Beruflich Dokumente
Kultur Dokumente
Interesting to recognize that it can be bloody, mucus, and can occur after amoxicillin
3) A 3-month-old boy is brought to the physician by his mother because of a 1-day
history of fever, vomiting, and fussiness. He was born at 39 weeks gestation following
an uncomplicated pregnancy and delivery. He is alert and mildly irritable but easily
consoled by his mother. His rectal temperature is 39C, pulse is 160/min, and
respirations are 38/min. Examination of the skin shows no abnormalities. The tympanic
membranes are mildly erythematous with normal landmarks and motility. The lungs are
clear to auscultation. The abdomen is soft with no palpable masses. The patient is
uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is the most
appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
E. Vancomycin Of these, 3rd gen cephalosporins are the best for empiric therapy.
Caution with ceftriaxone (it can cause hyperbilirubinemia - may not be a concern in this
kid). Cefotaxime is the best choice
4) A 3-year-old boy is brought for a well-child examination. His mother states that his
belly seems big. His vital signs are within normal limits. Examination shows aniridia.
There is a palpable mass in the right flank. The remainder of the examination shows no
abnormalities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic acid concentrations
(wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen WAGR syndrome -> abdominal US to detect
Wilms tumor
5) A 5-year-old boy is brought to the physician because of a 4-day history of increasing
difficulty breathing. His temperature is 37.5C, pulse is 116/min, respirations are 36/min,
and blood pressure is 116/80mmHg. Examination shows jugular venous distention and
mild swelling of the face and upper extremities. There are moderate intercostal
retractions. Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the
chest shows a mass in the superior mediastinum and a large pleural effusion in the right
hemithorax. Thoracentesis yields 400mL of reddish brown serosanguineous fluid
containing numerous erythrocytes. Which of the following is the most likely cause of the
pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion
Which of the following is the most likely explanation for these findings?
a) ABO isoimmunization
b) biliary obstruction
c) dehydration
d) Erythrocyte enzyme defect
e) physiologic jaundice
F) polycythemia This is physiologic jaundice! He is eating and pooping well and still
within the first week of life.
a 1 month old infant has had a 12x8 cm, red, raised, well-defined lesion that is lobulated
and compressible overlying the buttocks since birth. Examination also shows multiple
petechiae and bruises. Which of the following is the most likely explanation for these
findings.
a) DIC
b) high-output congestive heart failure
c) impaired tissue growth due to altered vascular supply
d) increased tissue growth due to increased vascular supply
e) thrombocytopenia from platelet sequestration E!
A healthy 16-year-old girl comes to the physician for an examination prior to
participation in school sports. She had chickenpox at age 3, but has no history of
serious illness. Her immunizations were up-to-date when she began kindergarten; the
only immunization she has received since then is a diphtheria-tetanus toxoid at the age
of 10 years for a laceration on her leg. She has been sexually active for the past year w/
two male partners who have used condoms consistently. She is 163cm and weights
54kg; BMI 21. Vital signs are w/in normal limits. Examination shows no abnormalities.
Administration of which of the following vaccines is most appropriate at this time?
a) acetaminophen
b) diphenhydramine
c) drain cleaner
d) ibuprofen
e) organophosphate
f) pseudoephedrine C! Drain cleaner - look up!
An 8yo girl is brought to the physician because of a diffuse rash for 24hr. She has had
cough, congestion, eye discharge, and fever for 4 days. The rash initially began on her
face and chest but has spread to involve her abdomen, back, and lower extremities. Her
temprature is 38.9 (102.1F), pulse is 100/min, RR 16/min, and BP is 115/70.
Examination shows diffuse red, macular and papular rash involving the face, trunk, and
extremities; there are no leasions on the palms or soles. Which of the following is the
most likely diagnosis?
a) Ehrlichiosis
b) HSP
c) Id reaction
d) Kawasaki disease
e) Pityriasis rosea
f) RMSF
g) Rubeola
h) scabies
i) Scarlet fever
j) Staph Scaled skin syndrome Rubeola
A 5yo girl w/ a 1 yr hx of chronic nonproductive cough is brought for a follow-up
examination. The cough occurs during the day and night and is not exacerbated by
exercise. She has not had chills, diarrhea, or weight loss. Inhaled beta adrenergic
agonists, two courses of oral abx, and 10 day course of orapred have not relieved her
symptoms. She is at the 50th percentile for height and weight. She appears well. Her
temp is 37.5C, pulse 96/min, RR 18/min, and BP 82/60. Examination shows no
abnormalities. An x-ray of the chest shows no abnormalities except for linear
consolidation in the right middle lobe. Which of the following is the most likely
diagnosis?
