Paediatric 3 Exam Questions and Answers

The species of malaria associated with adherence to endothelial walls, cerebral malaria, and a high mortality rate is: - P. falciparum The fever of malaria: - A, B& C (Can be tertian occurring every 48 hours, Can be quartan occurring every 72 hours, Occur with no pattern at all) The pathogenesis of malaria can affect which of the following organ systems: - A, B& C (Liver and brain, Lungs and kidneys, Spleen and GI tract) Encephalitis is usually the result of which of the following: - Viral What is most the endemic form of encephalitis in Cambodia? - Japanese encephalitis virus. Which viral infection involving the CNS is likely to present with focal neurological findings? - St. Louis virus Which microorganism is a common ethiology in endotoxic shock? - Escherichia coli A 2-year-old boy presents with fever, loss of appetite, sore throat, with red, blisterlike lesions on the tongue, gums and inside of the cheeks and a red rash, without itching on the palms, soles and the buttocks. Which of the following disease, you think the most probably. - Hand-foot-mouth disease Which of the following is a definite indication to start antiretroviral treatment in HIV infected children? - Pneumocystis carinii pneumonia. A patient with Cushing syndrome might present with any of the following EXCEPT: - Bronze or hyperpigmented skin What physical exam sign/symptom is most suggestive of foreign body aspiration? - Stridor Which of the following is NOT TRUE about breast feeding? - 50% of energy from proteins Which circulatory finding is the hallmark of the diagnosis of late decompensated. shock? - Absent distal pulses An alert, 6 month old male has a history of vomiting and diarrhea. He appears pale and has an RR of 45 breaths per minute, HR of 180 beats per minute, and a systolic blood pressure of 85 mm Hg. His extremities are cool and mottled with a capillary refill time of 4 seconds. What would best describe his circulatory status? - Late decompensated. shock caused by supraventricular tachycardia Which of the following factors leads to neonatal hyperbilirubinemia? - All of the above (Shortened neonatal red cell life span, Impaired excretion of unconjugated bilirubin, Limited conjugation of bilirubin in the liver, Increased enterohepatic circulation) Respiratory Problems in premature infants may be secondary to choose one: - A, B & C (Surfactant deficiency, Increased chest wall compliance, Incomplete alveolar development) A female infant is normal at birth but develops a severe hemolytic anemia after age 6 months. Peripheral blood smear shows a microcytic, hypochromic anemia with numerous target cells and increased reticulocytes. Hemoglobin electrophoresis at 9 months of age demonstrates hemoglobin F of 90%, increased hemoglobin A2, and decreased hemoglobin. Which of the following is the most likely diagnosis? - Alpha-thalassemiatrait AIDS is caused by a human retrovirus that kills - CD4-positive T lymphocytes. A positive tuberculin skin test a delayed hypersensitivity reaction. indicates that - a cell-mediated immune response has occurred. The most common cause of gross hematuria is only one answer: - All above (Urinary tract infections, Meatal stenosis, Trauma, Glomerulonephritis) The most common organism in patients with empyema purulent pleurisy is: - Staphylococcus aureus Hypertrophic pyloric stenosis is common in - Males A 3.8 kg baby of a diabetic mother developed seizures at 16 hours of birth. Most probable cause is: - Hypoglycemia A 5-year old boy comes with overnight petechial spots 2 weeks back he had history of abdominal pain and no hepato-splenomegaly. Diagnosis is: - Aplastic anemia The following features are true for tetralogy of Fallot, EXCEPT: - Atrial septal defect An 8-moth old infant was admitted with history of excessive crying and pain abdomen. The child is pale and having recurrent pain. An hour before hospitalization, the child was passing blood and mucous likely diagnosis is: - Acute intussusception Failure to initiate and maintain spontaneous respiration following birth is clinically known as - Respiratory failure A neonate is noted to have an abnormally shaped face with a very small jaw. Several hours after birth, the baby develops convulsions and tetany. Serum chemistries show the following: Sodium 1 40 mEq/L, Potassium 4 mEq/L, Chloride 100 mEq/L, Bicarbonate 24 mEq/L, Magnesium 2 mEq/L, Calcium 5 mg/dL, Glucose 100 mg/dL. This child's disorder is associated with aplasia or hypoplasia of which of the following organs? - Thymus An 18-month-old child is brought to the emergency department by his mother due to a one-day history of lethargy and anorexia. He had a fever the whole day yesterday, which responded to Tylenol Acetaminophen.. He then developed a petechial