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1. An 8 – year – old girl is brought in to the hospital while a actively seizing. She has been hospitalized many times before for status epilepticus. She.

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Presentation on theme: "1. An 8 – year – old girl is brought in to the hospital while a actively seizing. She has been hospitalized many times before for status epilepticus. She."— Presentation transcript:

1 1. An 8 – year – old girl is brought in to the hospital while a actively seizing. She has been hospitalized many times before for status epilepticus. She is receiving valproic acid at home to control the seizures. The first step in the management of this patient is to: A.Administer 20 mL/kg 0.9% normal saline B.Establish secure intravenous access and administer an anticonvulsant C.Administer activated charcoal via NG tube D.Stabilize airway and provide 100% oxygen E.Perform gastric lavage

2 2. An 8 – year-old, 40-kg child presents with a history of vomiting for 3 days. There is no fever or diarrhea. Her mother reports bedwetting and increased fluid consumption for the same period. Her vital signs are as follows: HR 140, RR 35, BP 94/60. available laboratory data includes Na 114 mEq/L, K+ 4.0 mEq/L, C1 95 mEq/L, HCO - 3 less than5 mEq/L, BUN 14mmol/l, and creatine 95 umol/L. The most likely cause for these electrolyte abnormalities is: A.Syndrome of inappropriate antidiuretic hormone (SIADH) B.Renal salt wasting C.Acute tubular necrosis D.Diabetic ketoacidosis (DKA) E.Hemolytic – uremic syndrome (HUS)

3 3. A 1-year-old child presents with severe, watery diarrhea for the last 4 days. You suspect rotaviral diarrhea. His eyes are sunken, the pulse is 190 beats/minute, and his extremities are cool. His weight on admission is 10 kg. His serum sodium is 175 mEq/L. Assuming body water is 60% of the body weight and his normal serum sodium is 140 mEq/L, which of the following is closet to his childs calculated free water deficit? A.500mL B.750mL C.1000mL D.1500mL E.2000mL

4 4. A 1-year-old child is being seen with a history of nausea, vomiting, and severe abdominal pain. There is no history of fever or rash. The mother reports no history of trauma. The physical examination is pertinent for significant, diffuse abdominal pain to palpation with no rebound tenderness. The laboratory evaluation is significant for an amylase of 1400 U/L, and a lipase of 3000 U/L. what is the most likely etiology of this patients disease? a)Pancreatitis b)Meckels diverticulum c)Primary peritonitis d)Intestinal worm infestation e)Acute appendicitis

5 A.Diplegia B.Hemiplegic CP C.Extrapyramidal cerebral palsy D.Quadriplegia E.Dystonic cerebral palsy 5. A 6-month-old infant was delivered at 33 weeks gestation. The neonatal course was complicated by grade II intraventicular hemorrhage on the left and initial slow feeding. The baby required ventilation for 3 days and was weaned off of oxygen after 10 days. The neuro-developmental out come expected for this infant is

6 6. A 2-week-old infant is admitted with history of troubled breathing. The parents report that hits child has had a stuffy nose since birth. Since their discharge home after delivery, they report that their child is congested. He struggles to breath and can eat only 1 oz of his bottle at a time. The parents have been taking turns getting up to feed him every hour.. The most likely diagnosis is: A.Nasal polyps B.Fractured nasal cartilage C.Choanal stenosis D.Snuffles E.Nasal encephalocoele

7 a.HIV DNA qualitative PCR b.HIV RNA quantitative PCR c.HIV ELISA/Western blot d.HIV viral load e.HIV culture 7. You are seeing a 1-month-old infant in your office. The birth history reveals that the mother is HIV positive. The child has been doing well and tolerating AZT. The physical examination is unremarkable except for some mild thrush. Which laboratory test would help rule out infection in this infant?

