Lub-Dub
A 1 month old boy is noted to have a grade 2/6 medium pitched systolic ejection murmur best heard at the left upper sternal border; it radiates to the right upper sternal border and into the posterior lung fields and axillae.
Which of the following is the most likely etiology of these findings?
A) Patent ductus arteriosus
B) Vibratory (Still's murmur)
C) Functional peripheral pulmonary artery stenosis
D) Venous hum
E) Ventricular septal defect
C) Functional peripheral pulmonary artery stenosis
The parents of a 2 mo old girl are concerned their child may be at risk for autism because her 18 mo old cousin was recently diagnosed with autism.
Which of the following most accurately describes an early sign of autism?
A) Absence of babbling and pointing by 9 mo old
B) Not using 2 word phrases by 18 mo old
C) Absence of social smile by 6 mo old
D) Lack of make-believe play by 12 mo old
E) Not using single words by 10 mo old
C) Absence of social smile by 6 mo old
After a fall while climbing on monkey bars, a 5 yr old boy is brought to the ED. Although alert, he states he cannot hear. On exam, fresh blood is present in the right external canal, and blood is noted behind an intact left TM. A profuse clear discharge from both nares is also noted.
Which of the following is most likely to develop over the next few days?
A) Septal deviation associated w/ a hematoma
B) Postauricular ecchymosis
C) Blood in the anterior chamber of the left eye
D) Loss of peripheral vision
E) Deviation of the uvula
B) Postauricular ecchymosis
Which of the following vaccines must be administered subcutaneously rather than intramuscularly?
A) Hepatitis B
B) MMR
C) Hib
D) DTaP
E) Pneumococcal conjugate vaccine
B) MMR
Which of the following best describes the time period in which a child with chicken pox is considered contagious?
A) 7 days after the onset of the rash
B) 1-2 days prior to the rash and until the lesions are crusted over
C) 2 days following the appearance of the rash and until the lesions are crusted over
D) 7 days prior to and after the onset of the rash
E) 4 days before to 4 days after the appearance of the rash
B) 1-2 days prior to the rash and until the lesions are crusted over
Following hospitalization of a 6 yr old girl for an acute febrile illness, a diagnosis of rheumatic fever is made based on both clinical findings and documentation of an elevated streptococcal antibody titer.
Which of the following is considered a major manifestation of rheumatic fever?
A) Fever
B) Elevated ESR
C) Arthralgia
D) Prolonged PR interval on EKG
E) Chorea
E) Chorea
A child is able to stack a tower of 8 blocks, build a 3 block bridge, draw a person with 2-3 parts, and copy a cross and a circle (but not a square).
These milestones are accomplished in the MAJORITY of kids by what age?
A) 3 years
B) 18 months
C) 2 years
D) 30 months
E) 4 years
A) 3 years
A 14 yr old boy presents to the ED after injuring his right arm during football practice. A plain XR of the right wrist is consistent w/ a Type 4 Salter-Harris fracture of the distal radius.
Which of the following best describes a Salter-Harris Type 4 fracture?
A) A fracture through the physis and adjacent metaphysis
B) A separation of the physis
C) Significant damage to only the physis
D) A fracture through the physis and adjacent epiphysis
E) A fracture through the physis, adjacent metaphysis, and epiphysis
E) A fracture through the physis, adjacent metaphysis, and epiphysis
During a WCV, parents of a 2 mo old girl have several questions about potential vaccine-associated adverse effects.
Which of the following has most often been reported following administration of a pertussis-containing vaccine?
A) Thrombocytopenia
B) Intussusception
C) Extreme irritability and crying for extended periods of time (3+ hrs)
D) Generalized macular rash and arthralgia
E) Localized vesicular rash at injection site
C) Extreme irritability and crying for extended periods of time (3+ hrs)
A 6 yr old girl presents w/ a 2 day hx of vaginal discharge described by Mom as "yellowish and blood-tinged". Mom also reports associated abdominal pain, watery diarrhea and one episode of emesis.
Which of the following pathogens is the most likely cause of this patient's symptoms?
