Pediatric final

A child can walk well holding on to furniture but is slightly wobbly when walking alone. She uses a neat pincer grasp to pick up a pellet, and she can release a cube into a cup after it has been demonstrated to her. She tries to build a tower of two cubes with variable success. She is most likely at which of the following age?

A 1-year-old presents for a well-child checkup, but the parents are concerned about giving the child his immunizations. Which of the following is a true contraindication to the administration of the fourth DTaP (diphtheria and tetanus toxoid and acellular pertussis) vaccine?

An 8-month-old infant arrives to the emergency department (ED) with a 2-day history of diarrhea and poor fluid intake. Your quick examination reveals a lethargic child; his heart rate is 180 beats per minute, his respiratory rate is 30 breaths per minute, and his blood pressure is low for age. He has poor skin turgor, 5-second capillary refill, and cool extremities. Which of the following fluids is most appropriate management for his condition?

A 20-month-old child is brought to the ED because of fever and irritability and refusal to move his right lower extremity. Physical examination reveals a swollen and tender right knee that resists passive motion. Which of the following is the most likely to yield the diagnosis in this patient?

A 14-year-old high school student arrives to your clinic for well-child care. In reviewing his records you determine that his most recent immunization for tetanus was at 4 years of age. Which of the following should you recommend?

A 5-year-old boy is brought into the ER immediately after an unfortunate altercation with a neighbor’s immunized Chihuahua that occurred while the child was attempting to dress the dog as a superhero. The fully immu- nized child has a small, irregular, superficial laceration on his right forearm that has stopped bleeding. His neuromuscular examination is completely normal, and his perfusion is intact. Management should include which of the following?

Aunt Mary is helping her family move to a new apartment. During the confusion, 3-year-old Jimmy is noted to become lethargic. The contents of Aunt Mary’s purse are strewn about on the floor. In the ER, the lethargic Jimmy is found to have miosis, bradycardia, and hypotension. He develops apnea, respiratory depression, and has to be intubated. His condition would most likely benefit from which of the following therapies?

A 15-year-old is participating in high school football practice in August in Texas. He had complained of headache and nausea earlier in practice, but kept playing after a cup of water. He is now confused and combative. He is dizzy and sweating profusely. His temperature is 41°C (105.8°F). Therapy should consist of which of the following?

As part of your anticipatory guidance to new parents of a healthy new- born, you suggest putting the child in which of the following positions for sleep?

A mentally retarded 14-year-old boy has a long face, large ears, micropenis, and large testes. Chromosome analysis is likely to demonstrate which of the following?

A 1-week-old child’s mother complains that the child has a transient rash that has splotchy areas of erythema with a central clear pustule. Your microscopic examination of the liquid in the pustule reveals eosinophils. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis.

A nurse calls you to evaluate an African American newborn whom she thinks has a bacterial skin infection. The areas in question have many scat- tered pustules full of a milky fluid. Upon examining pustules, they easily wipe away, revealing a small hyperpigmented macule. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis.

The obstetrical resident on call asks you to evaluate an area of a newborn’s scalp that seems to have no hair and is scaly and yellowish. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis.

A newborn’s mother complains that her infant seems to have very small white dots all over his nose. The dots do not wipe off with bathing, but they are also not erythematous. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis.

A newborn’s father complains that his son has dandruff, with many waxy flakes of skin on the scalp. When he scrapes the lesions, hair often comes off with the flakes of skin. In addition, the baby has flaking of the eyebrows. Many rashes and skin lesions can be found first in the newborn period. For the descriptions listed above, select the most likely diagnosis.

An afebrile, obese 14-year-old boy has developed pain at the right knee and a limp. For case above, select the most likely diagnosis.

A 6-year-old boy has developed a limp and has limited mobility of the hip, but denies pain and fever. For case above, select the most likely diagnosis.

A 2-year-old refuses to walk, has fever, has significant pain with external rotation of the right leg, and has an elevated WBC count. For case above, select the most likely diagnosis.

