USMLE Practice Questions and Answers(Random cases)

A 12-month-old girl has been spitting up her meals since 1 month of age. asymptomatic and without findings on physical examination. Diagnosis: GERD is a common pediatric complaint, often seen in the first 1 to 2 months of life and resolving by 1 to 2 years of age. For children w/ NO respiratory symptoms attributed to reflux, small feeds, avoid high-fat meals are enough. -medication or surgery only seen in rare cases. jaundice skin and the the sclera of the eye turn yellow due to excess bilirubin, a byproduct of old red blood cells. A 14-year-old boy has sickle cell disease. He presents to the emergency room with the complaints of Pain of the right upper quadrant, nausea, vomiting, fever, and jaundice. Diagnosis: acute cholecystitis (unusual in kids w/ anemia) -Confirmed with an ultrasound of the gallbladder (upper right quadrant) A 2-year-old presents to the emergency center with several days of rectal bleeding. The mother first noticed reddish-colored stools 2 days prior to arrival and has since changed several diapers with just blood. What diagnostic test will you use? Diagnosis: Meckel diverticulum :congenital abnormality of the small intestine. - First type involves ectopic (out of place) mucosal tissue and most often leading to GI bleeding in younger children. -Diagnostic Technique: technetium scan (common medical radioisotope) which collects data rapidly, but keeps total patient radiation exposure low. symptoms: kids have painless rectal bleeding in the first 2 years of life, but they can have symptoms throughout the first decade. 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 show?? Diagnosis: Cryptosporidium - important cause of diarrhea in immunocompromised patients (AIDS) and immunocompetent pts. - responsible for epidemics of diarrhea NOTE: Salmonella sonnei can be grown in culture, but microscopy is not helpful other than finding fecal leukocytes. Toxoplasma gondii intracellular parasite which does not ordinarily cause diarrhea and is NOT found in stool. A 16-day-old infant presents with fever, irritability, poor feeding, and a bulging fontanelle. Spinal fluid demonstrates gram-positive cocci. Which of the following is the most likely diagnosis? Diagnosis: Group B strep, In this case, meningitis. -Clinical manifestations of meningitis in neonates include lethargy, bulging fontanelle, seizures. Diagnostic test: CSF culture (check for meningitis) -blood culture, urine culture, chest x-ray - PT, PTT, CBC Tx: Meanwhile waiting for the CSF results, pt must be placed on antibiotics( ampicillin and gentamicin or cefotaxime) agains gram pos and gram neg bacteria.