rash over his entire body, which worsened in the last few hours. He is upto- date with his immunizations, and is an otherwise healthy baby. On examination, he is drowsy and lethargic. He has neck stiffness and appears septic. He flexes his hips when his neck is flexed. What is the most likely organism responsible for the patient's symptoms? - Meningococcus 6-month-old male is brought to the office due to fussiness and tugging at his right ear for the past 2 days. He has had a fever of 39.4° C 103° F. for the past 2 days. His past medical history is significant for recurrent ear and lung infections, oral candidiasis, and persistent diarrhea by rotavirus. His temperature is 39.4° C 103° F., pulse rate is 150/min, respirations are 28/min, and blood pressure is 80/60mm Hg. Physical examination reveals an erythematous, bulging right tympanic membrane with poor mobility on pneumatic otoscopy. His lymph nodes are not palpable, and his tonsils are not visualized. His B and T lymphocyte levels are markedly reduced. The chest x-ray reveals an absent thymic shadow. What is the most likely etiology of this patient's condition? - Severe combined immune deficiency A 1-day-old boy is evaluated in the nursery for minimal right arm movement. He was born at 41 weeks gestation to a woman with poorly controlled type 1 diabetes mellitus. Attempted vaginal delivery was complicated by shoulder dystocia and became a cesarean section delivery. Family history is positive for obesity in the boy's father and osteoporosis in both grandmothers. Birth weight was 4.5 kg. Examination shows crepitus and irregularity over the right clavicle. Moro reflex is absent on the right. Bilateral biceps and grasp reflexes are intact and symmetric. The infant is plethoric and has excessive fat accumulation in the abdominal and scapular regions. The remainder of the examination is normal. Which of the following is the most significant risk factor for this patient's condition? - Maternal history of diabetes A 1-day-old infant appears dusky in the newborn nursery during feeding. Oxygen is immediately administered by nasal cannula. Shortly afterward, she develops tachypnea. On physical examination, her blood pressure from the right upper arm is 50/30 mm Hg, her pulse is 180/min, and her respirations are 60/min. An echocardiogram is consistent with hypoplastic left heart syndrome. Which of the following would likely be found on auscultation? - No murmur, precordial hyperactivity, loud second heart sound A 1-week-old female infant is brought to the office by her 30-year-old mother because she has been "crying a lot." She was born at term. Her mother was diagnosed with gestational diabetes mellitus GDM. at 24 weeks gestation and had been on insulin injections since. During labor, there was a prolonged second stage due to difficulty in delivering the shoulders. Her Apgar scores were 8 and 10 at 1 and 5 minutes, respectively. Her birth weight is 3.8 kg 8.5 Ib.. On examination, the infant is active. On sudden extension of the head, there is extension of all the extremities, except for the left upper extremity. There is crepitus over the left clavicular bone. Which of the following statements is true for this baby? - This is a common outcome with large babies and related to gestational diabetes A 1-week-old infant is brought to the emergency department due to vomiting and poor feeding. The prenatal and birth histories are unremarkable. The infant's pulse is 140/min, temperature is 37 C 98.7 F., and capillary refill is 2 sec. He has sunken eyes, depressed anterior fontanel, and dry mucus membranes; skin elasticity is reduced. Heart and lungs are clear. There is no abdominal mass. Genital examination shows enlarged clitoris, and fusion of the labioscrotal folds. The initial laboratory work-up reveals the following: Sodium 128 mEq/L, Potassium 5.8 mEq/L, BUN 25 mg/dl. If this patient's karyotype is 46 XX, which of the following is most likely to be increased in this patient's serum? - 17 -alphahydroxyprogesterone A 1-week-old male newborn is seen in the office for "noisy breathing." The mother says that the "noisy breathing" is more prominent when the infant is lying on his back, and improves when he is in a prone position with his chin up. The newborn is afebrile and has no cough, vomiting, or cyanosis. There are no inspiratory retractions or wheezes. On direct laryngoscopy, the epiglottis is rolled in from side to side. Which of the following statements is true about the child's condition? - The child should be held in an upright position for 30 minutes after feeding and never fed while lying down A 1-year-old boy is brought to the physician by his parents for evaluation of bruising and blood in his stool. The child has had multiple episodes of otitis media and