Pediatric(51-100)

A 5-month-old child regularly regurgitates a large portion of her feeds. A pH probe study showed significant periods of low esophageal pH. The child has normal growth and no other significant past medical history. Which of the following is the best management at this point?

A 2-year-old presents to the emergency center with several days of rectal bleeding. The mother first noticed reddish-colored stools 2 days prior to arrival and has since changed several diapers with just blood. The child is afebrile, alert, and playful, and is eating well without emesis. He is slightly tachycardic, and his abdominal examination is normal. Which of the follow- ing is the best diagnostic study to order to confirm the diagnosis?

A 6-week-old infant is admitted to the hospital with jaundice. Her out- patient blood work demonstrated a total bilirubin of 12 mg/dL with a direct portion of 3.5 mg/dL. Which of the following disorders is most likely to be responsible?

A 2-year-old arrives in the emergency center after having swallowed a button battery from one of her toys. She is breathing comfortably, without stridor. Radiographs show the battery to be lodged in the esophagus. Which of the following is the correct next step?

An awake, alert infant with a 2-day history of diarrhea presents with a depressed fontanelle, tachycardia, sunken eyes, and the loss of skin elasticity. Which of the following is the correct percentage of dehydration?

A 9-month-old is brought to the emergency center by ambulance. The child had been having emesis and diarrhea with decreased urine out- put for several days, and the parents noted that she was hard to wake up this morning. Her weight is 9 kg, down from 11 kg the week prior at her 9-month checkup. You note her heart rate and blood pressure to be normal. She is lethargic, and her skin is noted to be “doughy.” After confirming that her respiratory status is stable, you send electrolytes, which you expect to be abnormal. You start an IV. Which of the following is the best solution for an initial IV bolus?

You are admitting to the hospital a 3-month-old infant who has been having poor feeding, emesis, and diarrhea for 3 days. In the emergency center, her electrolytes were found to be: sodium 157 mEq/L, potassium 2.6 mEq/L, chloride 120 mEq/L, bicarbonate 14 mEq/L, creatinine 1.8 mEq/L, blood urea nitrogen (BUN) 68 mEq/L, and glucose 195 mEq/L. She was given a fluid bolus in the emergency center and has subsequently produced urine. Which of the following is the most appropriate next step in her management?

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?

A 15-year-old vegetarian being treated for tuberculosis develops periph- eral neuropathy. For presented child above, choose the one most appropriate vitamin or trace element replacement therapy to treat the described condition

A 3-day-old infant born at home is brought to the emergency center with bloody stools,hematemesis, and purpura. His circumcision is oozing blood. For presented child above, choose the one most appropriate vitamin or trace element replacement therapy to treat the described condition.

A 17-year-old boy is brought to the emergency department by his parents with the complaint of coughing up blood. He is stabilized, and his hemoglobin and hematocrit levels are 11 mg/dL and 33%, respectively. During his ospitalization, he is noted to have systolic blood pressure persistently greater than 130 mm Hg and diastolic blood pressure greater than 90 mm Hg. His urinalysis is remarkable for hematuria and proteinuria. You are suspicious the patient has which of the following?

The mother of a 2-year-old male child states that she has noticed white, cheeselike materialarising from his foreskin and also that he cannot fully retract the foreskin behind the glans penis. Which of the following is the correct advice for this parent?

A 5-year-old girl without past history of UTI is in the hospital on antibio- tics for Escherichia coli pyelonephritis. She is still febrile after 4 days of appro- priate antibiotics. A renal ultrasound revealed no abscess, but a focal enlargement of one of the lobes of the right kidney. CT of the abdomen reveals a wedge- shaped area in the right kidney distinct from the normal tissue with minimal contrast enhancement. Appropriate management of this patient includes which of the following interventions?

A 4-year-old boy, whose past medical history is positive for three urinary tract infections, presents with a blood pressure of 135/90 mm Hg. He is likely to exhibit which of the following symptoms or signs?

A 4-year-old boy and his family have recently visited a local amusement park. Several of the family members developed “gastroenteritis” with fever and diarrhea, but the 4-year-old’s stool was slightly different, as it contained blood. His mother reports that in the past 24 hours he developed pallor and lethargy; she relates that his face looks swollen and that he has been urinating very little. Laboratory evaluation reveals a hematocrit of 28% and a platelet count of 2,000/μL. He has blood and protein in the urine. Which of the following diagnoses is most likely to explain these symptoms?

A 12-year-old boy comes to the emergency department at midnight with a complaint of severe scrotal pain since 7 PM. There is no history of trauma. Which of the following is the most appropriate first step in management?

