Pediatric(151-200)

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: