USS DES Test 9C (Start From page 1720 )

201) A 2-year-old patient arrives late to your office with his father and a sign-language translator. They are very apologetic, but the father communicates that he had car trouble at his dialysis center and thus was late picking up the child from day care. The father is concerned about his child’s having intermittent red, bloody-looking urine. A gross inspection of the child’s urine in your office looks normal, but the dipstick demonstrates 3+ blood. Which of the following is the most likely cause of this child’s hematuria?
Alport syndrome
Berger nephropathy (IgA nephropathy)
Idiopathic hypercalciuria
Membranousglomerulopathy
Goodpasture syndrome
202) A 2-year-old boy is brought to the clinic by his mother because he is lethargic and not as active as the other kids on their block. He has difficulty walking and getting up, and he always appears tired. His mother thinks that she has a relative with a disorder that causes weakness. On examination, the child is alert but quiet. His calves appear hypertrophied. His reflexes are depressed. When he gets up from the floor, he uses his hands to climb on his legs to assume an upright position. What is the most likely diagnosis of this child?
Myasthenia gravis
Dermatomyositis
Duchenne muscular dystrophy
Polio myelitis
Fragile X syndrome
203) A 2-month-old male infant is rushed to the emergency department by his baby sitter. She says that the baby became unresponsive and blue while feeding. The whole episode lasted 45-60 seconds, but the baby still appears pale. She denies any history of coughing or choking. On examination, the infant appears cyanotic and tachypneic. His blood pressure is 90/60 mm of Hg; his pulse rate is 155/min and regular. On auscultation, a harsh pansystolic murmur is noted at the left sternal border, along with a single S2. Hepatomegaly is noted. Pulse oximetry shows an oxygen saturation of 80%. Based on this history and physical examination, what is the most likely diagnosis?
Truncus arteriosus
Ventricular septal defect
Tetralogy of Fallot
Patent ductus arteriosus
Transposition of great vessels
  P1721 Q205P1721 Q205  204) A 13-year-old asymptomatic girl is shown below. She states that the findings demonstrated began more than a year ago. Which of the following is the most likely diagnosis?
 
Iodine deficiency
Congenital hypothyroidism
Graves’ disease
Exogenous ingestion of Synthroid
Lymphocytic (Hashimoto) thyroiditis
205) During a routine well-child examination a 10-year-old girl reports that she has occasional headache, “racing heart,” abdominal pain, and dizziness. Her mother states that she has witnessed one of the episodes, which occurred during an outing at the mall, and reported the child to be pale and to have sweating as well. Other than some hypertension, she has a normal physical examination. Evaluation of this child is most likely to result in which of the following diagnoses?
Hysterical fainting spells
Pregnancy
Diabetesmellitus
Pheochromocytoma
Migraine headache
206) A 4-year-old boy presents to the physician with fever and a sore throat. His illness began with rhinorrhea, cough, and congestion one week ago, but in the last 24 hours he has developed fever, a sore throat, and neck pain. His mother also reports that he sounds hoarse. His appetite is decreased and he complains of dysphagia. His temperature is 39.7 C (103.5F), pulse is 100/min, and respiratory rate is 25/min. On examination, the child appears sick. He has cervical lymphadenopathy on the right and decreased range of motion of his neck. His voice is muffled and sounds hoarse. His oropharynx is erythematous and a bulge is noted in the posterior pharyngeal wall. P1722 Q206
 A lateral radiograph of the neck is shown below. Which of the following is the most likely diagnosis?          (P1722 Q206)
Diphtheria
Viral pharyngitis
Epiglottitis
Infectious mononucleosis
Retropharyngeal abscess
P1722 Q207
207) A 10-year-old obese child (shown below) has central fat distribution, arrested growth, hypertension, plethora, and osteoporosis. Which of the following disorders is most likely responsible for the clinical picture that this boy presents?
 
(P1722 Q207 )
 
Bilateral adrenal hyperplasia
Adrenaladenoma
Adrenal carcinoma
Craniopharyngioma
Ectopic adrenocorticotropin-producing tumor
208) A 6-year-old boy is brought to your practice by his paternal grandmother for his first visit. She has recently received custody of him after his mother entered the penal system in another state; she does not have much information about him. You note that the child is short for his age, has downslanting palpebral fissures, ptosis, low-set and malformed ears, a broad and webbed neck, shield chest, and cryptorchidism. You hear a systolic ejection murmur in the pulmonic region. His grandmother reports that he does well in regular classes, but has been diagnosed with learning disabilities and receives speech therapy for language delay. His constellation of symptoms is suggestive of which of the following?
Noonan syndrome
Congenital hypothyroidism
Turner syndrome
Congenital rubella
Down syndrome
209) A 2-week-old infant is noted to be jaundiced. The baby's stools are pale, and his urine darkly colored. Physical examination demonstrates hepatomegaly. Serum studies show elevations of AST, ALT, conjugated bilirubin, and unconjugated bilirubin. By 2 months of age, the baby is notably irritated by pruritus, has retarded growth, and has visible dilated veins in the periumbilical area. Ultrasound fails to demonstrate a gallbladder. Which of the following is the most likely diagnosis?
Alpha-1-antitrypsin deficiency
Biliary atresia
Cystic fibrosis
Hepatitis B
Hepatitis C
210) A mother brings her 7-year-old son to the clinic because, over the past several days, his urine has become pink and bis eyes have looked puffy. About 2 weeks ago, he missed school because of fever and a sore throat. On examination, the boy's blood pressure is 130/85 mm Hg, his eyelids and scrotum appear puffy, and he has 1+ tibial edema. No rashes are noted. Which of the following is the most likely diagnosis?
Acute poststreptococcal glomerulonephritis
Hemolytic-uremic syndrome
Henoch-Schonlein purpura
Nephrotic syndrome
Vesicoureteral reflux
 
P724 Q211
 P724 Q211
211) The examination of a child’s back is shown below. Evaluation with ultrasound of this lesion may demonstrate which of the following?
Epsteinpearl
Mongolian spot
Cephalohematoma
Omphalocele
Occult spina bifida
212) An otherwise healthy 7-year-old child is brought to you to be evaluated because he is the shortest child in his class. Careful measurements of his upper and lower body segments demonstrate normal body proportions for his age. Which of the following disorders of growth should remain in your differential?
Achondroplasia
Morquio disease
Hypothyroidism
Growth hormone deficiency
Marfan syndrome
213) A 4-year-old immigrant boy is brought by his mother to a Medical Camp for the Uninsured for the evaluation of his inflamed right eye. He has had a nasal discharge for the past 10 days. His brother has similar symptoms. His vital signs are stable. There are follicles and inflammatory changes in the conjunctiva of his right eye. The cornea shows neovascularization. What is the most likely diagnosis?
Herpes simplex keratitis
Orbital cellulitis
Trachoma
Gonococcal conjunctivitis
Viral conjunctivitis
214) A previously healthy 7-year-old child suddenly complains of a headache and falls to the floor. When examined in the emergency room (ER), he is lethargic and has a left central facial weakness and left hemiparesis with conjugate ocular deviation to the right. Which of the following is the most likely diagnosis?
Hemiplegic migraine
Supratentorial tumor
Todd paralysis
Acute subdural hematoma
Acute infantile hemiplegia
215) An irritable 6-year-old child has a somewhat unsteady but nonspecific gait. Physical examination reveals a very mild left facial weakness, brisk stretch reflexes in all four extremities, bilateral extensor plantar responses (Babinski reflex), and mild hypertonicity of the left upper and lower extremities; there is no muscular weakness. Which of the following is the most likely diagnosis?
Pontineglioma
Cerebellar astrocytoma
Tumor of the right cerebral hemisphere
Subacute sclerosing panencephalitis
Progressive multi focal leukoencephalopathy
216) A previously healthy 4-year-old boy is brought to the physician for evaluation of fever and respiratory distress. The patient developed fever three days ago. Since then, he has had increasing fatigue, irritability, and respiratory distress. His temperature is 100 F (38.2C), pulse is 144/min, respiratory rate is 45/min, and blood pressure is 95/60 mm Hg. On examination, the child appears to be in moderate respiratory distress with tachypnea and subcostal retractions. He is tachycardic with an III/IV holosystolic murmur best heard at the cardiac apex. Peripheral  pulses are present and capillary refill is three seconds. His liver is 
P1726   Q216
P1726 Q216
  palpated three centimeters below the costal margin. A chest radiograph is shown below. Which of the following is the most likely cause of this patient's symptoms?
Community-acquired pneumonia
Viral hepatitis
Rheumatic fever
Kawasaki disease
Myocarditis
217) A 6-year-old boy presents in clinic for a routine visit. Examination reveals coarse, dark pubic hair, an enlarged penis and testes, and acne of the face and upper back. His mother notes that he has a body odor similar to that of her teenage son after playing sports. The child is in file 99th percentile of height for his age group. Which of the following is the most likely diagnosis?
Congenital adrenal hyperplasia
Hypothalamic tumor
Klinefelter syndrome
Male pseudohermaphroditism
XYY syndrome
218) A 10-year-old girl is brought to a pediatrician because her mother notices that she stumbles frequency at night, even with adequate lighting. Visual field testing demonstrates a relatively narrow mid-peripheral ring scotoma. Ophthalmoscopy demonstrates dark pigmentation in a bone spicule configuration involving the equatorial retina. Additional findings include a waxy yellow appearance to the disk and narrowed retinal arteries. Which of the following is the most likely diagnosis?
Cataract
Central retinal artery occlusion
Retinal detachment
Retinitis pigmentosa
Uveitis
219) A 6-week-old boy is brought to the physician because of a rash involving the diaper area. On examination, there are erythematous, slightly scaly patches covering the buttocks and the lower abdomen. Skin creases appear spared. The baby is otherwise healthy. Physical examination reveals no lymphadenopathy, fever, or other signs of organic illness. Which of the following is the most common cause of this condition?
Candidiasis
Irritant contact dermatitis
Langerhans cell histiocytosis
Psoriasis
Seborrheic dermatitis
220) A 3-year-old boy was bitten while teasing a neighborhood cat. On examination, there are two puncture wounds on the right hand and some superficial scratch marks. There is erythema, warmth, and induration around the puncture sites. Which of the following organisms most likely caused the infection?
Pasturella multicoda
Bartonella henselae
Eikenella corrodens
Peptostreptococcus species
alpha Streptococci
221) A 2-year-old boy has had a purulent drainage from the right nostril for a week. He is afebrile and has had no associated symptoms, such as cough. Which of the following is the most likely diagnosis?
Sinusitis
nasal polyps
an upper respiratory infection
a foreign body in the right nostril
Allergic rhinitis
222) You are called to examine a male newborn because his first feeding caused him to choke, cough and regurgitate. He was born at term via normal vaginal delivery. On examination, he has excessive salivation, fine, frothy bubbles in the mouth, abdominal distention and rattling breath sounds. Radiographs of the chest and abdomen reveal bilateral atelectasis and gastric distension. Which of the following can best explain the above findings?
Diaphragmatic hernia
Unilateral choanal atresia
Vascular ring
Duodenal atresia
Esophageal atresia
223) A 9-year-old boy is brought to the office by his parents due to headaches, vomiting and visual disturbances. One week ago, he began to experience headaches that were most prominent in the morning. He also became lethargic, and had a decreased appetite and decline in school performance. The pertinent physical findings include an unbalanced gait, trunk dystaxia, horizontal nystagmus, and papilledema. If this child had a medulloblastoma, which structure would most likely be affected?
Cerebellar hemispheres
Cerebellar vermis
Spinocerebellar tracts
Cerebellar peduncles
Frontal lobe
224) A 7 -year-old girl is brought to the clinic by her mother due to a persistent postnasal drip and repeated episodes of a runny nose. In the winter, she experiences several episodes of upper respiratory tract infections, which last for two to three weeks at a time. She snores, and is unable to smell her favorite food. Her immunizations are up-to-date. On examination, she is mildly underweight for her age. She has a runny nose, and her nasal drainage is colorless and stringy. Nasal inspection reveals bilateral nasal polyps, and auscultation of the chest reveals coarse rales. What is the one condition that you would like to rule out in this child?
Leukemia
Cystic fibrosis
Foreign body aspiration
Nasal septal deviation
Allergic rhinitis
225) A 2-year-old boy is brought by his mother to the emergency department because of a high-grade fever which "does not go away" with acetaminophen. For the last four days, the child has been very irritable and is crying a lot. He is also pulling his ear and not eating well. He has been generally well, other than the occasional sore throat this season. His temperature is 38.8° C (102.2° F), blood pressure is 90/60 mm Hg, pulse is 119/min, and respirations are 24/min. He appears well nourished, but is irritable. Physical examination reveals enlarged cervical lymph nodes and splenomegaly. The tympanic membranes are inflamed. CBC shows: WBC 81,100mm3, Hemoglobin 8.0 g/dL, Hematocrit 25%, Platelets 16,000 mm3, Blast forms 80%, Prolymphocytes 10%, Lymphocytes 10%. The blast cells have condensed nuclear chromatin, small nucleoli and scant agranular cytoplasm. Subsequent histochemical staining reveals strongly positive periodic acid Schiff (PAS) reaction. No Auer rods were seen. Which of the following is the most likely diagnosis?