has been hospitalized twice with pneumonia, but has never had bleeding or easy bruising in the past. He has been eating and drinking well with no vomiting or diarrhea. He is afebrile with a heart rate of 150/min and a blood pressure of 80/40 mmHg. On examination, he is well-developed, well-nourished, and has a fair complexion. There are dry, scaly patches on his cheeks and lower extremities. He also has bruising and purpura on his lower extremities. His diaper contains a small amount of occult blood positive stool, but no fissures are seen on rectal examination. The remainder of the physical examination is unremarkable. Laboratory studies show: Complete blood count: Hemoglobin 11 .5 g/dL, Platelet count 20,000/mm3, Leukocyte count 6,500/mm3, Neutrophils 76%, Eosinophils 1%, Lymphocytes 13%, Monocytes 10%. A peripheral smear reveals a low number of platelets, and the platelets that are seen are small. Which of the following is the most likely cause of his bleeding? - Impaired platelet production A 1-year-old boy presents with the complaint from his parents of "not developing normally." He was the product of an uneventful term pregnancy and delivery, and reportedly was normal at birth. His previous health-care provider noted his developmental delay, and also noted that the child seemed to have an enlarged spleen and liver. On your examination, you confirm the developmental delay and the hepatosplenomegaly, and also notice that the child has short stature, macrocephaly, hirsutism, a coarse facies, and decreased joint mobility. Which of the following is the most likely etiology of his condition? - Hurler syndrome A 1-year-old child with ALL in remission for 3 months is in the office for a health maintenance visit. He is due for multiple vaccinations including hepatitis B vaccine, inactivated polio vaccine IPV., varicella vaccine H. influenzae B vaccine Hib., and pneumococcal vaccine PCV.. You remember that some of these vaccines are live attenuated viruses and are contraindicated in immunocompromised patients. Which vaccine will you not give to this patient? - Varicella vaccine A 1-year-old patient is in the office for a health maintenance visit and is ready for immunizations. The child has a mild upper respiratory infection and a low-grade fever. The mother does not want the child to receive vaccine because she has been told that the vaccine could make the illness worse. You tell her the only true contraindication to vaccination is which of the following? - if the child has hypersensitivity to a vaccine component A 10-year-old boy is brought to the office for the evaluation of worsening fatigue for the past few weeks. He has sickle cell anemia, and has had several hospitalizations for painful crises. His vital signs are stable. He appears pale. He has a hemoglobin level of 7. 7 g/dl and hematocrit of 22.5%. Which is the most likely type of anemia of this patient? - Hemolytic anemia A 10-year-old boy comes to the office with fever and chills for 5 days and myalgia. He has recently returned from a 2-week vacation to NewEngland with his family. On physical examination he has mild splenomegaly. Which of the following is the most likely cause of his symptoms? - babesiosis A 10- year-old boy is admitted to the hospital because of bleeding. Pertinent laboratory findings include a platelet count of 50,000/μL, prothrombin time PT. of 15 seconds control 11.5 seconds., activated partial thromboplastin time aPTT. of 51 seconds control 36 seconds., thrombin time TT. of 13.7 seconds control 10.5 seconds., and factor VIII level of 14% normal 38%-178%.. Which of the following is the most likely cause of his bleeding? - Disseminated intravascular coagulation DIC. A 10-year-old boy presents with fever, headache, photophobia, and neck discomfort in the middle of summer. He is alert and oriented, but has neck pain with flexion and extension of the head. His fundi are normal, and there are no focal neurologic findings or skin changes. A lumbar puncture reveals normal protein and glucose with a cell count of 240/mL 90% lymphocytes.. Which of the following is the most likely causative organism? - enterovirus coxsackievirus or echovirus. A 10-year-old boy was healthy until about 10 days ago when he developed 7 days of fever, chills, severe muscle pain, pharyngitis, headache, scleral injection, photophobia, and cervical adenopathy. After 7 days of symptoms he seemed to get better, but yesterday he developed fever, nausea, emesis, headache and mild nuchal rigidity. Cerebrospinal fluid CSF. shows 200 white blood cells WBC. per microliter all monocytes. and an elevated protein. Correct statements about this infection include which of the following? - Most cases are mild or subclinical A 10-year-old girl has bullous target lesions and mucosal