A 7-year-old boy has cramping abdominal pain and a rash mainly on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and microhematuria. You diagnose Henoch-Schönlein, or anaphylactoid, purpura. In addition to his rash and abdominal pain, what other finding is he likely to have?

The 7-year-old boy now in your office was last seen 2 weeks ago with a mild viral upper respiratory tract infection. Today, however, he presents with fever, ataxia, weakness, headache, and emesis. In the office he has a 3 minute left-sided tonic-clonic seizure. You send him to the hospital and order a magnetic resonance imaging (MRI) of the brain, the results of which show disseminated multifocal white matter lesions that enhance with contrast. This boy’s likely diagnosis is which of the following?

Examination of the cerebrospinal fluid (CSF) of an 8-year-old, mildly febrile child with nuchal rigidity and intermittent stupor shows the following: WBCs 85/μL (all lymphocytes), negative Gram stain, protein 150 mg/dL, and glucose 15 mg/dL. A computed tomographic (CT) scan with contrast shows enhancement of the basal cisterns by the contrast material. Which of the fol- lowing is the most likely diagnosis?

A 6-year-old child is hospitalized for observation because of a short period of unconsciousness after a fall from a playground swing. He has developed unilateral pupillary dilatation, focal seizures, recurrence of depressed consciousness, and hemiplegia. Which of the following is the most appro- priate management at this time?

The parents of a 2-year-old bring her to the emergency center after she had a seizure. Although the parents report she was in a good state of health, the vital signs in the emergency center reveal a temperature of 39°C (102.2°F). She is now running around the room. Which part of the story would suggest the best outcome in this condition?

Your 6-year-old son awakens at 1:00 AM screaming. You note that he is hyperventilating, is tachycardic, and has dilated pupils. He cannot be consoled, does not respond, and is unaware of his environment. After a few minutes, he returns to normal sleep. He recalls nothing the following morning. Which of the following is the most likely diagnosis?

A 2-month-old child of an HIV-positive mother is followed in your pediatric practice. Which of the following therapies should be considered for this child?

An 18-month-old child presents to the emergency center having had a brief, generalized tonicclonic seizure. He is now postictal and has a tem- perature of 40°C (104°F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient?

A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. Which of the following is the most likely diagnosis?

The 3-year-old sister of a newborn baby develops a cough diagnosed as pertussis by nasopharyngeal culture. The mother gives a history of having been immunized as a child. Which of the following is a correct statement regarding this clinical situation?

A 16-day-old infant presents with fever, irritability, poor feeding, and a bulging fontanelle. Spinal fluid demonstrates gram-positive cocci. Which of the following is the most likely diagnosis?

A 14-month-old infant suddenly develops a fever of 40.2°C (104.4°F). Physical examination shows an alert, active infant who drinks milk eagerly. No physical abnormalities are noted. The WBC count is 22,000/μL with 78% polymorphonuclear leukocytes, 18% of which are band forms. Which of the following is the most likely diagnosis?

The parents of a 3-year-old patient followed in your clinic recently took their child on quickly planned 5-day trip to Africa to visit an ill grand-parent. Everyone did well on the trip, but since their return about 10 days ago the boy has been having intermittent, spiking fevers associated with headache, sweating, and nausea. The parents had not been too concerned since he was relatively well, except for being tired, between the fevers. Today, however, they feel that he looks a bit pale and his eyes appear “yellow.” Which of the following is likely to reveal the source of his problem?

A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. During the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the following is the most likely diagnosis?

A 2-month-old infant comes to the emergency center with fever for 2 days, emesis, a petechial rash, and increasing lethargy. In the ambulance he had a 3-minute generalized tonic/clonic seizure that was aborted with lorazepam. He does not respond when blood is drawn or when an IV is placed, but he continues to ooze blood from the skin puncture sites. On examination, his anterior fontanelle is open and bulging. His CBC shows a WBC of 30,000 cells/μL with 20% band forms. Which of the infant’s problems listed below is a contraindication to lumbar puncture?

Two weeks after a viral syndrome, a 2-year-old child develops bruising and generalized petechiae, more prominent over the legs. No hepatospleno- megaly or lymph node enlargement is noted. The examination is otherwise unremarkable. Laboratory testing shows the patient to have a normal hemo- globin, hematocrit, and white blood cell (WBC) count and differential. The platelet count is 15,000/μL. Which of the following is the most likely diagnosis?

On a routine-screening CBC, a 1-year-old is noted to have a microcytic anemia. A follow-up hemoglobin electrophoresis demonstrates an increased concentration of hemoglobin A2. The child is most likely to have which of the following?

