Pédiatrie 2018 QCM Basic

A 3-year-old boy who was involved in a motor vehicle crash sustained a significant head injury and had a Glasgow Coma Scale score of 8 on arrival in the emergency department. An endotracheal tube was placed shortly after his arrival, and the respiratory therapist is providing ventilation at 12 breaths/min with 100% oxygen via a bag-valve mask until a ventilator can be brought to the emergency department. Ten minutes later, the child becomes more restless and agitated. His heart rate has increased from an initial110 beats/min to about 150 beats/min, and he appears flushed. The monitor indicates that his oxygen saturation is 96% .Of the following, a TRUE statement about this child's ventilatory status is that

A 10-year-old boy (individual 111,1in the pedigree) presents for evaluation of ligamentous laxity and multiple joint dislocations.The family history is notable for a father who has scoliosis and ligamentous laxity, a paternal aunt who has had retinal detachments and mitral valve prolapse , and a paternal grandmother who had joint dislocations and now has osteoarthritis. Based on the family history , the MOST likely pattern of inheritance of this connective tissue disorder is

You are asked to evaluate a 1-day-old infant who has mild clitoromegaly and palpable masses in the labial folds bilaterally. Chromosome studies reveal that the infant has an XY karyotype. Of the following, additional history is MOST likely to reveal that the infant's

The parents of a child who was diagnosed at birth with Beckwith-Wiedemann syndrome bring in the baby for his 2-month evaluation. They ask about future health problems and his prognosis now that his omphalocele has been repaired. Of the following, the child is MOST at risk for

You are discussing the common indications for chromosome analysis with a group of third-year medical students. Of the following, the MOST appropriate statement to include in your discussion is that

You and your colleagues are discussing implementation of routine developmental screening in your office. In your research, you have found that

A term infant is delivered vaginally following a pregnancy complicated by diabetes mellitus. His oral and nasal airways are suctioned and found to be patent and free of meconium. He has cyanosis and respiratory distress immediately following birth that requires intubation and assisted ventilation with 100% oxygen.Because no improvement is apparent in the next 5 minutes, he is admitted to the neonatal intensive care unit. His birth weight is 4,500 g. A chest radiograph reveals fmdings consistent with decreased pulmonary blood flow. Of the following, the MOST likely cause of respiratory distress in this infant is

You are seeing a 14-year-old boy in your office who complains of fever, facial pain, and cough at night. His mother states that he has had problems with sinusitis for the past few months and has required repeated antimicrobial therapy during this period. Physical examination reveals a temperature of 101oF (38.3°C), yellow-green nasal discharge, and tenderness to palpation of the maxillary and frontal sinus regions. Of the following, the MOST likely pathogen associated with chronic sinusitis is

You are seeing a 2-month-old male infant who has trisomy 21 for a health supervision visit. The boy's mother expresses concern that the infant has been having "noisy breathing" during the past 2 to 3 weeks. The infant has been exclusively formula-fed and has had no choking or difficulty feeding. According to the mother, the noise, which occurs on inspiration, is louder when the infant is supine and when crying. She has not noticed any rhinorrhea, cough, or other upper respiratory viral illness symptoms. The infant was born via an uneventful vaginal delivery that did not require forceps. Apgar scores were 8 and 9 at 1and 5 minutes, respectively. On physical examination, the infant, whose physical appearance is consistent with trisomy 21, is resting comfortably. His vital signs are appropriate for age, but you hear an audible noise during inspiration. Of the following, the MOST likely explanation for the infant's respiratory symptoms is

A 2-year-old boy is brought to your clinic because he has a nighttime cough. According to his mother, several times over the past few months he has awakened with a barking, nonproductive cough that improves by the next morning. She denies fever and rhinorrhea with the episodes. Evaluation of his lungs yields normal results. Of the following, the clinical feature that is MOST suggestive of spasmodic croup rather than recurrent laryngotracheobronchitis in this boy is