A 3-year-old refuses to walk, is afebrile, had an upper respiratory tract infection a week ago, has right hip pain with movement, and has a normal WBC count. For case above, select the most likely diagnosis.

An 18-year-old friend of the family returns from spring break from a coastal town in Central America. He has an intensely pruritic lesion on his foot. The lesion is raised, red, serpiginous, and has a few associated bullae. Match the common skin condition with the most appropriate therapy

A 14-year-old child has headache, hypertension, edema, and a change in urine output and color.Match above clinical condition with the most likely cause

A 3-day-old infant was born to a mother with active systemic lupus erythematosus (SLE). Match above clinical condition with the most likely cause

A mother calls you frantic because she has just been diagnosed with chicken pox. She delivered 7 days ago a term infant that appears to be eating, stooling, and urinating well. The child has been afebrile and seems to be doing well. Which of the following is the most appropriate step in management?

A mother wishes to breast-feed her newborn infant, but is worried about medical conditions that would prohibit her from doing so. You coun- sel her that of her listed conditions, which of the following is a contraindication to breast-feeding?

At 43 weeks’ gestation, a long, thin infant is delivered. The infant is apneic, limp, pale, and covered with “pea soup” amniotic fluid. Which of the following is the best first step in the resuscitation of this infant at delivery?

The mother of a 2-week-old infant reports that since birth, her infant sleeps most of the day; she has to awaken her every 4 hours to feed, and she will take only an ounce of formula at a time. She also is concerned that the infant has persistently hard, pellet-like stools. On your examination you find an infant with normal weight and length, but with an enlarged head. The heart rate is 75 beats per minute and the temperature is 35°C (95°F). The child is still jaundiced. You note large anterior and posterior fontanelles, a distended abdomen, and anumbilical hernia. This clinical presentation is likely a result of which of the following?

A routine prenatal ultrasound reveals a male fetus with meningomyelocele. The 24-year-old primigravid mother is told the infant will require surgery shortly after birth. You counsel her about the etiology of this defect and the risk of further pregnancies being similarly affected, and state which of the following?

The signs and symptoms of meningitis in an infant can be different than those in an adult.Which of the following signs and symptoms of meningitis is more helpful in an adult patient than in a 4-month-old?

You are called to a delivery of a woman with no prenatal care; she is in active labor but has no history of amniotic rupture. The biophysical pro- file done in the emergency center revealed severe oligohydramnios. When you get this infant to the nursery, you should carefully evaluate him for which of the following?

Blood samples of a 3-day-old full-term infant are sent for screening to iden- tify diseases that would have serious, permanent consequences without prompt and appropriate treatment. Select the most appropriate treatment for Hypothyroidism

A 10-year-old boy, the star pitcher for the Salt Lake City Little League baseball team, had a sore throat about 2 weeks ago but did not tell anyone because he was afraid he would miss the playoffs. Since several children have been diagnosed with rheumatic fever in the area, his mother is wor- ried that he may be at risk as well. You tell her that several criteria must be met to make the diagnosis but the most common finding is which of the following?

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?

A cyanotic newborn is suspected of having congenital heart disease. He has an increased left ventricular impulse and a holosystolic murmur along the left sternal border. The ECG shows left-axis deviation and left ventricular hypertrophy (LVH). Which of the following is the most likely diagnosis?

A previously healthy, active, 18-month-old African American child presents with unilateral nasal obstruction and foul-smelling discharge. The child’s examination is otherwise unremarkable. Which of the following is the most likely diagnosis?

A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?

A 10-year-old girl has had a “cold” for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39°C (102.2°F), purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis?

You are awakened in the night by your 2-year-old son, who has deve- loped noisy breathing on inspiration, marked retractions of the chest wall, flaring of the nostrils, and a barking cough. He has had a mild upper respiratory infection (URI) for 2 days. Which of the following therapies is indicated?

