41.1C (106F), cough, coryza, and conjunctivitis. He then develops the erythematous, maculopapular rash pictured. He is noted to have white pinpoint lesions on a bright red buccal mucosa in the area opposite his lower molars. Which of the following is the most likely diagnosis?Rubeola
Varicella
Herpes
Rubella
Parvovirus
369) A 3-week-old infant with hypoplastic left heart syndrome comes to the physician for a follow-up visit. The infant was born at term via normal spontaneous vaginal delivery. The patient had the first of 3 palliative heart surgeries shortly after birth. He did well after surgery and was discharged home one week ago. Over the last 24 hours, the infant has difficulty feeding and one episodes of vomiting. On examination, the infant is afebrile, pulse is 160/min, respiratory rate is 55/min, blood pressure is 90/50mmHg, and pulse oximetry is 80% on room air. He is mildly cyanotic, small, but well developed. His cardiovascular exam reveals tachycardia and distant heart sounds with a systolic ejection murmur heard throughout the precordium. His chest radiographs from discharge and today are shown below. What is the most likely diagnosis?Pericardial effusion
Myocarditis
. Pleural effusion
Endocarditis
. Congestive heart failure
370) A mother wishes to breast-feed her newborn infant, but is worried about medical conditions that would prohibit her from doing so. You counsel her that of her listed conditions, which of the following is a contraindication to breast-feeding?
. HIV infection
Inverted nipples
Mastitis
Cracked and bleeding nipples
Upper respiratory tract infection
371) A mother brings her 6-year-old daughter for evaluation because she has never been able to toilet train her. The child states that she perceives the sensation of having to void, and empties her bladder normally at normal intervals, but is nonetheless wet with urine all the time. Which of the following is the most likely diagnosis?
Low implantation of one ureter
Meatal stenosis
Ureteropelvic junction obstruction
Ureterovesical reflux
Urethral valves
372) A 6-day-old girl who was born at home is being evaluated for bruising and gastrointestinal bleeding. Laboratory findings include partial thromboplastin time and prothrombin time, greater than 2 minutes; serum bilirubin, 4.7 mg/dL; alanine aminotransferase, 18 mg/dL; platelet count, 330,000/mm3; and hemoglobin, 16.3 g/dL. Which of the following is the most likely cause of her bleeding?
Vitamin K deficiency
Liver disease
Idiopathic thrombocytopenic purpura
Factor IX deficiency
Factor IX deficiency
373) A 1-year-old African American infant is in for well-child care. He is primarily breast-fed. His parents do not give him much solid food because he has no teeth. He receives no medications or supplements. His parents are concerned about his bowed legs. On examination, you note some other bony abnormalities including frontal bossing, enlargement of the costochondral junctions, a protuberant sternum (pigeon chest), and severe bowing of the legs. You obtain x-rays to confirm your clinical diagnosis and also note a healing fracture of the left femur. Which of the following is the most likely diagnosis?
Rickets
Chondrodystrophy
Congenital syphilis
Scurvy
Osteogenesis imperfecta
374) A 2-year-old boy is brought to the emergency department by his mother for the evaluation of a productive cough and low-grade fever. He has had ten such infections over the past year, all of which required antibiotics. He was delivered vaginally without any complications. He is an only child. His mother's siblings have a history of similar infections. He is alert and has normal vital signs, except for a mild fever. Auscultation reveals rales and rhonchi in both lungs. The chest x-ray is shown below. What is the most likely diagnosis?. Kartagener's syndrome
Foreign body
. Cystic fibrosis
Immunoglobulin deficiency
Congenital bronchiectasis
375) A 14-year-old boy presents with sudden onset of pain and swelling of his right testicle. There was no history of trauma, he is not sexually active, and denies any history of penile discharge. On examination, the scrotum is swollen and tender. The cremasteric reflex is absent. A testicular flow scan shows a “cold spot” or absent flow to the affected side. Which of the following is the most likely cause?
Testicular torsion
Torsion of the appendix testis
Epididymitis
Hydrocele
Inguinal hernia
376) The developmentally delayed 6-month-old child in the picture below had intrauterine growth retardation (including microcephaly), hepatosplenomegaly, prolonged neonatal jaundice, and purpura at birth. The calcific densities in the skull x-ray shown are likely the result of which of the following?Congenital cytomegalovirus (CMV) infection
Congenital toxoplasmosis infection
Congenital syphilis infection
Tuberculous meningitis
Craniopharyngioma
377) The infant pictured below develops infantile spasms. Which of the following disorders is most likely to be affecting this infant?Tuberous sclerosis
. Neurofibromatosis
Incontinentia pigmenti
. Pityriasis rosea
Psoriasis
378) A 28-year-old Caucasian female comes to the office due to fever for the past 3 days. She also complains of pain and swelling in her right breast for the past 4 days. She exclusively breastfeeds her 3-month-old baby. On examination, she is febrile. Her right breast is engorged, red and tender, without any area of fluctuation. She wants to know if she can continue to breastfeed. Which of the following is a contraindication to breastfeeding?