You are evaluating a 7-year-old boy who has sickle cell disease for a 5-day history of fever, rhinorrhea, headache, and worsening fatigue. Physical examination reveals a tired-appearing, pale boy who has a temperature of 101.5°F (38.6°C); heart rate of 150 beats/min; very pale conjunctivae and mucous membranes; and a faint diffuse, erythematous, lacy rash that is most prominent on his cheeks and trunk. Laboratory tests show a white blood cell count of 12x103/mcL (12x1091L), with 50o/o neutrophils, 45% lymphocytes, and 5o/o monocytes; hemoglobin of 4 g/dL (40 giL); hematocrit of 16% (0.16); and reticulocyte count of less than 1% (0.01). Of the following, the MOST likely cause for this patient's present illness is infection with

A 3-year-old boy presents to the emergency department following the abrupt onset of coughing and wheezing. You order a chest radiograph for evaluation of a suspected foreign body aspiration. Of the following, the MOST appropriate statement regarding foreign body aspiration is that

A 15-year-old girl who has juvenile rheumatoid arthritis has been treated with ibuprofen 30 mglkg per day for 3 months. She has had epigastric abdominal pain for 1month that has been unresponsive to empiric therapy with omeprazole 20 mg/day. You are considering adding misoprostol100 meg four times daily to her current treatment regimen. Of the following, a TRUE statement regarding misoprostol is that the drug

The mother of an infant born at 34 weeks' gestation asks you whether any of the medications she was given prior to delivery will have any effect on her daughter's growth and development. Of the following, the MOST correct statement concerning drugs commonly used in labor is that

A 3-month-boy who has been previously healthy is brought to the emergency department with a 3-day history of rhinorrhea, mild cough, and wheezing. He has been afebrile and has had some difficulty feeding. His pulse oximetry reading is 90o/o on room air, respiratory rate is 60 breaths/min, and heart rate is 130 beats/min. Chest examination reveals mild subcostal retractions, scattered wheezes, and coarse crackles bilaterally. The rest of the physical examination fmdings are normal. Of the following, the pathogen that is MOST likely responsible for his symptoms is

A 17-year-old girl presents with amenorrhea of 6 months' duration. One year ago she joined the cross country team at school. At that time, her periods had been regular, about every 26 days, and remained so for the 3-month running season. At the end of the season, she continued to run 5 miles a day to be more competitive for the subsequent season. She noticed that her menstrual flow was lighter for a few months preceding the amenorrhea. You suspect exercise-induced amenorrhea and recommend a decrease in exercise. Of the following, the factor MOST likely to be associated with a low bone density and stress fractures in this patient is

You diagnose attention-deficit/hyperactivity disorder in an 8-year-old girl and initiate therapy with a daily morning dose of long-acting methylphenidate. Her mother asks about using stimulant medication after school, on weekends, and during the summer. Of the following, your BEST response is that

A 14-year-old boy has a body mass index that is greater than the 95th percentile for age and an accelerating weight curve. His blood pressure is 135/85 mm Hg. His mother has type 2 diabetes that developed during her first pregnancy, and several paternal relatives also have type 2 diabetes. The family emigrated from the Caribbean when he was a toddler. He has dark velvety thickening of the skin on his neck and under his arms. Of the following, the findings that are MOST supportive of a diagnosis of metabolic syndrome in this young man are

You are present at the birth of an infant in whom bilateral hydronephrosis was diagnosed in utero. A fetal shunt was placed in each flank between the renal pelvis and the amniotic cavity. Nonetheless, the infant has bilaterally palpable flank masses, and the shunts are not apparent at birth. The infant shows no dysmorphisms and has no respiratory distress. Renal ultrasonography reveals bilateral hydronephrosis. Of the following, the MOST correct statement regarding the fetus/neonate who has obstructive uropathy is that

Numerous therapeutic agents are known to have teratogenic effects on the developing fetus. Of the following, the findings in the newborn that are MOST suggestive of prenatal exposure to an angiotensin-converting enzyme inhibitor are

The director of a community after-school program for adolescent boys is organizing an orientation session for new mentors. He wants some information about current substance abuse trends. Of the following, you are MOST likely to report that among adolescents,