Burkitt lymphoma
. Acute myelocytic leukemia
Prolymphocytic leukemia
Acute lymphoblastic leukemia
Myelodysplastic syndrome
226) A young infant is noted to have developed constipation over the past week, and then facial diplegia and difficulty sucking and swallowing. The child has been colicky, and the maternal grandmother has been treating the child with a mixture of weak tea, rice water, and honey. Which of the following disorders is the most likely culprit in this child?
Infantile spinal muscular atrophy
Myastheniagravis
Congenital myotonic dystrophy
Duchenne muscular dystrophy
Botulism
227) About 12 days after a mild upper respiratory infection, a 12-year-old boy complains of weakness in his lower extremities. Over several days, the weakness progresses to include his trunk. On physical examination, he has the weakness described and no lower extremity deep tendon reflexes, muscle atrophy, or pain. Spinal fluid studies are notable for elevated protein only. Which of the following is the most likely diagnosis in this patient?
Bell palsy
Muscular dystrophy
Guillain-Barré syndrome
Charcot-Marie-Tooth disease
Werdnig-Hoffmann disease
228) A premature neonate develops respiratory distress syndrome several hours after birth. The infant is placed on a respirator and given other appropriate care. However, when the infant reaches a corrected gestational age of 36 weeks, he does not tolerate weaning from the ventilator. A chest x-ray film demonstrates alternating areas of hyperaeration and pulmonary scarring, resulting in parenchymal streaks and hyperexpanded areas. Which of the following is the most likely diagnosis?
Apnea of prematurity
Bronchopulmonary dysplasia
Cystic fibrosis
Persistent pulmonary hypertension of the newborn
Transient tachypnea of the newborn
229) A neonate has Down syndrome. Maternal hydrammos had been noted prenatally. After the first feeding, the infant has projectile vomiting with bile-stained vomitus. An x-ray film demonstrates a "double-bubble sign" in the abdomen. Which of the following is the most likely diagnosis?
Duodenal atresia
Esophageal atresia
Hirschsprung disease
Hypertrophic pyloric stenosis
Meconium plug syndrome
230) A 10-year-old boy is brought to the office by his parents because he is developing dark facial hair, deepening of the voice and a rapid height increase. He also complains of persistent headaches which are resistant to over-the-counter analgesics for the past 2 weeks. He denies nausea, vomiting or visual disturbances. His medical history is unremarkable. Physical examination reveals coarse pubic and axillary hair. Other pertinent findings include lid retraction, paralysis of upward and downward gaze, and poor pupillary reaction to light. His deep tendon reflexes are normal, Babinski sign is negative, and there are no focal neurologic signs. What tumor is most likely responsible for this child's symptoms?
Medulloblastoma
Neuroblastoma
Oligodendroglioma
Craniopharyngioma
Pinealoma
231) A 17-year-old girl comes to the clinic with several weeks of joint pain and rash. The joint pain is most prominent in the hands. She states that the pain is most severe in the morning and tends to improve over the day. She has noted some swelling of her fingers. She has also had a rash on her face that becomes more prominent when she is outdoors. She states that sunlight tends to bother her eyes. On further questioning, she states that she has not felt well for several months. She has had intermittent fever, has been more tired than usual, and has lost weight although she has not been restricting her diet. On physical examination, she looks tired. She has lost 5 lbs since her last visit 1 year ago. She has an erythematous rash on her cheeks. She has several shallow ulcers in her mouth. She has fusiform swelling of her fingers and pain with movement of her fingers. Which of the following is the most likely diagnosis?
Systemic lupus erythematosus (SLE)
Dermatomyositis
juvenile rheumatoid arthritis
Rheumatic fever
Lyme disease
232) A full-term newborn develops cyanosis a few hours after birth. Oxygen administration does not improve color or oxygen saturations. Which of the following is the most likely diagnosis?
Atrial septal defect
ventricular septal defect
Patent ductus arteriosus
aortic stenosis
pulmonary stenosis
233) A 6-year-old male presents to the physician with eyelid swelling. His mother noted an insect bite on his left cheek yesterday, and states that this morning his left eyelid was completely swollen shut and painful. He has not had a fever, fatigue, headache, or rhinorrhea. On examination, he is afebrile. The left eyelid is erythematous, tender to palpation, and swollen shut. When trying to clinically distinguish between preseptal and orbital cellulitis, which of the following findings is most likely to be seen with preseptal cellulitis?
Decreased eye movements
Decreased visual acuity
Proptosis
Eyelid discoloration
Fever
234) A 4-year-old Caucasian boy is brought to his physician's office for a health maintenance exam. He will be starting preschool soon, and his parents want to make sure that he is in optimal health. The child has no complaints, and is generally happy. His medical history is significant for pneumonia as a newborn, and three episodes of otitis media since birth. He does not take any medications on a regular basis. His newborn screening test results are normal. His developmental milestones are at par with his age. He lives with his parents in a middle-class, suburban house built in 1981. Which of the following is the most appropriate next step for this child's primary care?
Screen him for inguinal hernias
Serum lead level
Meningococcal vaccine
Vision exam
Rotavirus vaccine
235) Initial examination of a full-term infant weighing less than 2500 g (5 lb, 8 oz) shows edema over the dorsum of her hands and feet. Which of the following findings would support a diagnosis of Turner syndrome?
A liver palpable to 2 cm below the costal margin
Tremulous movements and ankle clonus
Redundant skin folds at the nape of the neck
A transient, longitudinal division of the body into a red half and a pale half
Softness of the parietal bones at the vertex
236) While bathing her newly-received 2-year-old son, a foster mother feels a mass in his abdomen. A thorough medical evaluation of the child reveals aniridia, hypospadias, horseshoe kidney, and hemihypertrophy. Which of the following is the most likely diagnosis for this child?
Neuroblastoma
Wilms tumor
Hepatoblastoma
Rhabdomyosarcoma
Testicular cancer
237) A 7-day-old boy is admitted to a hospital for evaluation of vomiting and dehydration. Physical examination is otherwise normal except for minimal hyperpigmentation of the nipples. Serum sodium and potassium concentrations are 120 mEq/L and 9 mEq/L (without hemolysis), respectively; serum glucose is 40 mg/dL. Which of the following is the most likely diagnosis?