8 The most common side effect of AZT treatment to be expected in this patient is: a.Myopathy b.Pancreatitis c.Anemia d.Diarrhea e.Rash

9 8. A 3-week-old infant is hospitalized with fever, poor feeding, and fussiness for the last 2 days. The fever increased to 38.5C 0 on the day of admission. Maternal history is unremarkable and the delivery was uneventful. The mother is breastfeeding. Her diet is unremarkable, although she does use an unprocessed cheese that she procures at a local market. On examination, the baby is fussy irritable, The lungs are clear and there is no skin rash. The most important test to help in the diagnosis a. CBC, CRP b. Blood culture c. Ct- brain d. EEG e. CSF study

10 The most likely organism will be a)Escherichia coli (E. coli) b)Hemophilus influenzae c)Staphylococcus aureus d)Listeria monocytogenes e)Clostridium perfringens

11 A.impetigo B.Sinusitis C.Nasal foreign body D.Allergic rhinitis E.Basal skull fracture 9. A 3-year-old boy is brought to your office with the complaint of persistent rhinorrhea. No history oh head trauma. The following can be considered in diagnosis; Except

12 10. A 10-day-old baby presents to your office with a 1-day history of unilateral conjunctivitis. The upper and lower eyelids are mildly swollen, the sclera is inflamed and red, and there is a mucopurulent discharge. The baby is acting well and has no fever. The mother denies any sexually transmitted diseases (STDs) during pregnancy. In the delivery room, the baby received prophylactic erythromycin eye drops. The most likely cause of this childs problem is: A.Chemical conjunctivitis B.Gonococcal conjunctivitis C.Chlamydial conjunctivitis D.Allergic conjunctivitis E.Dacryostenosis

13 Infants treated with erythromycin should be followed for signs and symptoms of a.Renal impairment b.Malabsoebtion syndrome c.Hepatitis d.Hypertrophic pyloric stenosis e.Bone marrow depression

14 11. A 5-year-old girl is seen in the ED because of fever, sore throat, and respiratory distress that developed rapidly over the past 3 hours. She is drooling and holding her neck in a hyperextended position. She has mild inspiratory stridor but does not have a barky cough. A.Viral croup B.Spasmodic croup C.Epiglottitis D.Bacterial tracheitis E.Reactive airway disease (asthma)

15 12. A 9-year-old boy comes to your office because of progressive, generalized, bilateral lower extremity weakness and ataxia. He has also been complaining of some diminished sensation in his fingers and toe. On physical examination, you cannot elicit DTRs in his legs, and there appears to be mild facial weakness. Aside from a URI about 10 days ago, he has been healthy. CSF shows elevated protein with minimal pleocytosis. What is the most likely diagnosis? A.Viral meningitis B.Tick paralysis C.Enteroviral encephalitis D.Guillain-Barré syndrome E.Acute lymphoblastic leukemia

16 13. A 9-year-old infant who was previously healthy and gaining weight was recently discharged from the hospital. The hospitalization was the result of a bout of severe rotavirus diarrhea that required rehydration with IV fluids. Four days later, he is brought to your office because he continues to have loose stools after each feeding. He is now dinking his regular cows milk-based formula well. On physical examination he appears to be happy and well hydrated. A repeat rotavirus test is negative. What is the most likely reason for the babys continue loose stools? A.Cows mild protein allergy B.Starvation diarrhea C.Secondary lactose intolerance D.Viral gastroenteritis E.Cystic fibrosis

17 14. A 15-month-old boy comes to your office because of bloody diarrhea that started today. The previous night he was seen in the local emergency room for management of a febrile seizure. The child had no previous history of convulsions. You collect a stool sample for microscopic examination and note that the stool contains many polymorphonuclear cells. Which organism is most likely responsible for this childs illness? A.Group A Streptococcus B.Staphylococcus aureus C.E. coli D.Shigella E.rotavirus

18 15. A 10-year-old boy is brought to your office because of intermittent, unexplained fevers over the past 18 months. His mother is especially concerned because she thinks her son has stopped growing. In fact, when you look at the boys growth chart, you note no height increase since age 8 and his height percentile has fallen from the 25 th percentile to well below 5 th percentile for age. A CBC demonstrates very mild anemia, but the patients erythrocyte sedimentation rate (ESR) is elevated. The urine pH is 5 and the serum bicarbonate is normal. The mothers height and fathers height both fall at the 25 th percentile A.Constitutional growth delay B.Familial short stature C.Inflammatory bowel disease (IBD) D.Renal tubular acidosis E.Pituitary tumor and growth hormone deficiency

19 16. An 18-month-old child is admitted to the hospital because of a 2- day history of fever and extreme irritability. The CSF analysis shows 2000 WBCs of which 90% are polymorphonuclear cells. The spinal fluid glucose is markedly depressed. The patient is started on cefotamine and vancomycin. Eight hours after admission, the child has a generalized convulsion. What would be your next course of action? A.No additional diagnostic tests or treatment are needed B.Start aggressive antipyretic treatment to decrease the chance of febrile seizure C.Change antibiotics to provide a broader spectrum of coverage D.Order a set of electrolytes E.Order a computerized scan of the head to rule out a brain abscess.