A) Campylobacter jejuni
B) Yersinia enterocolitica
C) E. coli
D) Salmonella Typhi
E) Shigella flexneri
E) Shigella flexneri
A 17 yr old girl has decreased exercise tolerance over the last several months. She's concerned because she's always been a great athlete. No known history of any medical problems, and she takes no medications.
Which of the following is most often associated with a congenital heart lesion that often does not become symptomatic until the 2nd decade of life or later?
A) A fixed split 2nd heart sound
B) A harsh continuous murmur best heard in the 1st and 2nd intercostal spaces
C) A loud ejection murmur with radiation to scapula associated w/ weak femoral pulses
D) A continuous murmur through systole & diastole, heard best in the 1st and 2nd right intercostal spaces, varies in intensity when the neck position changes
E) A systolic ejection murmur associated w/ a systolic click along the left sternal border
A) A fixed split 2nd heart sound
During a WCV, you note findings of abnormal reflexes during the neuro assessment.
Which of the following is most suggestive of an abnormal neurodevelopmental condition?
A) A persistent parachute reflex at 4 yrs old
B) A Moro at 2 mo of age
C) A rooting reflex at 6 mo of age
D) An up-going Babinski reflex at 7 mo of age
E) Tonic neck response at 2 mo of age
C) A rooting reflex at 6 mo of age
A 3 yr old boy is transported to the ED following an accidental ingestion at his grandparents' home. On arrival, stabilization of his airway, breathing & circulation is promptly completed. There is no clinical evidence of associated trauma or illness.
For which of the following substances is activated charcoal likely to be most effective in the treatment of a poisoning?
A) Carbamazepine
B) Potassium chloride
C) Lithium
D) Iron
E) Aromatic hydrocarbons
A) Carbamazepine
Which of the following is considered a contraindication to varicella vaccination in a child who weighs 24 kg?
A) A child who has received 20 mg/day of prednisone daily during the previous 3 weeks
B) Household contacts of immunocompromised individuals
C) Breastfeeding moms
D) Adolescents > 15 yrs old
E) Severe atopic dermatitis
A) A child who has received 20 mg/day of prednisone daily during the previous 3 weeks
An 11 yr old girl presents w/ subjective fevers, myalgias, headache & a rash that first noted yesterday. On exam, her temp is 38.1*C. A 3x5cm erythematous lesion w/ central clearing is present on the left upper thigh.
Which of the following complications could be avoided by prompt treatment with tetracyclines?
A) Miosis, ptosis and anhidrosis
B) Temporary loss of vision associated w/ hemiparesis
C) Symmetric proximal lower extremity weakness
D) Unilateral facial nerve palsy
E) Lower back pain associated w/ parasthesias in the lower extremity and urinary retention
D) Unilateral facial nerve palsy
Nine months after successful transcatheter prosthetic device repair of an ASD, an 11 yo girl w/ no reported drug allergies is scheduled for extensive dental work that will include several extractions.
Which of the following is the most appropriate antimicrobial prophylaxis regimen for bacterial endocarditis in this patient?
A) Antimicrobial prophylaxis is not required
B) Amoxicillin 2gm PO 1 hr prior to surgery and 8 hrs after surgery
C) Amoxicillin 500mg PO BID, beginning 1 day prior to and ending 2 days following surgery
D) Amoxicillin 2gm PO 1 hr prior to surgery
E) Amoxicillin 1gm PO 8 hrs prior to surgery and immediately following surgery
A) Antimicrobial prophylaxis is not required
Which of the following is the correct method to calculate midparental height for a girl?
A) (Mother's Height + Father's Height) / 2
B) (Mother's Height + [Father's Height - 5 in]) / 2
C) (Mother's Height + [Father's Height + 5 in]) / 2
D) (Mother's Height + Father's Height) - (5 in / 2)
E) (Mother's Height - 5 in) + (Father's Height / 2)
B) (Mother's Height + [Father's Height - 5 in]) / 2
Which of the following medications did this patient most likely ingest?
A) Cimetidine
B) Phenobarbital
C) Warfarin
D) Imipramine
E) Fluoxetine
D) Imipramine
A 14 mo old boy, who is receiving antiretroviral therapy for HIV, has yet to receive a varicella vaccine. His CD4+ T-lymphocyte percentage has remained >20% for >6 months.