After being delivered following a benign gestation, a newborn infant is noted to have a platelet count of 35,000/μL, decreased fibrinogen, and ele- vated fibrin spilt products. On examination you note a large cutaneous heman- gioma on the abdomen that is purple and firm. Which of the following anomalies might also be expected in this infant?

A 2950-g baby boy is born at home at term. On arrival at the hospital, he appears pale, but the physical examination is otherwise normal. Laboratory studies reveal the following: mother’s blood type A, Rh-positive; baby’s blood type O, Rh-positive; hematocrit 38%; and reticulocyte count 5%. Which of the following is the most likely cause of the anemia?

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?

A 15-year-old female presents to your office with secondary amenor- rhea. As part of your evaluation, you find that she is pregnant. After inform- ing her of the pregnancy, you continue to explain that young mothers have a higher risk of several pregnancy-related complications, including which of the following?

A 3.3 kg infant delivered at 396 weeks arrives in the OPD of a pediatric hospital with normal vital signs and a respiratory rate of 80 breaths/ minute. The labor and subsequent delivery were precipitous according to the labor and delivery midwife.Which of the following statements is true?

A 3.3 kg infant delivered at 396 weeks arrives in the OPD of a pediatric hospital with normal vital signs and a respiratory rate of 80 breaths/ minute. The labor and subsequent delivery were precipitous according to the labor and delivery midwife. Which of the following is manifest during the first hours after delivery?

A 3.3 kg infant delivered at 396 weeks arrives in the OPD of a pediatric hospital with normal vital signs and a respiratory rate of 80 breaths/ minute. The labor and subsequent delivery were precipitous according to the labor and delivery midwife. Which of the follow is not a common pathogen found in neonatal sepsis?

A 28-year-old primigravida develops an erythematous skin discoloration in the upper outer quadrant of the left breast. She has achy, flu-like symptoms and fever to 38.3C. You suspect bacterial mastitis. At this time, what would you do?

A mother comes to your office with her 6 weeks of age infantwhohas been “spitting up”all of her formula “since birth.” She is afraid the infant is malnourished. The baby weighs 5 kg. Her birth weight was 3.5 kg. At this time, you should advise the mother to do which of the following?

A mother comes to your office with her 8-week-old infant girl. The mother is tearful and depressed. She has been trying to breastfeed, but she tells you, “I’m obviously inadequate. I’m not producingenough milk, and the baby is fussy all of the time.” On examination, the infant looks thin. Since her lastcheckup 3 weeks ago, she has gained only 90 g. The rest of the physical examination is normal. At this time, what should you not do?

After two more visits, the mother decides to bottle-feed. She returns when the child is 3 months old, complaining that the infant is constipated. After a careful history, you find that the infant has one hard stool a day but otherwise has no symptoms. On examination, the infant is well hydrated and has had adequate weight gain. The physical exam, including the anal sphincter tone, is normal. You advise which of the following?

A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a “cold” and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which immunization should be given to this childnow, according to the national EPIrecommendations?

A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a “cold” and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements regarding future immunizations for the child is true?

A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a “cold” and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements regarding vaccination against poliomyelitis is true?

A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a “cold” and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements is true regarding hepatitis B vaccine in children?

A 4-month-old infant is brought to your clinic by his mother . The mother said that when she took the babyfor a 2-month examination at a health center, the nurse said the baby had a “cold” and could not receive his immunizations. The baby has gotten only his 1stOral Polio and hepatitis B immunization in the hospital.The baby has had ARI for the past week, but according to the mother he is happy, interactive, afebrile, and feeding well. On physical examination, the baby is appropriate weight and length for age, smiles and interacts, and the rest of the exam is completely normal with the exception of minimal clear nasaldischarge. Which of the following statements regarding immunization against measlesis true?

A 15-month-old is seen in your office for the 4th time this month with unexplained intermittent episodes of fever of 39°C. The mother has used children’s ibuprofen to treat the fever and has been able to bring the temperature down to 38°C. However, the mother is now frustrated because thisis her 4th visit to the office and nobody knows why her child is continuing to have these fevers. The child is not in day care and has no history of any serious illnesses, travel, or sick contacts. The child has had no symptoms of an upper respiratory infection. On examination, the child is actively playing with his toys. He does not look ill. His rectal temperature is 39°C. The head, neck, lungs, cardiovascular, abdominal, neurologic, and musculoskeletal examination are all normal.Your clinical judgment is that the child looks well and has no serious illness. What is your diagnosis at this time?