Pyloric stenosis
Congenital adrenal hyperplasia
Secondary hypothyroidism
Panhypopituitarism
Hyperaldosteronism
238) A 12-week-old female infant is brought to the office by her mother due to a three-week history of weakness, poor appetite, and choking spells during feeding. Other accompanying symptoms include excessive sleeping, constipation and apathy. Her prenatal history is unremarkable. She was delivered vaginally at 38 weeks of gestation. Her weight and length at birth were within normal range. She is exclusively breastfed. Her mother's family history is unremarkable. The identity and family history of her father are unknown. The pertinent physical findings include apathy, weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, and an umbilical hernia. Based on the given information, what is the most likely diagnosis?
Infant botulism
Werdnig-Hoffmann syndrome
Myotonic congenital myopathy
Congenital hypothyroidism
Myasthenia gravis
239) While making rounds in the newborn nursery, the nurses ask you to examine a 2-day-old infant who is not feeding well. The nurse reports that the infant is irritable, is not sleeping well, and has had several episodes of vomiting and loose stools today. A review of the maternal history reveals that she had poor prenatal care and the pregnancy was complicated by intrauterine growth restriction. On examination, the infant is diaphoretic and has a high-pitched cry. The infant is also noted to have occasional sneezing and is mildly tachypneic. No dysmorphic features are noted and the remainder of the examination is unremarkable. This infant's symptoms are most likely caused by prenatal exposure to which of the following?
Valproic acid
Phenytoin
Alcohol
Cocaine
Heroin
240) A 10-year-old boy is brought to the emergency department due to abdominal pain and bloody diarrhea. The mother says that he was "fine" a few days ago, and then suddenly became ill. Physical examination shows a pale and jaundiced child. There is diffuse abdominal tenderness and 2+ pedal edema. Laboratory studies show anemia, thrombocytopenia and renal insufficiency. What is the most likely cause of the patient's symptoms?
Vibrio cholera
Escherichia coli
Crohn's disease
Lactose intolerance
Salmonella poisoning
241) A 16-year-old girl is brought to the office due to abdominal pain and bloody diarrhea for the past two days. Her immunizations are up to date. Her past medical history is unremarkable. On examination, she appears lethargic and weak. Her skin turgor is poor, face and extremities are swollen, and skin appears yellow. Abdominal examination shows moderate non-localized, abdominal pain. Laboratory studies show: Hb 64 g/dl, Hct 26.9%, Platelets 45,000/mm3, Creatinine 2.3 mg/dl, Total bilirubin 5.0 mg/dl. What is the most common complication of the patient's condition? Renal damage Liver damage Bone marrow failure Pneumonia Bowel obstruction
Renal damage
Liver damage
Bone marrow failure
Pneumonia
Bowel obstruction
P1734 Q242     
P1734 Q242
242) A 24-year-old woman arrives in the emergency center in active labor. She is at term, but received no prenatal care after 16 weeks of gestation when she lost her insurance coverage. The mother has an uncomplicated vaginal delivery. You are paged shortly after birth when the baby is noted to have respiratory distress. The infant has diminished breath sounds on the left, and the PMI is shifted toward the right. A chest radiograph is shown. The NG tube you placed earlier reveals the stomach to be below the diaphragm. Which of the following is the most likely diagnosis at this point?
Congenital cystic adenomatoid malformation
Congenital diaphragmatic hernia
Bronchogenic cysts
Congenital lobar emphysema
Congenital pneumonia
243) 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?
Multiple cranial nerve palsy
Headache
Hyporeflexia
Increased urine output
Right ventricular hypertrophy
P1735 Q244
244) The 1-year-old boy in the photograph below, who recently had a circumcision, requires an additional operation on his genitalia that will probably eliminate his risk of which of the following?
P1735 Q244
Testicular malignancy
Decreased sperm count
Torsion of testes
Urinary tract infection
Epididymitis
245) A 6-year-old boy is brought to the ER with a two-day history of difficulty walking. He is dragging his right leg and seems to have weakness in his right arm. He also complains of headaches. The family just emigrated from Eastern Europe. According to his parents, the child suffers from delayed growth compared to his peers and does not like to engage in active play. His lips and fingers turn blue when he cries. His vital signs today are a blood pressure of 100/70 mmHg, pulse of 90/min, temperature of 38.3 0C (102.0 0F), and respiratory rate of 22/min. Which of the following is most likely responsible for his current complaints?
Glycogen storage disorder
Demyelinating disorder
Malignancy
Brain abscess
Malformation of the central nervous system
246) The term infant pictured below weighs 2200 g (4 lb, 14 oz). He is found to have a ventricular septal defect on cardiac evaluation. This infant appears to have features consistent with which of the following?
P1736 Q146
P1736 Q146
Perinatal phenytoin exposure
Trisomy 21
Alport syndrome
Fetal alcohol syndrome
Infant of diabetic mother
247) A 4-year-old, apparently healthy child is examined by a pediatrician. The pediatrician hears a loud systolic ejection murmur with a prominent systolic ejection click. He also hears a soft, early diastolic murmur. Both murmurs are heard best at the upper right sternal border. ECG shows left ventricular hypertrophy. Which of the following is the most likely diagnosis?
Aortic valve stenosis
Atrial septal defect
Tetralogy of Fallot
Transposition of great arteries
Ventricular septal defect
248) A 19-year-old primiparous woman develops toxemia in her last trimester of pregnancy and during the course of her labor is treated with magnesium sulfate. At 38 weeks’ gestation, she delivers a 2100-g (4-lb, 10-oz) infant with Apgar scores of 1 at 1 minute and 5 at 5 minutes. Laboratory studies at 18 hours of age reveal a hematocrit of 79%, platelet count of 100,000/μL, glucose 41 mg/dL, magnesium 2.5 mEq/L, and calcium 8.7 mg/dL. Soon after, the infant has a generalized convulsion. Which of the following is the most likely cause of the infant’s seizure?
Polycythemia
Hypoglycemia
Hypocalcemia
Hypermagnesemia
Thrombocytopenia
249) A 4-year-old child presents with an enlarged submandibular node that is 4 cm in diameter, nontender, and not fluctuant. The node has been enlarged for about 4 weeks, and there is no history of fever or contact with any person who was ill. A CBC is normal, and a Mantoux test with 5 tuberculin units of PPD shows 6 mm of induration. Which of the following is the most likely diagnosis?
Cat-scratch fever
acute pyogenic lymphadenitis
acute lymphoblastic leukemia
tuberculous lymphadenitis
Atypical mycobacteria lymphadenitis
250) A 7-month-old patient presents with a history of 3 days of fever to 104°F, which resolved the same day that an exanthem erupted. The exanthem is prominent on the neck and trunk. It is macular, with discrete lesions 3–5 mm in diameter. Which of the following is the most likely diagnosis?
