Milestones
9-month-old came for the Well child's visit. What do you expect him to do?
A Pull to a standing position
B Use a cup well
C Understand 1-step commands
D Walk without help
E Offer a toy to an adult
A Pull to a standing position
Can also say Mama, Dada unspecifically and start to have mature pincer grasp
A 5-year-old boy with a known history of premature closure of bilateral coronal sutures presents for his physical exam. Findings include:
Normal intelligence Normal hands and feet Midface hypoplasia Proptosis
What syndrome does this child most likely have?
A Carpenter syndrome
B Crouzon syndrome
C Apert syndrome
D Pfeiffer syndrome
E Sotos syndrome
B Crouzon syndrome
The parents of a 10-year-old boy express concern that their son has few friends and appears
little interest in playing with others. They describe him as somewhat awkward and quite shy. He keeps a well-organized set of small trucks and cars and is able to describe his collection in great detail, comparing similarities and differences between models and makes. He becomes flustered and anxious when his daily routines are interrupted. He is pleasant but very shy during the visit; he has difficulty maintaining eye contact.
When considering this patient’s history, which of the following is most likely to be associated with this patient?
A Choreic movements
B Sensitivity to certain food textures and clothing
C Multiple motor tics with one or more vocal tics
D A history of microcephaly, first noted at 9–12 months of age
E Stereotypical hand wringing
B Sensitivity to certain food textures and clothing
A 10-year-old Black boy presents to the emergency department about 1 hour after falling at the playground and injuring his right arm. His vital signs include a heart rate of 130 bpm, respiratory rate of 25 breaths/minute, and blood pressure of 125/65 mmHg. On exam, he is quiet but grimaces with any movement of the right arm. There is an obvious closed deformity of the right distal forearm; sensation and strength are intact, and there is a 2+ radial pulse.
The physician deems the patient’s pain to be “mild,” and he is given a dose of acetaminophen; a forearm x-ray is ordered.
This scenario is most likely an example of which of the following?
A. In-group bias
B. Ethnocentrism
C. Unconscious/Implicit bias
D. Racial colorblindness
E. Overt racism
C. Unconscious/Implicit bias
unconscious—or implicit—bias, which is defined as the preconceived notions we develop about others based on our environment, upbringing, and education.
A 6-year-old girl comes to your office for her annual well visit. She started kindergarten 3 months ago and her parents report that she is not doing well in school because she refuses to speak in the classroom setting. When she has individual time with classmates at school, she speaks well. While she has always been a quieter child, she interacts well with other children her age at home and is very talkative with her parents. She has learned a lot in school already and seems to understand the material. Overall, she is a happy child who states that she enjoys going to school.
What is the most likely diagnosis?
A Selective mutism
B Autism spectrum disorder
C Separation anxiety disorder
D Generalized anxiety disorder
A Selective mutism
At which age are the majority of infants likely to first demonstrate a social (reciprocal) smile when responding to an adult voice?
A. 6 months of age
B. 12 months of age
C. 5 months of age
D. 24 months of age
E. 2 months of age
E. 2 months of age
A 3-month-old boy presents to the emergency department due to excessive irritability and difficulty feeding. Findings on physical examination include a heart rate of 190 beats/minute associated with a gallop rhythm and bilateral basilar rales. An echocardiogram reveals an echogenic, well-defined, 10- mm mass located in the upper portion of the interventricular septum, which is partially obstructing the left ventricular outflow tract.
Based on the above information, what other clinical findings may this child also exhibit?
A Infantile spasms
B Congenital cataracts
C Bile duct paucity
D Renal tubular acidosis
E Idiopathic hypercalcemia
A Infantile spasms
A 15-year-old girl presents to her pediatrician with her parents because they are concerned
her refusal to go to school. Her parents report that she has been irritable and restless for the last 3–4 weeks. She has had difficulties with concentration for the last month, stating that she thinks a lot about her future and worries about her grades and her chance of getting into college. In school, she is afraid of being embarrassed in front of her peers, making mistakes while answering teachers’ questions, and failing her exams. Her thoughts about failure have become intrusive. She had been a very good student before her symptoms started. She feels that her friends do not like her anymore, making her reluctant to go to any social events. She denies any illicit drug use. Her vital signs and physical exam are normal. Her urine drug screen is negative.
What is the most likely diagnosis?
A Conduct disorder
B Generalized anxiety disorder
C Bipolar disorder
D Marijuana use
E Attention deficit hyperactivity disorder
B Generalized anxiety disorder
A 10-year-old boy has a prolactin level of 68 ng/mL, confirmed on repeat testing when fasting.
This patient is most likely undergoing treatment with a medication for which of the following disorders?
A Type 2 diabetes mellitus associated with hypertriglyceridemia
B Disruptive behavior and hyperactivity associated with autism spectrum disorder
C Steroid-resistant minimal change nephrotic syndrome
D Absence seizure disorder
E Failure to thrive associated with cystic fibrosis
B Disruptive behavior and hyperactivity associated with autism spectrum disorder
A 7-year-old boy is brought in by his parents for inattention at home and school, impulsive behavior, and inability to get along with his peers. After extensive evaluation, it is determined he would likely benefit from treatment for his condition.
Which of the following medications is the best treatment for this patient?
A Clonidine
B Imipramine
C Propranolol
D Methylphenidate
E Valproate
D Methylphenidate
At what age can 90% of children walk unassisted?