22. You are evaluating a 6-year-old boy who has Duchenne muscular dystrophy. He is doing well in a regular classroom and will be attending second grade in a different school next year. On physical examination, you note a healthy-appearing boy who has pseudohypertrophy of the calf muscles and uses a Gower maneuver to rise from the floor. In gathering information to help this child's transition to a new school, you are MOST likely to ask about

An 11-day-old infant presents to the clinic with a history of a temperature of 100.80F (38.20C) and a 1-day history of poor feeding. Findings on physical examination are normal. You initiate a sepsis evaluation that includes a lumbar puncture. The cerebrospinal fluid results demonstrate a white blood cell count of 6x103/mcL (6x109/L), with 68% neutrophils, 2% bands, and 30% lymphocytes. The protein concentration is 200mg/dL (2g/L), and the glucose value is 36mg/dL (2.0mmol/L). The abnormal findings prompt you to order magnetic resonance imaging, which demonstrates abnormal frontal lobes bilaterally that includes some degree of infarction but also abscesses and cerebritis. Of the following, the MOST likely pathogen is

An 11-year-old highly competitive gymnast presents to your office with complaints of increasing right wrist pain over the past 2 to 3 months. She recalls no specific trauma to the wrist or arm. On physical examination, you note no swelling of the distal forearm or wrist. She has normal range of motion at the wrist. There is moderate-to-marked tenderness of the distal radius, but no tenderness more distally over the wrist joint. A radiograph of the forearm shows slight widening of the distal radial physis. Of the following, you MOST likely to explain to the child and family that

You have just diagnosed Ebstein anomaly in a newborn. Of the following, the MOST likely prenatal exposure to result in this abnormality is

A 14-year-old-boy has been followed by another physician. When you see him for the first time, he brings records that you use to construct a growth curve (Item Q186A). His parents state that they are not worried about his growth because his 20-year-old brother was a slow grower and still seems to be growing a little. Physical examination reveals 6-mL testes and Sexual Maturity Rating 2 pubic hair. There are no other signs of puberty. His bone age on radiography is 12years. Of the following, the MOST appropriate suggestion for the family is that

You see a 9-month-old girl for a health supervision visit. She is in her infant carrier with a propped bottle. The mother explains that the infant does not sleep through the night, which is disrupting the mother’s ability to function well at work. The infant appears well, with length and head circumferences at the 25th percentile and weight at the 98th percentile. During the examination, the infant cries. The mother hands you a bottle and asks if she may leave to check on a referral for her older child. Of the following, you are MOST likely to suggest to the mother

A 4-month-old boy presents to the clinic with a 2-day history of a temperature of 100.6°F (38.1°C) and vomiting. The infant was born at 26 weeks' gestation, and his birthweight was 960g. He remained in the hospital for 3 months after birth because of multiple complications, including bilateral grade 4 intraventricular hemorrhages necessitating the placement of a ventriculoperitoneal shunt 6 weeks ago. Physical examination reveals an afebrile infant who has a shunt bubble on the right temporo-occipital region and a gastrostomy button. You explain that his shunt bubble requires aspiration to evaluate the cerebrospinal fluid for infection. Of the following, the organism that is MOST likely to be isolated in the aspirate is

A 16-year-old previously healthy boy presents with a 2-week history of intermittent elevated temperatures to 102°F (39°C), headache, malaise, fatigue, myalgias, and a progressively worsening nonproductive cough. During history-taking, be reports that recently he explored several caves while hiking in a forest preserve in Ohio. Physical examination reveals a tiredappearing adolescent who has a temperature of 102.4°F (39.1°C), a dry cough, and diffuse intermittent rhonchi on chest auscultation. Laboratory findings include a white blood cell count of 12x103/mcL (12x109/L), with 60% neutrophils, 2% band forms, and 38% lymphocytes. Chest radiograph (Item Q190A) shows patchy left upper and left lower lobe opacities and hilar adenopathy. Of the following, the MOST likely pathogen causing this patient's condition is