erythema, which developed after her third dose of trimethoprim-sulfamethoxazole for a urinary tract infection. Which of the following is a likely associated clinical finding? - Fever A 10-year-old male fell while riding his scooter down a steep hill. In the Emergency Department, his injuries included a fractured wrist and a lacerated spleen, which required surgical removal. Two years later he is diagnosed with bacterial pneumonia. Which of the following bacterial agents is the most likely pathogen for this patient's pneumonia? - Streptococcus pneumoniae A 10-year-old presents with 2 months history of heavy menstrual-like bleeding. Menarche occurred 6 months ago and this first menses consisted of spotting for 3-4 days without cramps. Subsequent periods were light in flow but lasted 6 to 8 days. Which of the following is the most likely cause of her bleeding? - Dysfunctional uterine bleeding A 12-month-old patient has allergies to multiple foods. The child's mother has eliminated the foods from the diet and wants to know if these allergies will be lifelong. You tell her that some allergies do get better if the food is eliminated for 1-2 years. In which of the following is the allergy most likely to resolve, with elimination of the food from the diet? - milk A 12-year-old boy is brought to the office due to a 2-day history of high-grade fever and chills. He was apparently well before the onset of fever. He has no bone pain. He has sickle cell disease and has had 4 hospitalizations for painful crises and one episode of osteomyelitis. His blood pressure is 90/60 mm Hg, pulse is 100/min, respirations are 22/min and temperature is 38.9 C 102F.. He appears drowsy. His laboratory report shows a total WBC count of 16,000/mm3 with 12% bands and Hb of 9.0 g/dl. Which of the following is the most likely cause of this patient's condition? - Streptococcus pneumoniae A 12-year-old male is found to have a murmur during a routine sports physical. He has a family history of sudden death at a young age. It is a harsh crescendodecrescendo murmur that begins after S1 and is best heard at the left lower sternal border. Valsalva maneuver intensifies the murmur. Which of the following is the most likely mitral valve abnormality in this patient? - Abnormal mitral leaflet motion A 12-year-old boy is brought to the clinic by his parents because "he cannot walk anymore." Yesterday, he became irritable, uneasy, and complained of tingling and weakness in both his legs. This morning, he couldn't stand up or move his legs, and complained of pain in his leg and thigh muscles. He denies any headaches, nausea or vomiting. He had an episode of febrile diarrhea 10 days ago. His family history is unremarkable. Physical examination reveals symmetric flaccid paralysis of both legs, absent deep tendon reflexes, and decreased superficial touch and vibratory sense. There is no nuchal rigidity. What structure is most likely affected in this patient's condition? - Peripheral nerves A 12-year-old boy is brought to the emergency department because of severe pain near his left knee. He has sickle cell disease and has been hospitalized previously for sickle cell crisis. Vital signs are notable for persistent fever. Examination of the left lower extremity reveals a normal knee joint with marked tenderness and swelling over the proximal tibia. Laboratory studies show leukocytosis and elevated ESR. Imaging studies confirm the diagnosis of osteomyelitis. Which of the following organisms is the most likely cause of his condition? - Salmonella species A 12-year-old boy is brought to the emergency department with a temperature of 39.1 C 102.4 F. at home, difficulty speaking, and odynophagia for 2 days, Physical examination reveals marked erythema of the right tonsil pillar and edema of the uvula with deviation to the left. In addition to anaerobic bacteria, which of the following organisms is most likely to be isolated from a tonsillar pillar aspirate? - Beta-hemolytic Streptococcus A 12-year-old girl comes to the physician because of a 2-day history of periorbital edema and abdominal distention. She has no other complaints. She has never been diagnosed with hypertension. Her father died at the age of 40, with renal failure. Her temperature is 37.1°C 98.9°F., blood pressure is 125/75 mm Hg, pulse is 80/min, and respirations are 14/min. Examination shows facial puffiness, shifting dullness, and 1+ bilateral pitting pedal edema. Urinalysis shows 3+ proteinuria and lipid laden casts. 