Usmle

4) A 1-day-old infant who received silver nitrate eye drops in the delivery room is suffering from bilateral purulent conjunctival discharge. Which of the following is the most likely cause of this child’s condition?
N. Gonorrhoeae infectio
herpes simplex infection
nasolacrimal duct obstruction
chemical irritation
Pseudomonas infection
5) A 1-day-old infant who was born by a difficult forceps delivery is alert and active. She does not move her left arm spontaneously or during a Moro reflex. Rather, she prefers to maintain it internally rotated by her side with the forearm extended and pronated. The rest of her physical examination is normal. This clinical scenario most likely indicates which of the following?
Fracture of the left clavicle
Fracture of the left humerus
Left-sided Erb-Duchenne paralysis
Left-sided Klumpke paralysis
Spinal injury with left hemipare
 
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6) A 1-day-old infant with Down syndrome, feeding intolerance, bilious vomiting, and a double bubble on plain radiographs (Figure 6-18). Which one is the most likely diagnostic?
. Congenital hypertrophic pyloric stenosis
. Annular pancreas
. Duodenal atresia
. Midgut volvulus
. intussusception
7) A 1-day-old male infant has bilious vomiting after every feeding. He hasn't passed any stools yet. He had no prenatal care, and was delivered vaginally at term. He weighs 3kg (6.61b), and his APGAR scores were 6 and 7 at 1 min and 5 min, respectively. On examination, the neonate is hypotonic, he has a flat facial profile, short ears with downfolding ear lobes, a single palmar crease, and a depressed fontanel. There is abdominal distention which is most prominent in the upper abdomen. His abdominal x-rays show gastric and duodenal gas distension with no air distally. What other anomaly can also be expected in this infant?
Sigmoid volvulus
Meconium plug syndrome
Hirschsprung's disease
Intussusception
Meckel's diverticulum
8) 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?
. Duodenal atresia
. Intussusception
. Hirschsprung disease
. Midgut volvulus
. Pyloric stenosis
10) A 1-month-old infant is seen in a well-baby clinic. The mother states that the baby is constipated and feeds poorly. On examination, he is jaundiced, has a large posterior fontanel and an umbilical hernia, and exhibits poor muscle tone. He has gained only 300 g since discharge from the normal newborn nursery. Which of the following is the most likely diagnosis?
Alpha1-antitrypsin deficiency
Biliary atresia
Congenital hypothyroidism
Pyloric stenosi
Syphilis
11) A 1-month-old, previously healthy infant develops forceful projectile vomiting. No bile is seen in the vomitus. After the infant feeds, gastric peristaltic waves are visible crossing the epigastrium from left to right. Several minutes later, the projectile vomiting occurs. Which of the following is the most likely diagnosis?
Diaphragmatic hernia
Duodenal atresia
Esophageal atresia
Hypertrophic pyloric stenosis
Meconium plug syndrome
12)A 1-week-old infant presents to her general pediatrician’s office for a well-child visit. She was born at 37 weeks’ gestation without complications. Her temperature is 37.0°C (98.6°F), pulse is 130/min, blood pressure is 72/54 mmHg, and respiratory rate is 28/min. She is currently at the 50th percentile for weight and 75th percentile for height. She is acyanotic and has a wide, fixed split S2, with a 2/6 systolic ejection murmur at the left upper sternal border. The remainder of the examination is unremarkable. Which of the following is the most likely diagnosis?
Atrial septal defect
Coarctation of the aorta
Dextratransposition of the great arteries
Tetralogy of Fallot
Ventricular septal defect
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13) A 1-week-old previously healthy infant presents to the emergency room with the acute onset of bilious vomiting. The abdominal plain film in the emergency department (Image A) and the barium enema done after admission (Image B) are shown. Which of the following is the most likely diagnosis for this patient?
. Acute appendicitis
. Intussusception
. Jejunal atresia s
. Hypertrophic pyloric stenosis
. Malrotation with volvulu
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