20 17. A mother brings her 2-month-old baby girl for a regular checkup. She says that a friend told her she should always put the baby to sleep on her belly to prevent choking, in case the baby spits up. With regard to infant sleeping position, how should you counsel the mother? A.Place baby on the belly (prone) B.Place baby on the side C.Place baby on the back (supine) D.Elevate head of infants crib E.Elevate foot of infants crib

21 18. A 4-month-old boy comes to your office for a well-baby check-up. His mother expresses concern about his slow growth and poor motor development that she noticed over the last month. There is no history of constipation. On physical examination, the baby appears to be hypotonic and weak. You are unable to elicit DTRs. There is visible atrophy and fasciculation's of the tongue, but no ptosis or facial weakness. The most likely diagnosis is: A.Guillain-Barré syndrome B.Infant botulism C.Hypothyroidism D.Spinal muscular atrophy E.Myasthenia gravis

22 19. A 5-month-old baby presents to the Urgent Care Center with a fever and history of chronic, draying ear. You note a severe diaper rash, cradle cap, and a scailing, purpuric, papular rash appearing over the trunck on your thorough physical examination. Your diagnosis is: A.Otitis externa from the bath water B.Contact dermatitis from the laundry detergent C.Langerhans cell histiocytosis D.Atopic dermatitis E.scabies

23 20. The parents of a 6-month-old Saudi boy report that the child has been turning blue since birth. In the first few weeks of his life, they noted that his fingers and toe seemed bluish, although that condition has resolved. Now they notice that the skin around his mouth is blue, especially when he is outside in cool air. The child has been otherwise well, growing, gaining weight, and developing appropriately. Vital signs and physical examination are normal, with normal pulses in all extremities, and no audible murmurs or abnormal cardiac sounds. What is the next step in evaluating this child? A.Echocardiogram B.Electrocardiogram C.Cardiology consult D.Reassurance only E.Chest radiograph

24 21. A 14-month-old-boy is seen in your office because his mother is concerned about his bowlegs. He began walking at 10 months, and since then she has noticed that his gait is becoming worse. On examination, you find he does have significant leg bowing bilaterally, and x-rays reveal evidence of rickets. Regarding his diagnosis, which one or the following is true? A.Rickets of any kind is always associated with low serum calcium B.Alkaline phosphates is high in this child C.Parathyroid hormone is high in all forms of rickets D.This boy cannot have vitamin D-resistant rickets if his mother is normal E.Patients with vitamin D-deficiency rickets frequently have normal serum phosphorus

25 22. A 6-year-old boy comes to your office for a well-child checkup. His mother tells you that she is concerned about his nightly bedwetting. The boy has never had a prolonged period of nighttime dryness, and he never has accidents while awake. He has no dysuria and his urinary stream is normal. What is the most common cause of primary nocturnal enuresis A.UTI B.Vesicoureteral reflux C.Psychological problem D.Normal developmental variant E.Unstable bladder

26 23. Your are seeing a 10-year-old boy for his well-child checkup and notice that he is hypertensive. He has otherwise been doing well. When looking back through his old chart, you realize that his previous blood pressures were normal. What would be your next course of action? A.Urinalysis B.Renal ultrasound C.24-hour blood pressure monitoring D.Rechecking his blood pressure in 1 week E.Basic metabolic

27 24. A 7-month-old male is being seen in your office after hospitalized with streptococcus pneumoniae bacteremia and pneumonia. When looking through his chart, you notice that he has had multiple otitis media, and both his height and weight are at the 5 th percentile. Which of the following is the most likely diagnosis? A.X-linked agammaglobulinemia B.Wiskott-Aldrich syndrome C.Chronic granulomatous disease D.Chediak-higashi syndrome E.Leukocyte adhesion defect

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