An 8-year-old girl presents with well-controlled, moderately persistent asthma. Her therapies consist of occasional use of short-acting β-agonists, daily inhaled steroids, and a leukotriene inhibitor. She presents with white patches on her buccal mucosa. You recommend which of the following?

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?

A previously healthy 18-month-old 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?

A 6-week-old child arrives with a complaint of “breathing fast” and a cough. On examination you note the child to have no temperature eleva- tion, a respiratory rate of 65 breaths per minute, and her oxygen saturation to be 94%. Physical examination also is significant for rales and rhonchi. The past medical history for the child is positive for an eye discharge at 3 weeks of age, which was treated with a topical antibiotic drug. Which of the following organisms is the most likely cause of this child’s condition?

One of your asthmatic patients arrives for a checkup. The mother reports that the child seems to need albuterol daily, especially when exercising, and she has coughing fits that awaken her from sleep about twice a week. Her grandmother had recommended a Chihuahua as a “cure” for her asthma, but her mother has seen no difference since the arrival of the pet. Appropriate treatment measures would include which of the following?

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?

A 3-year-old child presents to your office for an evaluation of consti- pation. The mother notes that since birth, and despite frequent use of stool softeners, the child has only about one stool per week. He does not have fecal soiling or diarrhea. He was born at term and without pregnancy com- plications. The child stayed an extra day in the hospital at birth because he did not pass stool for 48 hours, but has not been in the hospital since. Initial evaluation of this child should include which of the following?

A 17-year-old adolescent female is 6 weeks postpartum. She presents to the emergency room with the complaints of increased jaundice, abdomi- nal pain, nausea, vomiting, and fever. Her examination is remarkable for jaundice, pain of the right upper quadrant with guarding, and a clear chest. Chest radiographs appear normal. Which of the following tests is most likely to reveal the cause of this pain?

An 8-year-old is accidentally hit in the abdomen by a baseball bat. After several minutes of discomfort, he seems to be fine. Over the ensuing 24 hours, however, he develops a fever, abdominal pain radiating to the back, and persis- tent vomiting. On examination, the child appears quite uncomfortable. The abdomen is tender, with decreased bowel sounds throughout, but especially painful in the midepigastric region with guarding. Which of the following tests is most likely to confirm the diagnosis?

A 10-month-old baby boy, recently adopted from Guyana, has a 5-hour history of crying, with intermittent drawing up of his knees to his chest. On the way to the emergency room he passes a loose, bloody stool. He has had no vomiting and has refused his bottle since the crying began. Physical examination is noteworthy for an irritable infant whose abdomen is very difficult to examine because of constant crying. His temperature is 38.8°C (101.8°F). The rectal ampulla is empty, but there is some gross blood on the examining finger. Which of the following studies would be most helpful in the immediate management of this patient?

A 12-month-old girl has been spitting up her meals since 1 month of age. Her growth is at the 95th percentile, and she is otherwise asymptomatic and without findings on physical examination. Which of the following is the most likely diagnosis?

A 14-year-old girl has a 9-month history of diarrhea, abdominal pain (usually periumbilical and postprandial), fever, and weight loss. She has had several episodes of blood in her stools. Which of the following is the most likely diagnosis?

A 4-year-old boy, recently adopted through an international adoption service, is noted to have intermittent watery diarrhea, nausea, belching, and abdominal pain. His weight is less than the fifth percentile for his age. Which of the following studies would be most helpful in making the diagnosis?

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?