An African-American mother brings her previously healthy 2-year-old son to the emergency department because he looked pale when he woke up this morning. She also reports fever and decreased activity over the last few days. He was diagnosed with a urinary tract infection and given trimethoprim-sulfamethoxazole 3 days ago. On physical examination, he is markedly pale and appears jaundiced. His heart rate is 170 beats/min, and his respiratory rate is 30 breaths/min. The rest of his physical examination findings are unremarkable. Laboratory evaluation reveals a hemoglobin concentration of 5 g!dL (50 giL).Of the following, the MOST likely cause of this boy's anemia is

A 3-year-old girl is brought to your office for re-evaluation of a fever that began 6 days ago. Her mother tells you that her daughter's temperature has been as high as 102.2°F (39°C). Her physical examination was unremarkable when you examined her 3 days ago, but today you note injected sclera; cracked, red lips; a strawberry appearance of her tongue; and a swollen, nontender , cervical node.You tell her mother that you believe this is Kawasaki disease. Of the following, the MOST appropriate statement to make to the mother is that

The mother of a 14-year-old boy arranges to meet with you privately before the boy's annual health supervision visit. She is concerned because he is quiet, has no athletic interests, and has only a few friends. He is content to spend the weekend shopping, cooking, reading, and listening to music. Although he doesn't like school, he is an honor student. The mother also tells you her husband's youngest brother recently disclosed his homosexuality and wants to introduce his male partner to the extended family. Of the following, while counseling the mother, you are MOST likely to include a statement that

You are evaluating a short 14-year-old boy who is underweight for height. His growth curve is shown in Item Q202A. He says he is feeling well. His mother worries that he does not have as much stamina as he did at age 12 years. Of the following, the laboratory study that is MOST likely to be useful in assessing the reason for poor growth is measurement of

You are asked to review a case for morbidity and mortality conference. The infant was born at term to a 19-year-old gravida 1, para 1woman by normal spontaneous vaginal delivery. The mother was known to be group B Streptococcus-negative, but she did have genital warts. The Apgar scores were 9 at 1minute and 10 at 5 minutes. On the seventh postnatal day, the infant developed a temperature of 103°F (39.4°C) and was brought to the emergency department. At this time, the infant was in shock and required mechanical ventilation. Physical examination revealed scleral icterus and hepatosplenomegaly but no skin lesions. A lumbar puncture could not be performed. Laboratory results include: White blood cell count of 2.34x103/mcL (2.34x109/L), with 32% lymphocytes, 41% neutrophils, 8% bands, 15% monocytes, 3% eosinophils, and 1% basophils, Hemoglobin of 7.1 g/dL (71 giL), Hematocrit of 21% (0.21), Platelet count of 40x103/mcL (40x109/L), Prothrombin time of 41.2 seconds, Activated partial thromboplastin time of>106 seconds, Aspartate aminotransferase concentration of 3,086 UIL, Alanine aminotransferase concentration of 456 UIL, Total bilirubin of 4.4 mg/dL (75.2 mcmol!L). The chest radiograph demonstrated diffuse interstitial infiltrates bilaterally (Item Q204A). The patient did poorly over the next 3 days and died despite aggressive management in a pediatric intensive care unit. Of the following, the MOST likely cause of this patient's death is

A 5-month-old female infant presents with a 1-day history of fever to 102°F (38.9°C), emesis, and multiple episodes of greenish diarrhea with streaks of blood. Her mother states that the infant is less active, sleepier, and has no interest in feeding. Physical examination reveals a listless infant who has a sunken anterior fontanelle, dry mucous membranes with decreased skin turgor, and skin irritation in the diaper area. Of the following, the MOST likely cause of this patient's gastroenteritis is

A mother brings in her 2-year-old boy for food avoidance education after he was seen in the emergency department last week for anaphylaxis following peanut ingestion. This is the third anaphylactic episode after peanut ingestion since he was diagnosed with a peanut food allergy at age 1year. At that time, he was evaluated by a pediatric allergist and determined to have positive skin tests and an elevated serum immunoglobulin (lg) E to peanut antigen, consistent with an lgE-mediated allergy. The mother is frustrated and would like advice regarding peanut food allergy. Of the following, the BEST advice at this time is to