Acquired immune deficiency syndrome
. Mastitis
. Maternal rubella infection
Breast milk jaundice
Hemolytic disease of the newborn
379) Among the conditions that cause edema of the eyelids is orbital cellulitis. This is a serious infection that must be recognized early and treated aggressively if complications are to be avoided. Which of the following features is useful in differentiating orbital cellulitis from periorbital (preseptal) cellulitis?
Proptosis
Elevated WBC count
Fever
Lid swelling
Conjunctival inflammation
380) A 30-minute-old male newborn is noted to have central cyanosis. He was born to a 16-year-old white female at 28 weeks gestation. His respirations are rapid and shallow at 70/min. His other vital signs are stable. On examination, there is audible grunting, intercostal and subcostal retractions, nasal flaring, and duskiness. On auscultation, fine rales are heard over the lung bases. Nasal oxygenation does not improve his cyanosis. A chest roentgenogram shows fine reticular granularity, predominantly in the lower lobes. Arterial blood gas analysis shows evidence of hypoxemia and metabolic acidosis. What is the most likely diagnosis of this patient?
. Hyaline membrane disease (HMD)
Transient tachypnea of the newborn
. Persistent pulmonary hypertension of the newborn (PPHN)
. Meconium aspiration syndrome
Intracranial hemorrhage
381) A 10-year-old patient (pictured below) calls his parents from summer camp to state that he has had fever, muscular pain (especially in the neck), headache, and malaise. He describes the area from the back of his mandible toward the mastoid space as being full and tender and that his earlobe on the affected side appears to be sticking upward and outward. Drinking sour liquids causes much pain in the affected area. When his father calls your office, you remind him that he had refused immunizations for his child on religious grounds. Which of the following preventable diseases has this child acquired?Mumps
Varicella
Rubella
Measles
Diphtheria
382) A healthy 1-year-old child comes to your office for a routine checkup and for immunizations. His parents have no complaints or concerns. The next day, the CBC you performed as customary screening for anemia returns with the percentage of eosinophils on the differential to be 30%. Which of the following is the most likely explanation?
Helminth infestation
Tuberculosis
Fungal infections
Chronic allergic rhinitis
. Bacterial infections
383) Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatosplenomegaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemoglobin, hematocrit, and white blood cell (WBC) count and differential. The plateletcount is 15,000/μL. Which of the following is the most likely diagnosis?
Idiopathic (immune) thrombocytopenic purpura (ITP)
Acute leukemia
Von Willebrand disease (vWD)
. Aplastic anemia
Thrombotic thrombocytopenic purpura
384) A 30-minute-old male newborn is noted to have central cyanosis. He was born to a 16-year-old white female at 28 weeks gestation. His respirations are rapid and shallow at 70/min. His other vital signs are stable. On examination, there is audible grunting, intercostal and subcostal retractions, nasal flaring, and duskiness. On auscultation, fine rales are heard over the lung bases. Nasal oxygenation does not improve his cyanosis. A chest roentgenogram shows fine reticular granularity, predominantly in the lower lobes. Arterial blood gas analysis shows evidence of hypoxemia and metabolic acidosis. What is the most likely diagnosis of this patient?
Hyaline membrane disease (HMO)
Transient tachypnea of the newborn
Persistent pulmonary hypertension of the newborn (PPHN)
Meconium aspiration syndrome
Lntracranial hemorrhage
385) Friends are considering adopting a “special needs” child from another country. The family has few details, but the information they have received so far suggests the 4-year-old child has had surgery for an endocardial cushion defect, is short for his age, and had a history of what sounds like surgically repaired duodenal atresia at birth. You are suspicious this child may have which of the following syndromes?
Down
Down
Marfan
Waardenberg
Kleinfelter
386) An 8-year-old boy is brought to his physician by his mother, who is worried by the child's frequent episodes of daydreaming, which have apparently resulted in a decline in school performance. The child's psychomotor development appears normal. EEG recording reveals bilateral and symmetric 3 Hz spike-and-wave discharges, which begin and end abruptly on a normal background. Which of the following is the most likely diagnosis?