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 the most appropriate next step in the workup of this patient?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which of the following best describes your clinical impression at this time?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which laboratory testing would you order at this time?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which of the following is the most likely organism that you need to consider in this situation?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which one of the following antibiotics would you consider in the treatment of this condition?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. What would you do next concerning this patient?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What is the most likely diagnosis in this child?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What is the most frequent pathogen associated with this condition?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What investigation should be done at this time?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. Which of the following statements regarding the common cold is true?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. Which of the following statements regarding treatment of the condition described in this case is true?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What is the most effective preventive measure against the common cold?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. What is the diagnosis?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. Which of the following agents is the least likely cause of the condition?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. Which of the following statements about the treatment of this condition in infants is true?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. Which of the following is the most common bacterial complication of this condition?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Which statement regarding management of this condition is true?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. The most common cause of bronchiolitis is

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Which of the following statements about RSV is untrue?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. All of the following are associated with increased risk of severe bronchiolitis except

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Pathologic features of acute bronchiolitis include all but

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. In which of the following patients is palivizumabnot indicated?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Which of the following statements regarding antibiotic use in bronchiolitis is true?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following interventions provides the most useful information at this time?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following statements about childhood pneumonia is true?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following statements about CAP in neonates is false?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. What is the most common bacterial cause of CAP after the neonatal period?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following signs is suggestive of hypoxemia?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following is true concerning this child?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following differential diagnoses should you exclude in this child?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following is true concerning treatment of this child?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. In discussing treatment plans with the parents, they ask about various medications used in asthma therapy. Which of the following medications has been shown to be most effective in the treatment of asthma in children and should be used at firstline treatment if maintenance therapy is begun?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following statements is false concerning asthma in children?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following is included in the diagnosis of asthma in children?

A 7-year-old female presents to your office with a history of 1 week of gradually increasing chest tightness and mild dyspnea. She has had nasal drainage and a nighttime cough. Her mother states that she has had no fever and has been going to school. Her medical history is significant for only oneprevious episode of wheezing for which she was treated with an antibiotic and an inhaler. Her familyhistory is significant for an older brother with asthma. Her father is a smoker.On examination, she has a temperature of 38°C, blood pressure of 90/50 mmHg, respiratoryrate of 20 breaths/minute, and pulse of 100 beats/minute. She appears in no distress but is audibly wheezing. She has mild nasal turbinate swelling, postnasal drainage, and diffuse expiratorywheezes. After a nebulizer treatment with albuterol, she feels much better, and her lungs are completely clear. Which of the following do you advise the patient and her parent?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. She has a completely normal physical exam and her peak flow is 90% predicted. Which of the following diagnoses and treatments are correct?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. The patient returns for regular follow-up but she continues to have symptoms that require her to use the rescue medication four or five times a week. She now has daily symptoms and coughs more than one night a week. Which of the following would be appropriate to recommend?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. While discussing elimination of triggers with the child and her parents, you mention all of the following as possible triggers. Which of these is most commonly implicated in causing exacerbations, and possibly even influencing the development of asthma in populations as a whole?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. Disease severity in asthma is not determined by which of the following?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Which of the following statements is true?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. You explain to her that the following pathologic change(s) is(are) found in the airways of patients with asthma, with or without symptoms:

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. You check an influenza swab, which is negative, and treat the child with inhaled albuterol with a spacer, an inhaled corticosteroid, and a short course of oral steroids. When he returns in 3 days, he has already improved dramatically and has a normal physical exam. Which of the following is true concerning monitoring of asthma in children?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Written action plans for asthma patients should include all of the following except

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Based on the history of this patient, which Medicine do you recommend for maintenance?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. All of the following statements concerning treatment of asthma in children have highest level Cevidence except

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Which of the following statements concerninguse of oral corticosteroids in children with asthmais true?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Goals of asthma therapy (according to recentrecommendations) include all of the followingexcept

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Which of the following statements is correct,according to the most recent guidelines for asthma management?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. What do you think this child has?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. What is the first step in treatment that you would recommend to these patients?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. What is the most effective pharmacologic treatmentfor the condition described here?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. Which of the following therapies for allergic rhinitishas the fewest side effects?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. The mother of the child calls your office andrequests “blood work” to confirm the diagnosis before she starts the child on the medications yourecommended. You call back and tell her which of the following?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. Which of the following is not a physiologically based treatment for allergic rhinitis?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. In patients with significant allergic rhinitis, qualityof life is

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. What is the most likely diagnosis in this child atthis time?