a) Esophagostomy
b) Fundoplication
c) Gastrostomy
d) pyloromyotomy
e) vagotomy and pyloroplasty Fundoplication for GERD
5)A previously healthy 4-year-old boy is brought to the physician because of a 2-week
history of mild itching of his head and scattered areas of hair loss on his scalp.
Examination shows several small oval areas of alopecia over the posterior scalp with
numerous hairs broken off close to the scalp. Several small, occipital, nontender lymph
nodes are palpated. The remainder of the examination shows no abnormalities. Which
of the following is the most likely causal organism?
A)Candida albicans
B)Epidermophyton floccosum
C)Malassezia furfur
D)Microsporum audouinii
E)Trichophyton tonsurans E! Trichophyton > Microsporum as most common
Microsporum could also be yellow-green fluorescent on Wood's lamp
A 9-year-old girl with type 1 diabetes mellitus is brought to the emergency department
because of lethargy, labored breathing, and seven episodes of vomiting over the past 6
hours. Her skin is flushed and warm and she appears severely dehydrated. There is a
fruity odor to her breath. She is at the 75th percentile for height and 25th percentile for
weight. Her temperature is 37.2°C (99°F), pulse is 110/min, respirations are 24/min, and
blood pressure is 100/60 mm Hg. Capillary refill time is 4 seconds, and capillary blood
glucose concentration is greater than 500 mg/dL. Which of the following is the most
appropriate initial step in management?
Her urine output is 1.5 mL/kg/h. Arterial blood gas analysis on 40% oxygen shows:
pH 7.2
Pco2 35 mm Hg
Pao2 100 mm Hg
One hour later, her urine output decreases to less than 0.5 mL/kg/h. A chest x-ray
shows hazy lung fields bilaterally and cardiomegaly. Which of the following is the most
appropriate next step in management?
Tx supportively!
1. An otherwise healthy 16yo girl is brought to the physician b/c of 6mo of increasing
severe pain with menses. Her mother reports that during this time, her daughter has
missed 2 days of school during each menstrual period because of severe pelvic cramps
associated w/ vomiting. Menses occurs at regular 28day intervals and lasts 4-5 days.
Her last menstrual period was 7 days ago. She currently takes acetaminophen, which
provides minimal relief of her symptoms. She has had three lifetime sexual partners,
and they use condoms inconsistently. PEx shows no abnormalities. Pelvic examination
shows a ternder, normal sized uterus and no masses. Which of the following is the most
appropriate next step in management?
a) Pregnancy Test
b) Pelvic US
c) Narcotic therapy
d) NSAIDS
e) SSRI Likely D but will need to double check to confirm
A 6yo girl is brought to the physician because of a scaly, pruritic rash on the
intertriginous areas of her elvows and knees that worsens in the spring and the fall; it
often appears in conjunction with episodes of respiratory distress and wheezing. Tx with
which of the following is the most effective short term treatment of the rash?
a) Clotrimazole
b) Coal Tar
c) Griseofulvin
d) Lindane
e) Triamcinoline E! Triamcinolone is a steroid that you can use for atopic dermatitis
3. A 6hr old newborn has had cyanosis of her arms and legs since birth. She was born
at 38wk gestation following an uncomplicated pregnancy and c-section for breech
presentation. She weighed 2090g at birth. She has been breast feeding well. She is
alert and is not in acute distress. Her rectal temprature is 36.2C, puse is 112, RR 36, BP
80/45. Pulse ox 96%. Examination shows cyanosis of the upper and lower extremities
but no circumoral cyanosis. Cardiopulmonary examination shows no abnormalities. Cap
refill is mildly delayed. Which of the following is the most appropriate step in
management?