Absence seizures (petit mal)
Complex partial seizures
Pseudoseizures
Simple partial seizures
Tonic-clonk seizures (grand mal)
387) A 1400-g infant, born at 35 weeks' gestation, is 42 cm in length and a head circumference of 28 cm. One day after birth, she becomes very irritable, tremulous, and inconsolable. Her cry is high-pitched. Her pulse is 174/min. There are no dysmorphic facial features. To which of the following substances was this newborn most likely exposed in utero?
Cocaine
Marijuana
Barbiturates
Alcohol
Opiates
388) A 16-year-old female presents to the emergency room with severe right- sided abdominal pain. Her last menstrual period was 2 weeks ago and felt to be normal. She displays painful difficulty in positioning herself on the examination table. Her temperature is 38.5 C (101.3 F), blood pressure is 128/75 mm Hg, pulse is 80/min, and respirations are 22/min. Examination of the throat reveals mild pharyngitis. Her abdomen is diffusely tender, especially the lower abdomen. Rectal examination reveals tenderness anteriorly on the right side. Stool guaiac is negative. A pelvic examination is performed, and there is evidence of cervical tenderness and questionable fullness in the right adnexal area. Which of the following is the most likely diagnosis?
Pelvic inflammatory disease
Pyelonephritis
. Ovarian cyst
Constipation
Endometriosis
389) The mother of one of your regular patients calls your office. She reports that her daughter has a 3-day history of subjective fever, hoarseness, and a bad barking cough. You arrange for her to be seen in your office that morning. Upon seeing this child, you would expect to find which of the following?
Infection with parainfluenza virus
. Expiratory stridor
. A temperature greater than 38.9C (102F)
Hyperinflation on chest x-ray
A child between 6 and 8 years of age
390) A 2 and a half-year-old child is brought to the office for the evaluation of easy bruising, nosebleeds, and decreased activity over the past week. He had an upper respiratory infection that was treated with an antibiotic 2 weeks ago. On examination, he is well-developed, seems well-nourished, anicteric, and pale. Pertinent findings include some small palpable posterior cervical lymph nodes, sinus tachycardia, a grade I/VI systolic ejection murmur, ecchymoses on his left shoulder and both lower extremities, and petechiae over his extremities and groin. There is no hepatosplenomegaly. The laboratory findings are as follows: Hemoglobin 7.9 g/dl, Hematocrit 24%, Platelet count 12, 000/mm3, WBC 3,000/mm3, Reticulocyte count 0.5%. A bone marrow biopsy reveal a markedly hypocellular marrow with decreased megakaryocytes and precursors of the erythroid and myeloid cell lines. What is the most likely diagnosis?
Acquired aplastic anemia
. Fanconi's anemia
Diamond-Biackfan anemia
Transient erythroblastopenia
. Acute myeloid leukemia
{"name":"Part 7 (1762-1784)(1530-1784) Pogba KH 8", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"326) A 17-year-old boy comes to medical attention because of recurrent sinusitis and pneumonia, and persistent watery diarrhea due to Giardia lamblia. His parents and a sister are in excellent health. Physical examination reveals enlarged lymph nodes in cervical, axillary and inguinal regions. A lymph node biopsy shows hyperplastic follicles with an absence of plasma cells. Laboratory investigations show: Hematocrit44%, Leukocyte count9, 800\/mm3, Neutrophils55%, Lymphocytes30%, Monocytes5%, CD4 T-cell count1000 cells\/mm3, Proteins, serum6.2 g\/dL, Albumin5.0 g\/dL, Globulin1.2 g\/dL. Additional studies demonstrate severely depressed levels of serum IgG, with slightly below-normal levels of IgM and IgA. Which of the following is the most likely diagnosis?, 327) An 8-year-old boy presents with a 2-day history of rash. The rash started on the head and spread downward to his trunk and extremities. He also complains of a fever, cough, and a runny nose for the past 5 days. On physical examination, his temperature is 38.2 C (100.7 F), blood pressure is 88\/56 mm Hg, pulse is 76\/min, and respirations are 16\/min. There is a small, irregular red spot with a central gray color on his buccal mucosa. The rash on his body is erythematous and maculopapular in quality. Which of the following is the most likely diagnosis?, 328) A 3-year-old child presents in clinic with marked erythema of the cheeks, with no prior symptoms. The rash soon involves the arms and has a reticular erythematous maculopapular appearance. The patient has been previously healthy and is not on any medications. He has not been exposed to any other ill individual. Which of the following is the most likely diagnosis?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}