Which of the following is the most appropriate plan for varicella vaccination in this patient?
A) The patient should not receive a varicella vaccine until his CD4+ T-lymphocyte percentage reaches >35%
B) The patient should receive a varicella vaccine during this visit, followed by an additional dose 1 month or later if his CD4+ T-cell percentage remains >15%
C) Varicella vaccine is contraindicated because of the patient's immune status
D) The patient should be given MMRV as a combination dose to achieve better immunity
E) The patient should receive a varicella vaccine during this visit, followed by a 2nd dose 3 months or later if his CD4+ T-cell percentage remains >15%
E) The patient should receive a varicella vaccine during this visit, followed by a 2nd dose 3 months or later if his CD4+ T-cell percentage remains >15%
A 6 wk old girl is taken into protective custody after her aunt noticed she would not move her left arm. Mom received no prenatal care and has 2 older children. On exam, all growth parameters are <3rd %ile. She refuses to the move her left arm and cries during range of motion testing. An XR of the left arm reveals evidence of osteochondritis at the metaphyses and periostitis of the radius and ulna.
Which of the following is the most likely cause of this patient's findings?
A) Treponema pallidum
B) Toxoplasmosis
C) Staphylococcus aureus
D) CMV
E) Rubella
A) Treponema pallidum
A 1 day old is identified to be cyanotic, with an O2 sat measured at 71%. Minimal improvement is noted after initiation of supplemental oxygen.
Which of the following is the most common cyanotic heart defect manifesting in the first days of life?
A) Tetralogy of Fallot
B) Total Anomalous Pulmonary Venous Return
C) Transposition of the Great Arteries
D) Tricuspid Atresia
E) Ventricular Septal Defect
C) Transposition of the Great Arteries
A 5 yr old boy w/ known hx of premature closure of bilateral coronal sutures presents for his physical exam. Findings include normal intelligence, normal hands & feet, midface hypoplasia, and proptosis.
What syndrome does this child most likely have?
A) Soto syndrome
B) Apert syndrome
C) Pfeiffer syndrome
D) Carpenter syndrome
E) Crouzon syndrome
E) Crouzon syndrome
An 18 yr old male is brought to the ED 1 hr after an intentional overdose on his brother's medications. His pupils are small, and he is difficult to arouse. His heart rate is 50 bpm, respiratory rate is 8 per min, and his BP is 70/30. His temp and glucose are normal.
The medication that most likely caused his symptoms is used to treat which disorder?
A) Diabetes
B) Influenza
C) Infestation
D) ADHD
E) Depression
D) ADHD
A 28 month old boy presents for his first WCV after coming to the US from Honduras with his adoptive parents. Review of his immunization status reveals he has not been vaccinated with either the Hib conjugate vaccine or PCV13.
Which of the following is the most appropriate "catch up" schedule for these 2 vaccines?
A) 1 dose of PCV13 is required; 2 doses of Hib, given 4 weeks apart, are required
B) 1 dose of both Hib and PCV13 is required
C) 2 doses of both PCV13 and Hib, given at least 8 weeks apart, are required
D) 1 dose of Hib is required; 2 doses of PCV13, given at least 8 weeks apart, are required
E) A total of 3 doses of both PCV13 and Hib are required, with the 2nd dose given at least 4 weeks after the 1st dose and the 3rd dose given at least 16 weeks after the 2nd dose
B) 1 dose of both Hib and PCV13 is required
A 2 wk old presents with 24 hrs of poor feeding and irritability. On exam, his temp is 38.4*C. He is lethargic, difficult to arouse, and has a bulging anterior fontanelle. Findings on LP include a WBC count of 8,600/uL, protein of 190mg/dL, and glucose of 22mg/dL. An MRI reveals abscess formation in both the frontal lobes along with meningeal enhancement consistent w/ meningitis.
Which of the following is the most likely cause of these findings?
A) Citrobacter koseri
B) Herpes simplex virus
C) E. coli
D) Listeria monocytogenes
E) Group B streptococci
A) Citrobacter koseri