a) ALL
b) Anemia of Chronic Disease
c) Autoimmune hemolytic anemia
d) G6PD deficiency
e) HUS
f) Hereditary spherocytosis
g) Lead poisoning
h) Red blood cell aplasia
i) Sickle cell disease
j) thalassemia
k) uremia of chronic renal failure A! ALL
A 4yo boy is hospitalized because of fever, shallow breathing, and unresponsiveness
for 3hrs. His temprature is 40C, pulse 160, RR 60 and BP is 60/35. Examination shows
purpura over the loewr extremities. He is intubated and mechanically ventilated. Blood
cultures grow Neisseria meningitidis. Two days later, an x-ray of the chest shows
bilateral patchy infiltrates. Which of the following is the most likely mechanism of these
findings?
a) Cholinergic hyperactivity
b) enzymatic deficiency
c) Increased vascular permeability
d) Mucosal inflammation
e) Oxygen toxicity
f) Surfactant deficiency C - Damage to endothelial cells of the pulmonary
vasculature in sepsis leads to increased vascular permeability and thus pulmonary
edema
A previously healthy 8yo boy brought to the emergency department of difficulty
breathing 10mins after being stung by a bee. His temp is 36.5C, pulse 130, RR 28 and
BP 65/50. Examination shows wheezing, audible stridor, and a generalized urticarial
rash. Epi and methlprednisolone are administered. Administration of which of the
following is the most appropriate next step?
a) Cromolyn sodium
b) Dopamine
c) Fluid
d) Lidocaine
e) NE Give fluids - he is in anaphylactic shock
3*-year-*old boy is brought to the physician for a follow*up examination 2 weeks after
being treated for an ear infection. He has had recurrent ear infections, sinusitis, and two
episodes of bacterial pneumonia since birth. Over the past year, he has undergone
placement of two sets of tympanostomy tubes for otitis media. His mother is HIV
negative. He currently takes no medications. He is at the 25th percentile for height and
weight. Examination shows no abnormalities except for small anterior cervical lymph
nodes. Which of the following is the most likely mechanism of disease?
A) Antibody deficiency
B) Impaired chemotaxis
C) Impaired respiratory burst
D) Splenic dysfunction
E) T-*lymphocyte dysfunction Recurrent sinopulmonary and bacterial infections =
humoral deficiency
A 5-*year-*old boy is brought to the physician for a well*-child examination. He is active
and has been healthy except for an episode of otitis media 3 weeks ago treated with
amoxicillin. His parents emigrated from Vietnam. His diet consists mainly of fruits and
vegetables; he occasionally eats fish and chicken but no red meat. Examination shows
no abnormalities. Laboratory studies show:
Hemoglobin 10 g/dL
Mean corpuscular volume 64 μm3
Leukocyte count 6100/mm3
Platelet count 225,000/mm3
Red cell distribution width 10% (N=13%-15%)
Urine protein 1+
Pulmonary function tests show a decrease in forced vital capacity from 75% to 30% of
predicted value over the past year. An x-*ray of the chest shows marked hyperinflation
with coarse nodular infiltrates bilaterally. Which of the following is the most likely
explanation for this patient's edema?
Hemoglobin 10 g/dL
Leukocyte count 2100/mm3
Segmented neutrophils 80%
Lymphocytes 18%
Monocytes 2%
Platelet count 180,000/mm3
Serum
lgA 340 mg/dL
lgG 2300 mg/dL
lgM 390 mg/dL
A) Bacterium
B) Fungus
C) Rickettsia
D) Spirochete
E) Virus D! Spirochete
A 9-month-old boy is brought to the physician 2 months after his parents noticed that he
seemed to be ignoring them. On questioning, they note that he does not appear to be
startled by loud noises. Growth and development have been otherwise normal. He was
born at term to a 28-year-old woman, gravida 2, para 1. His mother's blood group is A.
Rh-negative, and his blood group is A. Rh-positive. He had a serum total bilirubin
concentration of 25 mg/dL at the age of 2 days and received phototherapy for 2 days.
He continued to be mildly jaundiced until the age of 1 month. Serum studies since then
have shown no abnormalities. Examination today shows no abnormalities. which of the
following is most likely to have prevented this patient's current condition?
A. Avoidance of breast-feeding
B. Water supplementation
C. Longer course of phototherapy
D. Antibiotic therapy
E. Exchange transfusion Rh hemolytic disease of the newborn -> do exchange
transfusion