Erythema infectiosum
measles
roseola infantum
rubella
Scarlet fever
251) A 3-year-old boy’s parents complain that their child has difficulty walking. The child rolled, sat, and first stood at essentially normal ages and first walked at 13 months of age. Over the past several months, however, the family has noticed an increased inward curvature of the lower spine as he walks and that his gait has become more “waddling” in nature. On examination, you confirm these findings and also notice that he has enlargement of his calves. Which of the following is the most likely diagnosis?
Occult spina bifida
Muscular dystrophy
Brain tumor
Guillain-Barrésyndrome
Botulism
252) 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?
Seizure disorder
Night terrors
Drug ingestion
Psychiatric disorder
Migraine headache
253) A 5-year-old febrile child presents with swelling of the right eyelid. Proptosis and limitation of ocular movements is noted. Which of the following is the most likely diagnosis?
Retinoblastoma
Orbital cellulitis
periorbital cellulitis
neuroblastoma
hyphema
254) A 10-year-old boy is brought in with a chief complaint of multiple colds. On further questioning, you elicit a history of chronic, clear nasal discharge with no seasonal variation. Other symptoms include sneezing, itching of the nose and eyes, as well as tearing and occasional eye redness. Some relief is obtained with an over-the-counter cold medicine containing antihistamine and a decongestant. His history suggests which of the following?
Nasal foreign body
Immunologic deficiency
rhinitis medicamentosa
chronic sinusitis
Allergic rhinitis
255) A 15-year-old boy comes to the physician with left shoulder joint pain and swelling. He has had these symptoms for the past 3 months and they are getting progressively worse. He has no fever, weight loss, or night sweats. The patient lifts weights and plays baseball 5 days a week. He has taken acetaminophen and ibuprofen with little relief. Examination shows a tender mass at the left proximal humerus. Range of motion is normal. Laboratory evaluation shows elevated alkaline phosphatase, erythrocyte sedimentation rate, and lactate dehydrogenase. X-ray of the shoulder is shown in the photograph below. Which of the following is the most likely diagnosis?
P1739 Q255
P1739 Q255
Ewing sarcoma
Osteoid osteoma
Osteomyelitis
Osteosarcoma
Stress fracture
256) A 4-day-old infant presents with yellow discoloration of the skin and sclera. The baby was born at term by a normal vaginal delivery. Pregnancy was uncomplicated; there were no risk factors for sepsis and no history of maternal alcohol or drug use. The baby is breast-fed and has been nursing every 2 hours, about 10 minutes at each breast. The bilirubin level is 15 mg/dL (all unconjugated), the hematocrit is 45%, and the Coombs test is negative. Which of the following is the most likely diagnosis?
Congenital biliary atresia
isoimmune hemolytic disease
Crigler-Najjar syndrome
breast milk jaundice
Breast-feeding jaundice
257) 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?
Foreign body
Nasal polyps
Frontal sinusitis
Choanal atresia
Deviated septum
258) A 7-month-old baby presents with a history of constipation for 1 month. He has one hard stool every week. He has been well otherwise. His physical examination is normal. Which of the following is the most likely cause of his problem?
Hypothyroidism
lead poisoning
functional constipation
Hirschsprung disease
hypocalcemia
259) A specific pattern of abnormalities has been identified among infants born to mothers who consume moderate-to-large amounts of alcohol during their pregnancies. Which of the following abnormalities is characteristic of these infants?
Cataracts
developmental dysplasia of the hip
gonadal dysgenesis
neural tube defects
mental retardation
260) A newborn infant develops respiratory distress immediately after birth. His abdomen is scaphoid. No breath sounds are heard on the left side of his chest, but they are audible on the right. Immediate intubation is successful with little or no improvement in clinical status. Emergency chest x-ray is shown (Image A) along with an x-ray 2 hours later (Image B). Which of the following is the most likely explanation for this infant’s condition?
P1741 Q160
P1741 Q160
 
Pneumonia
Cystic adenomatoid malformation
Diaphragmatic hernia
Choanal atresia
Pneumothorax
261) The parents of a previously healthy 2-year-old child note her to be pale and bring her to your clinic for evaluation. She currently has no fever, nausea, emesis, bone pain, or other complaints. Her examination is significant for pallor, tachycardia, and a systolic ejection murmur, but she has no organomegaly. Her complete blood count (CBC) reveals a hemoglobin of 4 g/dL, normal indices for age, a WBC count of 6.5/μL, and a platelet count of 750,000/μL. Her reticulocyte count is 0%. Coombs test is negative. Her peripheral blood smear shows no blast forms and no fragments. Red blood cell (RBC) adenosine deaminase levels are normal. A bone marrow reveals markedly decreased erythroid precursors. Which of the following is this child’s likely diagnosis?
Diamond-Blackfan anemia
Sickle-cell anemia
Pearson marrow-pancreas syndrome
Iron deficiency anemia
Transient erythroblastopenia of childhood
262) 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?
Iron deficiency
β-Thalassemia trait
Sickle-cell anemia
Chronic systemic illness
Lead poisoning
263) A 2-year-old child is brought to the office by his parents for the evaluation of failure to thrive and chronic diarrhea. His diarrhea is "almost continuous", and he also has recurrent episodes of fever. He was initially quite well and was on the 60th percentile for weight; however, for the past seven months, he didn't seem to grow and failed to gain weight. Over the past three months, he fell to the 3rd percentile for weight. His parents deny any use of drugs, but they drink occasionally. His mother mentions that her former boyfriend was a heroin addict. Physical examination reveals oral thrush, generalized lymphadenopathy and eczema. What is the most likely diagnosis in this patient?
Congenital Toxoplasmosis
HIV infection
Non-Hodgkin lymphoma infiltrating small intestine
Miliary tuberculosis
Malabsorptive disease
264) After being delivered following a benign gestation, a newborn infant is noted to have a platelet count of 35,000/μL, decreased fibrinogen, and elevated fibrin spilt products. On examination you note a large cutaneous hemangioma on the abdomen that is purple and firm. Which of the following anomalies might also be expected in this infant?