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. What is the most outstanding feature of this illness?

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. What is the causative agent of this infection?

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. This infection can occur in adulthood. Which of thefollowing is a unique feature in this recurrence?

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. What is the current recommendation for thetreatment and prevention of this condition?

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. The father is concerned about his 5-year-old childcontracting the disease. What will you tell him?

A 3-year-old is brought to your office with fatigue andirritability and a low-grade fever that he has had for3 days. The child attendsday care, where a virus is reportedly “going around.” The child was treated by acetaminophen, which has helped to decreaseirritability; although the child’s appetite is suppressed,he is still taking in a good amount of fluids. On physical examination, the child does not lookill. His temperature is 38°C. His skin examinationshows scattered small vesicles on an erythematousbase. The rash was seen first on the face and seemsto be spreading to the trunk. What is a complication(s) associated withvaricella infection?

A 5-year-old is brought to the office with a 3-day history of fever, nonproductive cough, coryza, and conjunctivitis. This morning, a rash appeared on his forehead and behind the ears, and it appears to be spreading to his upper arms and chest. On physical examination, you note a fine maculopapular rash over the face that appears to be spreading to the back and thighs. What is the most likely diagnosis in this patient?

A 5-year-old is brought to the office with a 3-day history of fever, nonproductive cough, coryza, and conjunctivitis. This morning, a rash appeared on his forehead and behind the ears, and it appears to be spreading to his upper arms and chest. On physical examination, you note a fine maculopapular rash over the face that appears to be spreading to the back and thighs. What are the hallmark signs and symptoms of this infection?

A 5-year-old is brought to the office with a 3-day history of fever, nonproductive cough, coryza, and conjunctivitis. This morning, a rash appeared on his forehead and behind the ears, and it appears to be spreading to his upper arms and chest. On physical examination, you note a fine maculopapular rash over the face that appears to be spreading to the back and thighs. Which of the following is a relatively common complication of this infection?

A 5-year-old is brought to the office with a 3-day history of fever, nonproductive cough, coryza, and conjunctivitis. This morning, a rash appeared on his forehead and behind the ears, and it appears to be spreading to his upper arms and chest. On physical examination, you note a fine maculopapular rash over the face that appears to be spreading to the back and thighs. What treatment recommendations will you make to the child?

A 5-year-old is brought to the office with a 3-day history of fever, nonproductive cough, coryza, and conjunctivitis. This morning, a rash appeared on his forehead and behind the ears, and it appears to be spreading to his upper arms and chest. On physical examination, you note a fine maculopapular rash over the face that appears to be spreading to the back and thighs. What would be the recommendations for the exposed members of the family?

A mother brings her child in for a 2-month visit. She gives a history of no prenatal care and a normal vaginal delivery. The baby has received no medical care since discharge. The infant has a large, protruding tongue; short palpebral fissures; and epicanthal folds. He has a simian palmar crease and a large space between the first and second toes. On cardiac examination, you note a harsh III/VI systolic murmur on the left sternal border. Your leading cardiac diagnosis is

You are asked to evaluate a term infant in the delivery room. He was born a few minutes earlier by spontaneous vaginal delivery with Apgar scores of 9 and 9. The mother had good prenatal care and a normal pregnancy. No significant family history is noted. On physical examination, the infant appears alert and is active and crying. Acrocyanosis is noted on extremities. A grade II/VI soft, systolic murmur is audible at the left upper sternal border. Otherwise, the exam is completely normal. What would you do about the murmur at this time?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. What is the treatment of choice in this infant at this time?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. Nvestigations at this time should include which of the following?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. Which of the following statements about the treatment of the condition described here is true?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. Which of the following represents the composition of an ideal rehydrating solution for moderate dehydration?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. What is the most common bacterial cause of diarrhea in children?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. Which of the following infectious agents may produce bloody diarrhea in infants and children?

A 15-month child is brought to you fordiarrhea, with an average 7 loose stools per day for the past 4 days. The stool is watery without any mucus or blood. He also vomited several times during the first 2 days but now it appears to be subsiding. He has been drinking fluids but has not had much appetite for food. For the past 2 days, he has been running a “low-grade fever” and appears to have some abdominal discomfort. He attends a local day care, where some of the children have had similar symptoms.On physical examination, the child is active without any fever. He has dry, cracked lips with moist oral mucosa. The ears, throat, lungs, and abdomen are normal. There are no abdominal masses and no palpable tenderness. Which of the following is a common cause(s) of antibiotic-associated diarrhea in infants and children?

An 23-month-old infant is brought to the emergency department by his mother. He has had diarrhea and vomiting for the past 3 days and appears to be at least 15% dehydrated. His eyeballs are sunken, and his skin is doughy. The child has no satisfactory veins in which to place an IV line. What should you do now?

An 23-month-old infant is brought to the emergency department by his mother. He has had diarrhea and vomiting for the past 3 days and appears to be at least 15% dehydrated. His eyeballs are sunken, and his skin is doughy. The child has no satisfactory veins in which to place an IV line. Which of the following investigations should not be performed on any child who has ongoing diarrhea and severe dehydration?

A mother comes to your office with her 5-year-old boy who has developed severe crampy diarrhea and mild fever. The family has just returned from a trip inMondulkiri province; the child became sick on the third day. He was apparently drinking water from a local stream. What is the most likely diagnosis in this patient?

A mother comes to your office with her 5-year-old boy who has developed severe crampy diarrhea and mild fever. The family has just returned from a trip inMondulkiri province; the child became sick on the third day. He was apparently drinking water from a local stream. Which of the following pediatric infections often presents with diarrhea as the initial symptoms?

A mother comes to your office with her 5-year-old boy who has developed severe crampy diarrhea and mild fever. The family has just returned from a trip inMondulkiri province; the child became sick on the third day. He was apparently drinking water from a local stream. Which of the following is the most common cause of acute abdominal pain in children?

A mother comes to your office with her 5-year-old boy who has developed severe crampy diarrhea and mild fever. The family has just returned from a trip inMondulkiri province; the child became sick on the third day. He was apparently drinking water from a local stream. All of the following factors are associated with an increased risk of gastroenteritis except

A 13-year-old girl is brought to your office with a history of recurring abdominal pain. She has had episodes of abdominal pain at least once or twice a week for the past 3 months. These episodes last approximately 6 to 8 hours. You have seen her for the same problem on many occasions. The following were done previously and all results were normal: complete blood count (CBC); erythrocyte sedimentation rate (ESR); urinalysis; stool for ova and parasites; an ultrasound of the kidneys, ureter, and bladder; and an abdominal plain film. The pain is described as umbilical in location with a quality described as a “dull ache.” She rates the pain at a baseline quantity of 6/10, with increases to 8/10 and decreases to 4/10. It is not associated with any food intake, and it is not associated with any diarrhea or constipation. Her mother says that she has been missing school because of the pain. On physical examination, the girl is in no apparent distress. Her vital signs, height, and weight are normal for her age. On abdominal exam there is slight tenderness in the area of the peri-umbilical region. There is no hepatosplenomegaly and no other masses. What is the most likely diagnosis in this patient?

A 13-year-old girl is brought to your office with a history of recurring abdominal pain. She has had episodes of abdominal pain at least once or twice a week for the past 3 months. These episodes last approximately 6 to 8 hours. You have seen her for the same problem on many occasions. The following were done previously and all results were normal: complete blood count (CBC); erythrocyte sedimentation rate (ESR); urinalysis; stool for ova and parasites; an ultrasound of the kidneys, ureter, and bladder; and an abdominal plain film. The pain is described as umbilical in location with a quality described as a “dull ache.” She rates the pain at a baseline quantity of 6/10, with increases to 8/10 and decreases to 4/10. It is not associated with any food intake, and it is not associated with any diarrhea or constipation. Her mother says that she has been missing school because of the pain. On physical examination, the girl is in no apparent distress. Her vital signs, height, and weight are normal for her age. On abdominal exam there is slight tenderness in the area of the peri-umbilical region. There is no hepatosplenomegaly and no other masses. The mother of the patient is extremely anxious and wants to know if the investigations need to be repeated at this time. You tell her which of the following?