The family of a diabetic patient in your practice requests evaluation for celiac disease. They have heard from other families of children who have diabetes that patients who have type 1diabetes are at increased risk for this condition. Of the following, a TRUE statement regarding celiac disease screening is that

A newborn in your neonatal intensive care unit has had intermittent seizures for 72 hours. You have been unable to control the seizures with phenobarbital, hydantoin, and lorazepam. Electrolyte, calcium, magnesium, and glucose concentrations are normal. The infant subsequently becomes apneic, comatose, and unresponsive. Of the following, the BEST laboratory test to determine the cause of coma in this infant is

During clinic rounds with medical students, you are seeing a 2-year-old girl who has otitis media. One of the students asks about the potential complications of otitis media. Of the following, the statement you are MOST likely to make is that

40. An 18-year-old girl presents for a health supervision visit prior to leaving for college. She has a letter from the college she plans to attend instructing entering freshman who choose to live in the dormitories to obtain a meningococcal vaccination. You review vaccine information and obtain consent for the immunization. Of the following, an ACCURATE statement about recommendations for the use of the meningococcal MCV4 vaccine is that it

You are seeing a 6-year-old girl whose mother is concerned about the girl masturbating. For the past several months, the girl has touched her genitals while watching television with her mother. The parents have been divorced for 2 years, and the girl spends weekends with her father. You question her mother further. Of the following, the response that MOST increases your suspicion for behavior that is out of the norm is

The mother of a 4-month-old infant is planning a winter trip to the tropics with her infant and asks about the use of sunscreens and the safe amount of sun exposure for the infant. Of the following, the MOST appropriate advice for the infant is to

A 5-month-old infant presents with a history of vomiting between 10 and 20 times a day. She is growing and developing normally. There is no blood in the vomitus, no respiratory symptoms, and no history of apnea. The parents are frustrated from cleaning up after the baby vomits and want something done. Physical examination and upper gastrointestinal radiograph evaluation results are normal. Of the following, the MOST accurate statement about this patient is that she

A 4-year-old girl remains intubated, mechanically ventilated , and completely unresponsive in the intensive care unit following a massive subarachnoid hemorrhage of unknown cause. She is hemodynamically stable and not receiving any sedating medications. She has a temperature of 98.1°F (36.7°C) and has no evidence of infection. The girl has not exhibited any brainstem or cerebral function for more than 24 hours. Of the following, the statement you are MOST likely to make while on rounds with the resident team is that

A 4-month-old child is admitted to the hospital for evaluation of failure to thrive and generalized seizures. On physical examination, the child appears wasted and has a protuberant abdomen and marked hepatomegaly. Laboratory evaluation reveals fasting hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. The boy's parents are first cousins. Of the following, the BEST long-term management of this disorder is

A 17-year-old boy presents for a sports physical. He has a learning disability and is shy. His height is at the 75th percentile, and his body mass index is at the 85th percentile. Physical examination findings include minimal facial hair, bilateral gynecomastia (breast >4 em in diameter), and small testes (testicular volume of 6 mL). Of the following, the MOST likely cause of this patient's gynecomastia is

You are evaluating a 5-year-old boy who has cerebral palsy and mental retardation, is fed through a gastrostomy tube, and is dependent for all his care. He will be attending a full-day program at the school in which he previously was enrolled. His parents are divorced, and his mother is his primary caretaker. She will begin working while he is in school. He has a 10- yearold brother with whom he shares a room and who alerts his mother when his brother needs help at night. Of the following, the concern you are MOST likely to address is

You are discussing diarrheal diseases with a group of medical students interested in international health. You advise them that there are more than 2,000 serovars of Salmonella. Of the following, the serovar that has the MOST public health implications is

The father of three children in your practice recently was diagnosed with Crohn disease. His wife does not have Crohn disease. He asks you if his children, ages 10, 12, and 16 years, are at increased risk for developing the same illness. Of the following, you are MOST likely to advise the father that

During a health supervision visit of a 6-year-old child, you ask the mother if there are any guns in the home. She states that her husband is a hunter, but he keeps his shotgun in his pickup truck. Of the following, the BEST anticipatory guidance with regard to firearm safety is to tell the mother to