Kaposiform hemangioendothelioma
Nevus simplex
Nevus flammeus
PHACE(S) syndrome
Infantile fibrosarcoma
265) A 6-year-old girl has a low-grade fever, headache, and nasal congestion. She has a flushed face and has developed a lacy reticular rash on the trunk and extensor surface of her arms and legs. Palms and soles are spared. Her mother has been ill with a low-grade fever and some joint stiffness and pain. Which of the following is the most likely diagnosis?
rubella
measles
scarlet fever
roseola infantum
Erythema infectiosum (fifth disease)
266) A 3-year-old boy has had fever for 4 days. On physical examination he has bilateral cervical lymphadenopathy, injected pharynx, and dry cracked lips. A throat swab is done and the rapid strep test is negative. The child is sent home and advised to follow-up if symptoms worsen. The child is brought back 2 days later with all previous findings including a maculopapular rash, swollen hands, and conjunctivitis. Which of the following is the most likely diagnosis? Scarlett fever Kawasaki disease toxic shock syndrome infectious mononucleosis erythema infectiosum
Scarlett fever
Kawasaki disease
toxic shock syndrome
infectious mononucleosis
Erythema infectiosum
267) An 8-year-old Caucasian boy is brought to the office for the evaluation of high-grade fever, flank pain and burning micturition for the last two days. He has had two previous episodes of acute pyelonephritis. Physical examination reveals costovertebral angle tenderness. Urinalysis shows pyuria, significant bacteriuria, WBC casts, positive nitrite and esterase. The voiding cystourethrogram (VCUG) reveals vesicoureteral reflux. What is the most likely complication of this condition, if left untreated?
Hydronephrosis
Renal stones
Renal scarring
Renal abscess
Renal cell carcinoma
268) A woman comes to an emergency department because she is in labor. She has had no prenatal care. Her baby is delivered and appears to be of about 32 weeks' gestation. The newborn is very pale and shows severe, generalized edema. Cord-blood hematocrit is 22%, and cord-blood bilirubin is 7 mg/dl. Ultrasound examination demonstrates pleural effusions, ascites, cardiomegaly, and hepatomegaly. Which of the following is the most likely diagnosis?
ABO incompatibility
Beta thalassemia
Congenital spherocytosis
Sickle cell anemia
Rh incompatibility
269) A neonate is examined following a protracted breech delivery. One of the infant's arms is partially paralyzed. The affected arm is adducted and internally rotated at the shoulder, and the forearm is pronated. Which of the following is the most likely diagnosis?
Bell palsy
Erb palsy
Klumpke palsy
Pseudobulbar palsy
Supranuclear palsy
270) A 2-year-old boy presents with refusal to use his right arm for 1 day. He is otherwise well. His mother states she pulled upward on his arm the previous evening to keep him from tripping down the stairs. Which of the following is the most likely diagnosis?
Colles fracture
Fractured clavicle
Greenstick fracture of the humerus
rotator cuff injury
Subluxation of the radial head
271) A 1-day-old infant who received silver nitrate eye drops in the delivery room is suffering from bilateral purulent conjunctival discharge. Which of the following is the most likely cause of this child’s condition?
N. Gonorrhoeae infection
herpes simplex infection
Nasolacrimal duct obstruction
chemical irritation
Pseudomonas infection
272) A 14-year-old girl has a history of red eyes with clear discharge that she suffers from in a seasonal pattern. Together with these symptoms, she reports itching, which is her most bothersome complaint. Physical examination shows conjunctival redness, tearing, and swelling, but there is no purulent discharge. This clinical picture is most compatible with a diagnosis of which of the following conditions?
Allergic conjunctivitis
Bacterial conjunctivitis
Blepharitis
Corneal abrasion
Trachoma
273) A 6-year-old female is brought to the physician with a rash and joint pains. Her mother reports that she has been previously healthy except for a sore throat a few weeks ago. One week ago, the patient developed pain in her knees. The knee pain resolved after a few days, but now her ankles and wrists are tender. She has also developed a pink rash on her trunk that is non-pruritic. Vital signs are temperature 38.3°C (101°F), pulse 85/min, and respiratory rate 20/min. On examination, there is pain and stiffness during manipulation of the wrists and ankles. A faint, erythematous, centrifugal rash on her trunk and proximal limbs is present. Laboratory studies show: Complete blood count: Hemoglobin 12.5 g/dL, MCHC 32%, MCV 85 fl, Reticulocyte count 0.1%, Platelet count 200,000/mm3, Leukocyte count 6,500/mm3, Neutrophils 56%, Eosinophils 1%, Lymphocytes 33%, Monocytes 10%, C-reactive protein 3.5 mg/dL, Erythrocyte sedimentation rate 38 mm/hr. Which of the following is the most likely diagnosis?
Juvenile rheumatoid arthritis
Rheumatic fever
Acute lymphoblastic leukemia
Systemic lupus ery1hematosus
Fibromyalgia
274) A 14-year-old boy presents with decreased exercise tolerance. He is noted to have a grade III/VI systolic ejection murmur best heard at the left upper sternal border and a grade II/VI mid-diastolic murmur at the lower left sternal border. The first heart sound is normal. The second heart sound is widely split and fixed. A right ventricular impulse is palpated. On a chest roentgenogram, the pulmonary artery segment is enlarged, and pulmonary vascular markings are increased. An ECG shows right axis deviation. Which of the following congenital heart diseases does this boy most likely have?
Aortic stenosis
Atrial septal defect
Coarctation of the aorta
Patent ductus arteriosus
Ventricular septal defect
275) A 7-year-old boy presents with a rash. His mother states that he was well until 3 days ago when he developed fever and malaise. The next day, the rash started as papules on the trunk, which rapidly changed to vesicles. The lesions have spread all over the body. On physical examination, he has no fever and seems well. You note numerous vesicles all over the body, some of which have crusted over. Which of the following is the most likely diagnosis?
Chicken pox
Kawasaki disease
Measles
rubella
Staphylococcal scalded skin syndrome
276) A 4-year-old boy presents to the emergency department with generalized tonic-clonic seizures. On physical examination, the child is noted to be lethargic. His temperature is 37.4 C (99.3 F), blood pressure is 100/60 mm Hg, pulse is 72/min, and respirations are 16/min. His oral mucosa is moist, and there is no peripheral edema. Laboratory tests show: Blood: Sodium 120 mEq/L, Potassium 4.2 mEq/L, Chloride 96 mEq/L, Bicarbonate 20 mEq/L, Blood urea nitrogen 9.6 mg/dL, Creatinine 0.4 mg/dL, Glucose 88 mg/dL, Urine: Sodium 55 mEq/L, Potassium 16 mEq/L, Osmolality 530 mOsmol/kg. Which of the following is the most likely diagnosis?
Acute renal failure
Addison disease
Congestive heart failure
Hyponatreraic dehydration
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
277) A 1-month-old, previously healthy infant develops forceful projectile vomiting. No bile is seen in the vomitus. After the infant feeds, gastric peristaltic waves are visible crossing the epigastrium from left to right. Several minutes later, the projectile vomiting occurs. Which of the following is the most likely diagnosis?