A 14-year-old male is brought into the office by his mother. For the past 2 weeks, he has been very tired and has felt short of breath. The mother tells you that she thinks he has been losing weight. On physical examination, the child is alert and in nodistress; vital signs are normal, but he has lost 3.5 kg since his last visit 6 months ago. The lungs are clear bilaterally, and the heart examination is normal. You palpate an enlarged supraclavicular node. Chest radiography reveals a large mediastinalmass. What is the most likely diagnosis?

A 14-year-old male is brought into the office by his mother. For the past 2 weeks, he has been very tired and has felt short of breath. The mother tells you that she thinks he has been losing weight. On physical examination, the child is alert and in nodistress; vital signs are normal, but he has lost 3.5 kg since his last visit 6 months ago. The lungs are clear bilaterally, and the heart examination is normal. You palpate an enlarged supraclavicular node. Chest radiography reveals a large mediastinalmass. Which of the following is commonly associated with non-Hodgkin’s lymphoma?

A 14-year-old male is brought into the office by his mother. For the past 2 weeks, he has been very tired and has felt short of breath. The mother tells you that she thinks he has been losing weight. On physical examination, the child is alert and in nodistress; vital signs are normal, but he has lost 3.5 kg since his last visit 6 months ago. The lungs are clear bilaterally, and the heart examination is normal. You palpate an enlarged supraclavicular node. Chest radiography reveals a large mediastinalmass. The presence of Reed–Sternberg cells in tissue is diagnostic of which disease?

A 14-year-old male is brought into the office by his mother. For the past 2 weeks, he has been very tired and has felt short of breath. The mother tells you that she thinks he has been losing weight. On physical examination, the child is alert and in nodistress; vital signs are normal, but he has lost 3.5 kg since his last visit 6 months ago. The lungs are clear bilaterally, and the heart examination is normal. You palpate an enlarged supraclavicular node. Chest radiography reveals a large mediastinalmass. The most common malignancy in childhood is which of the following?

A 3-year-old female presents for her routine visit. The physician notes pallor and bruising. On physical examination, the vital signs are normal but there is a generalized lymphadenopathy and hepato-splenomegaly. A complete blood count (CBC) reveals a white blood cell (WBC) count of 33,000/mm3 and a platelet count of 81,000/mm3. The peripheral blood smear shows blasts, and the lactate dehydrogenase activity is elevated. CBC shows blasts as well as hypochromic red blood cells. The most common leukemia among children is which of the following?

A 3-year-old female presents for her routine visit. The physician notes pallor and bruising. On physical examination, the vital signs are normal but there is a generalized lymphadenopathy and hepato-splenomegaly. A complete blood count (CBC) reveals a white blood cell (WBC) count of 33,000/mm3 and a platelet count of 81,000/mm3. The peripheral blood smear shows blasts, and the lactate dehydrogenase activity is elevated. CBC shows blasts as well as hypochromic red blood cells. Most cases of acute lymphoblastic leukemia (ALL) are diagnosed between the ages of which of the following ranges?

A 3-year-old female presents for her routine visit. The physician notes pallor and bruising. On physical examination, the vital signs are normal but there is a generalized lymphadenopathy and hepato-splenomegaly. A complete blood count (CBC) reveals a white blood cell (WBC) count of 33,000/mm3 and a platelet count of 81,000/mm3. The peripheral blood smear shows blasts, and the lactate dehydrogenase activity is elevated. CBC shows blasts as well as hypochromic red blood cells. Which of the statements regarding the disease described in here is true?