24-hour urinary protein excretion is 5 g/day, total serum protein is 4.5 g/dl and serum albumin is 2.3 g/dl. Which of the following is this patient at increased risk of developing? - Accelerated atherogenesis A 12-year-old girl comes to the physician for an annual examination. She has been in good health for the past year and has no complaints. She began having menses this year and, after a few irregular cycles, is now having a monthly period. Past medical history is significant for multiple episodes of otitis media as a child. Past surgical history is unremarkable. She takes no medications and has no known drug allergies. Physical examination is unremarkable. If not currently immune, which of the following immunizations should this patient most likely receive? - Hepatitis B virus immunization A 12-year-old girl comes to the physician for chronic weight loss and fatigue. She has a history of bulky, floating, foul-smelling stools, flatulence and meteorism. She also has bone pain and easy bruising. Laboratory studies show anemia with serum iron: 25 mg/dl , ferritin: 25 mg/dl and serum total iron binding capacity 600 mg/dl normal 300-360 mg/dL.; PT is 16 sec. Physical examination shows loss of subcutaneous fat, pallor, hyperkeratosis and abdominal distention; bowel sounds are increased. Which of the following is most likely associated with this patient's condition? - Anti-endomysial antibodies A 12-year-old girl is brought to the clinic due to a 2-month history of headaches. Her headaches last 1-2 hours and have no fixed time of occurrence. She denies nausea, vomiting, chills or fevers. She has no other medical problems and takes no medication. Her family history is significant for hypertension and diabetes. Her blood pressure is 156/90 mm Hg, pulse is 80/min, and respirations are 14/min. Examination shows an alert child in no distress. There is a soft to-and-fro bruit heard at the right costovertebral angle. Which of the following is the most likely cause of her hypertension? - Fibromuscular dysplasia A 13-year-old comes to your office expressing concern about his height. He had first seen you a year prior for his routine checkup and a preparticipation sports physical for soccer see growth curve.. Now in the eighth grade, all of his friends are taller than he is, and he is at a disadvantage on the soccer field playing against much larger boys. After obtaining height information from his parents shown here, you order a skeletal bone age radiograph. Which of the following results would allow you to assure him of an excellent prognosis for normal adult height? - A bone age of 9 years A 2 -year-old child is evaluated by a neurologist because of difficulty walking. Neurological examination documents ataxia and mental retardation. The neurologist notes the presence of multiple telangiectasias involving the conjunctiva, ears, and antecubital fossae. The child also has a history of multiple respiratory tract infections. Immunoglobulin studies on the child would most likely demonstrate an absence of which of the following? - IgA and IgE A 2-day-old male infant is jaundiced. He was born at term from an uncomplicated pregnancy, and was normal at birth. He otherwise appears healthy and is feeding well. Vital signs are stable. Physical examination shows jaundice. There is no organomegaly. Laboratory investigations show: Hemoglobin 17.0 g/L, MCV 88 fl, Platelets 220,000/mm3, Leukocyte count 4,500/mm3, Total bilirubin 7.5 mg/dL, Indirect bilirubin 6.0 mg/dL. What is the most likely cause of this patient's jaundice? - Physiologic jaundice A 2-month-old infant comes to the emergency center with fever for 2 days, emesis, a petechial rash, and increasing lethargy. In the ambulance he had a 3-minute generalized tonic/clonic seizure that was aborted with lorazepam. He does not respond when blood is drawn or when an IV is placed, but he continues to ooze blood from the skin puncture sites. On examination, his anterior fontanelle is open and bulging. His CBC shows a WBC of 30,000 cells/μL with 20% band forms. Which of the infant's problems listed below is a contraindication to lumbar puncture? - Uncorrected bleeding diathesis A 2-month-old male is brought to the emergency department for evaluation of cyanosis, which occurred earlier in the day while the infant was taking his bottle. Initially, he became fussy and sweaty, then his mother noticed that his lips turned blue. He became intermittently tachypneic and continued to cry. As the crying continued, the cyanosis worsened. His temperature is 37C 98.6 F., blood pressure is 80/50 mmHg, pulse is 150/min, and respiratory rate is 45/min. On examination, the child is alert, cyanotic, and tachypneic. Cardiac auscultation reveals a normal S 1 followed by a systolic ejection click. A grade 2/6 crescendo-decrescendo systolic ejection murmur is heard at the left upper sternal border. The patient is immediately placed in a knee-chest position. This maneuver will improve this patient's condition by which of the following mechanisms? - Increased systemic vascular resistance