Diaphragmatic hernia
Duodenal atresia
Esophageal atresia
Hypertrophic pyloric stenosis
Meconium plug syndrome
278) A 5-month-old girl is brought to the office by her mother, who states that the girl had an episode following feeding during which she began to breathe deeply, became blue, and then lost consciousness. The mother states that she picked her up and held her, and the infant regained her usual color and became alert. Physical examination reveals a harsh systolic murmur. Which of the following is the most likely diagnosis?
Aortic stenosis
Coarctation of the aorta
Patent ductus arteriosus
Tetralogy of Fallot
Ventricular septal defect
279) Physical examination of an infant delivered to a 42-year-old, gravida 3, para 2, woman, is remarkable for slight hypotonia and a poor Moro reflex. Further examination reveals upslanting palpebral fissures, epicanthal folds, excess nuchal skin, an enlarged tongue, clinodactyly of the fifth fingers, and a single transverse palmar crease. Which of the following is the most likely diagnosis?
Down syndrome
Edwards syndrome
Fetal alcohol syndrome
Marfan syndrome
Turner syndrome
280) You are called to the newborn nursery to evaluate a term infant with bilious emesis. Although the mother had poor prenatal care, she had a normal vaginal delivery with no complications. The infant began having bilious vomiting several hours after birth. The infant has urinated, but has not had a bowel movement. Vital signs are temperature 36.9 0C (98.4 0F), pulse 150/min, and respiratory rate 40/min. On examination, the abdomen is distended and there are decreased bowel sounds. The remainder of the physical examination is unremarkable. An abdominal radiograph is shown below. Which of the following is the most likely diagnosis?
P1747 Q280
P1747 Q280
Pyloric stenosis
Intestinal atresia
Hirschsprung disease
Necrotizing enterocolitis
Gastroesophageal reflux
281) A 10-month-old infant on long-term aspirin therapy for Kawasaki disease develops sudden onset of high fever, chills, diarrhea, and irritability. A rapid swab in your office identifies influenza A, adding her to the long list of influenza patients you have seen this December. Over the next few days, she slowly improves and becomes afebrile. However, 5 days after your last encounter you hear from the hospital that she has presented to the emergency center obtunded and posturing with evidence of liver dysfunction. Which of the following statements about her current condition is correct?
With proper supportive care, the overall mortality rate is low
With her progressiveliver dysfunction, increased total serum bilirubin is anticipated
Administration of N-acetylcysteine is first-line therapy
Seizures are uncommon with this condition
Death is usually associated with increased intracranial pressures and herniation
282) The parents of a 7-month-old boy arrive in your office with the child and a stack of medical records for a second opinion. The boy first started having problems after his circumcision in the nursery when he had prolonged bleeding. Studies were sent at the time for hemophilia, but factor VIII and IX activity were normal. At 2 months he developed bloody diarrhea, which his doctor assumed was a milk protein allergy and changed him to soy; his parents note he still has occasional bloody diarrhea. He has seen a dermatologist several times for eczema, and he has been admitted to the hospital twice for pneumococcal bacteremia. During both admissions, the parents were told that the infant’s platelet count was low, but they have yet to attend the hematology appointment arranged for them. The child’s WBC count and differential were normal. Which of the following is the most likely diagnosis in this child?
Idiopathic thrombocytopenic purpura
Wiskott-Aldrich syndrome
Acute lymphocytic leukemia
Adenosine deaminase deficiency
Partial thymic hypoplasia
283) A one-day-old infant with Down syndrome has developed persistent vomiting. He was delivered vaginally at 34 weeks without any complications. On examination, he appears dehydrated and slightly tachypneic. His abdomen is soft and not distended. Abdominal x-ray reveals two large distinct air bubbles, but there are no dilated bowel loops or air fluid levels. What is the most likely diagnosis of this patient?
Pyloric stenosis
Reflux disorder
Tracheoesophageal fistula
Bowel obstruction
Duodenal atresia
284) A 10-year-old boy from the Connecticut coast is seen because of discomfort in his right knee. He had a large, annular, erythematous lesion on his back that disappeared 4 weeks prior to the present visit. His mother recalls pulling a small tick off his back. Which of the following is a correct statement about this child’s likely illness?
The tick was probably a Dermacentor andersoni
The disease is caused by a rickettsial agent that is transmitted by the bite of a tick
In addition to skin and joint involvement, CNS and cardiac abnormalities may be present
Therapy with antibiotics has little effect on the resolution of symptoms
The pathognomonic skin lesion is required for diagnosis
285) Two weeks ago, a 5-year-old boy developed diarrhea, which has persisted to the present time despite dietary management. His stools have been watery, pale, and frothy. He has been afebrile. Microscopic examination of his stools is likely to show which of the following?
Salmonella sonnei
Enterobius vermicularis
Sporothrix schenckii
Toxoplasmagondii
Cryptosporidium
286) The rash and mucous membrane lesions shown in the photograph below develop in an infant 5 days into the course of an upper respiratory infection with otitis media; the child is being treated with amoxicillin. The child’s condition is likely which of the following?
P1749 Q286
P1749 Q286
 
Urticaria
Rubeola
Stevens-Johnson syndrome
Kawasaki disease
Scarlet fever
287) A 6-year-old boy is brought to the physician for evaluation of behavior problems. His parents report he is "hyperactive all the time." They cannot get him to sit still. When he does sit, he fidgets and tries to get out of his seat. He is easily distracted and frequently changes from one activity to another. He does not seem to listen when his parents talk to him, and often forgets to do his chores. He talks excessively and often interrupts other people. His parents state that he has been like this for a few years, but they had originally assumed his behavior was normal for his age. His physical examination is unremarkable. Which of the following will be of most help in establishing the diagnosis? .
Family history of similar behavior
Educational testing
Teacher evaluations
Sleep history
Symptoms of an anxiety disorder
288) An 8-year-old boy is brought to the office due to headaches and impaired walking. These symptoms started seven days ago, and progressed gradually. He just recently recovered from otitis media that was superimposed on an acute respiratory infection. His past medical history is significant for three episodes of otitis media and one episode of pneumonia. His temperature is 36.7C (98F), blood pressure is 100/60 mm Hg, pulse is 110/min, and respirations are 20/min. Physical examination reveals mild right-sided hemiparesis and a slightly dilated left pupil. The funduscopic examination is normal. Which of the following is the most likely diagnosis?