A 3-year-old female presents for her routine visit. The physician notes pallor and bruising. On physical examination, the vital signs are normal but there is a generalized lymphadenopathy and hepato-splenomegaly. A complete blood count (CBC) reveals a white blood cell (WBC) count of 33,000/mm3 and a platelet count of 81,000/mm3. The peripheral blood smear shows blasts, and the lactate dehydrogenase activity is elevated. CBC shows blasts as well as hypochromic red blood cells. Which of the following increases the risk of a child developing AML?

You ask the school nurse to help you calculate the BMI of the students. Which statement about BMI is false?

Abdominal manifestations of Henochschonlein purpura include all EXCEPT:

What is the most common congenital heart defect with a left to right shunt causing congestive heart failure in the pediatric age group?

The earliest sign of congestive heart failure on a chest X-ray is:

All of the following are included in the revised Jones Major criteria EXCEPT:

A 7 year old girl presents with a tender and swollen right knee as well as a more recently appearing swollen left wrist. She also has a fever. This patient fulfills which of the following modified Jones criteria?

The most common cause of bronchiolitis is:

Treatment of bronchiolitis should include all of the following EXCEPT:

The species of malaria associated with adherence to endothelial walls, cerebral malaria, and a high mortality rate is:

The fever of malaria:

The pathogenesis of malaria can affect which of the following organ systems:

Encephalitis is usually the result of which of the following:

What is most the endemic form of encephalitis in Cambodia?

Which viral infection involving the CNS is likely to present with focal neurological findings?

Which microorganism is a common ethiology in endotoxic shock?

A 2-year-old boy presents with fever, loss of appetite, sore throat, with red, blister-like lesions on the tongue, gums and inside of the cheeks and a red rash, without itching on the palms, soles and the buttocks. Which of the following disease, you think the most probably.

Which of the following is a definite indication to start antiretroviral treatment in HIV infected children?

A patient with Cushing syndrome might present with any of the following EXCEPT:

What physical exam sign/symptom is most suggestive of foreign body aspiration?

Which of the following is NOT TRUE about breast feeding?

Which circulatory finding is the hallmark of the diagnosis of late (decompensated) shock?

An alert, 6 month old male has a history of vomiting and diarrhea. He appears pale and has an RR of 45 breaths per minute, HR of 180 beats per minute, and a systolic blood pressure of 85 mm Hg. His extremities are cool and mottled with a capillary refill time of 4 seconds. What would best describe his circulatory status?

Which of the following factors leads to neonatal hyperbilirubinemia?

Respiratory Problems in premature infants may be secondary to (choose one):

A female infant is normal at birth but develops a severe hemolytic anemia after age 6 months. Peripheral blood smear shows a microcytic, hypochromic anemia with numerous target cells and increased reticulocytes. Hemoglobin electrophoresis at 9 months of age demonstrates hemoglobin F of 90%, increased hemoglobin A2, and decreased hemoglobin. Which of the following is the most likely diagnosis?

AIDS is caused by a human retrovirus that kills

A positive tuberculin skin test (a delayed hypersensitivity reaction) indicates that

The most common cause of gross hematuria is (only one answer):

The most common organism in patients with empyema (purulent pleurisy) is:

Hypertrophic pyloric stenosis is common in

A 3.8 kg baby of a diabetic mother developed seizures at 16 hours of birth. Most probable cause is –

A 5-year old boy comes with overnight petechial spots 2 weeks back he had history of abdominal pain and no hepato-splenomegaly. Diagnosis is

The following features are true for tetralogy of Fallot, EXCEPT:

An 8-moth old infant was admitted with history of excessive crying and pain abdomen. The child is pale and having recurrent pain. An hour before hospitalization, the child was passing blood and mucous likely diagnosis is:

Failure to initiate and maintain spontaneous respiration following birth is clinically known as