Brain abscess
Bacterial meningitis
Toxoplasmosis
Venous thrombosis
Arterial thrombosis
289) A 1-day-old male infant has bilious vomiting after every feeding. He hasn't passed any stools yet. He had no prenatal care, and was delivered vaginally at term. He weighs 3kg (6.61b), and his APGAR scores were 6 and 7 at 1 min and 5 min, respectively. On examination, the neonate is hypotonic, he has a flat facial profile, short ears with downfolding ear lobes, a single palmar crease, and a depressed fontanel. There is abdominal distention which is most prominent in the upper abdomen. His abdominal x-rays show gastric and duodenal gas distension with no air distally. What other anomaly can also be expected in this infant?
Sigmoid volvulus
Meconium plug syndrome
Hirschsprung's disease
Intussusception
Meckel's diverticulum
290) A 14-year-old boy is brought to the emergency room because of persistent midepigastric pain for two days. The pain is getting no better, yet it is no worse, and radiates to his back. The boy also has had fever, as well as nausea and vomiting that is worse when his temperature rises in the afternoon. On examination, his temperature is 39.2C (102.5F) and there is marked upper abdominal tenderness with guarding. Mild abdominal distention is present with no audible bowel sounds. A complete blood count reveals an elevated leukocyte count and a normal serum amylase. Which of the following is the most likely diagnosis?
Fitz-Hugh-Curtis syndrome
Intussusception
Wilms tumor
Pancreatitis
Pyelonephritis
291) A baby is born at 34 weeks gestation. The amniotic fluid is brown and murky. The baby has low APGAR scores and appears to be septic, with lethargy, apnea, bradycardia, and temperature instability. The mother lives on a farm and gives a history of a flu-like illness one month before delivery. Gram's stain of a smear from the mother's cervix demonstrates abundant, pleomorphic, gram-variable coccobacillary forms. Which of the following is the most likely diagnosis?
Congenital cytomegalovirus infection
Congenital rubella
Congenital syphilis
Neonatal herpes simplex infection
Neonatal listeriosis
292) A 14-year-old black male comes to the office for the evaluation of pain in his right hip that started several weeks ago. The pain has gradually progressed, and now it limits his daily activities. He has sickle cell disease and was hospitalized three months ago due to a painful crisis that was successfully treated with hydration, oxygen, and analgesics. His temperature is 37.2C (99F), blood pressure is 100/70 mmHg, pulse is 80/min, and respirations are 16/min. Physical examination reveals no local tenderness, but there is restriction of abduction and internal rotation of the hip What is the most likely diagnosis?
Osteomyelitis caused by Salmonella
Osteomyelitis caused by Staphylococcus
Joint effusion from septic arthritis
Avascular necrosis
Femoral fracture
293) A 6-year-old Caucasian male is brought to your office with a two-week history of right shoulder pain. Physical examination reveals localized swelling below the shoulder joint, and x-ray shows a single lytic lesion in the right humeral head. Laboratory analyses show mild hypercalcemia but are otherwise within normal limits. Which of the following is the most likely diagnosis?
Osteoporosis
Sarcoidosis
Langerhans histiocytosis
Primary hyperparathyroidism
Osteogenesis imperfect
294) An infant is born prematurely and is small for gestational age. At birth, the infant is obviously ill with jaundice, fever, hepatosplenomegaly, myocarditis, and rashes. Neurologic involvement is prominent, with hydrocephalus, intracranial calcifications, and seizures. The mother has a cat and continued to clean the cat's litter box during the pregnancy. Which of the following is the most likely causative agent?
Cytomegalovirus
Herpes simplex
Rubella virus
Toxoplasma
Treponema pallidum
295) A beekeeper’s previously healthy 6-month-old son develops gradual onset of lethargy, poor feeding, constipation, and generalized weakness. On taking a history, you determine that the child has recently been placed on a homemade formula consisting of evaporated milk, water, and honey. Which of the following is the most likely explanation for this symptom complex?
Sodium intoxication
Hirschsprung disease
hypothyroidism
spinal cord tumor
Botulism
296) A 12-year-old girl is taken to a pediatrician complaining of a sore mouth. On questioning, the child states that she has been feeling poorly, with fatigue and weakness. She began menstruating briefly and then stopped. Physical examination is notable for focal white crusting of the oral cavity; biopsy of one of these areas later shows candidiasis, Laboratory studies show the following: Sodium 127 mEq/L, Potassium 5.3 mEq/L, Bicarbonate 24 mEq/L, Calcium 7.5 mEq/dL, Phosphorus 5.5 mg/dL, Glucose 87 mg/dL. Which of the following is the most likely diagnosis?
Multiple endocrine neoplasia, type I
Multiple endocrine neoplasia, type IIA
Polyglandular deficiency syndrome, type I
Polyglandular deficiency syndrome, type II
Polyglandular deficiency syndrome, type III
297) A 15-year-old girl presents with a 2-day history of pain and swelling in her left knee. She plays soccer regularly on her school team. There is no history of trauma. On physical examination, there is marked swelling and tenderness over her anterior tibial tuberosity. A radiograph of her left knee reveals irregularities of the tubercle contour and haziness of the adjacent metaphyseal border. Which of the following is the most likely explanation for her symptoms?
Avascular necrosis of the hip
Legg-Calve-Perthes disease
Osgood-Schlatter disease
Septic arthritis
Slipped capital femoral epiphysis
P1753 Q299     
P1753 Q299
298) A 7-year-old male is brought to the emergency department for a suspected femur fracture. He has had multiple fractures in the past after minor trauma. Today, his mother states that he was running and fell. He complained of pain in his thigh after he fell. His examination is remarkable for tenderness to palpation and slight deformity of his right proximal thigh. He has decreased muscle tone throughout. His eye examination is shown below. Which of the following is the most likely associated finding?
Aortic root dilatation
Horseshoe kidney
Opalescent teeth
Mental retardation
Ash leaf macules
299) A 2-day-old male infant presents with multiple episodes of bilious vomiting over the past 24 hours. He has a prominent tongue, flat occiput and slanting eyes. His hands are short, and there are wide gaps between his first and second digits. His abdomen is soft and without any distention, guarding or rigidity. On auscultation of the chest, there is a systolic ejection murmur along the left sternal border, with a wide and fixed splitting of S2. Abdominal x- rays show air trapped in the first portion of the duodenum and stomach. What is the most likely cause of the child's symptoms?
Pyloric stenosis
Gastroesophageal reflux
Duodenal atresia
Mesenteric adenitis
Acute appendicitis
300) A 2-year-old girl presents to the office with a dry cough and a low-grade fever. Over the last two days, she has become very irritable and difficult to feed. She has also had a runny nose. On examination, there is significant wheezing and tachycardia. Evaluation of the nasal discharge confirms the diagnosis of respiratory syncytial virus infection. In the future, which of the following does this child have a slight risk of developing?
Pneumonia
Lung abscess
Cystic fibrosis
Asthma
Aspergillosis
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