A 18 months of age
B 15 months of age
C 11 months of age
D 24 months of age
E 9 months of age
B 15 months of age
A 3-year-old girl is diagnosed with a seizure disorder. Her mother had an uneventful pregnancy, labor, and delivery of this child, and “all of her prenatal tests were normal.” The neonatal period was equally uneventful.
The patient is microcephalic. She “cruises” but does not walk independently. Her movements are jerky. She has no discernable speech. She has bouts of laughter that are unrelated to interactions with others.
What is the most likely diagnosis?
A Achondroplasia
B Angelman syndrome
C Williams syndrome
D Cri-du-chat syndrome
E 22q11.2 deletion syndrome
B Angelman syndrome
The parents of a 2-month-old girl are concerned that their child may be at risk for autism, because her 18-month-old cousin was recently diagnosed with autism.
Which of the following most accurately describes an early sign of autism?
A Not using 2-word phrases by 18 months of age
B Not using single words by 10 months of age
C Absence of social smile by 6 months of age
D Absence of babbling and pointing by 9 months of age
E Lack of make-believe play by 12 months of age
C Absence of social smile by 6 months of age
A 17-year-old boy who chronically inhales drugs is admitted to a drug treatment facility after arrest for possession of controlled substances with the intent to sell
Which of the following cutaneous findings might you find in this patient?
A Keratosis pilaris
B Perioral dermatitis
C Papular acrodermatitis
D Erythema nodosum
E Granuloma annulare
B Perioral dermatitis
A 17-year-old presents to the pediatrician’s office for a well visit. She is a high-achiever and describes herself as a “very competitive” person. She takes multiple advanced placement classes in school. Over the past several months she has noticed increasing irritability, fatigue, poor sleep, and unintentional weight loss. She denies suicidal ideation. You perform a thorough medical workup which is negative for abnormalities.
What is the next best step in management?
A. Refer the patient for cognitive-behavioral therapy (CBT).
B. Recommend a local substance use support group.
C. Recommend reducing the advanced placement course load.
D. Prescribe a benzodiazepine.
E. Prescribe a nighttime sleep aid.
A. Refer the patient for cognitive-behavioral therapy (CBT).
Which of the following is most suggestive of an abnormal neurodevelopmental condition?
A A persistent parachute reflex at 4 years of age
B An up-going Babinski reflex at 7 months of age.
C Tonic neck response at 2 months of age
D A rooting reflex at 6 months of age
E A Moro reflex at 2 months of age
D A rooting reflex at 6 months of age
A 25-day-old female infant is noted to have a hyperdynamic precordium and bounding pulse
single 2nd heart sound, a systolic ejection click, and a systolic ejection murmur along the left sternal border are present. On chest x-ray, the thymic shadow is absent; biventricular cardiac enlargement and prominent pulmonary vascularity are noted.
Chromosome analysis is most likely to reveal which of the following abnormalities?
A Pericentric inversion
B Microdeletion
C A chromosome break
D Aneuploidy
E Unbalanced translocation
B Microdeletion
An 18-month-old girl presents for continued evaluation after recently being discharged from the emergency department following a generalized tonic-clonic seizure. Her parents report that this was her first seizure but express concern that “she is just not herself.” She appears less interested in playing, is more irritable and is difficult to console. She is less interactive with other family members. They also report that her language development “appears to be going nowhere,” and she is far less verbal than she was just a few months ago.
Review of her growth chart indicates that her head circumference is below the 3rd percentile. Her expressive and receptive language skills are poor. Physical findings also include an ataxic gait, which her parents report to be of relatively recent onset.
Which of the following findings is most likely to be identified during additional evaluation of this patient?
A Rapid weight gain associated with an incessant craving for food
B Rapid deterioration of vision
C Hearing loss associated with an acoustic neuroma
D Midline stereotypic hand movements
E Loss of scalp and eyebrow hair
D Midline stereotypic hand movements
Within several days of starting a new medication, a 17-year-old girl presents to the emergency department with pressured speech and flight of ideas—after not sleeping for the previous 36 hours. During her intake examination, she claims to have "the answers to all world problems" and says, “I don't need sleep because I'm so busy fixing the world."
Which of the following medications is most likely to have led to this patient’s current condition?
A Propranolol
B Fluoxetine
C Doxycycline
D Acetazolamide
E Cyclosporine
B Fluoxetine
A 6-year-old boy with autism spectrum disorder (ASD) is reported by his special education teacher to have significant difficulty functioning in the classroom. He is extremely irritable and often aggressive to peers and adults. Other children are frightened by his behavior. At times, his behavior disrupts classroom activities for an extended length of time.
Which of the following is the most appropriate approved choice in the medical management of this child?
A Buspirone
B Phenobarbital
C Methylphenidate extended release
D Risperidone
E Clonazepam
D Risperidone
A child can run well, build a tower of 5 blocks, and walk up and down stairs, placing 2 feet on step. They have a vocabulary of 50–100 words, use 2-word phrases, and can identify 6 body parts.
Which of the following is likely to be their age?
A 36 months of age
B 24 months of age
C 9 months of age
D 12 months of age
E 18 months of age
B 24 months of age
A 4-month-old girl with a history of prolonged neonatal jaundice presents for evaluation of a heart murmur. Her most recent laboratory findings included a total bilirubin of 11 mg/dL with a direct fraction of 35%. An echocardiogram showed peripheral pulmonic stenosis associated with a ventricular septal defect. A liver biopsy at 3 months of age revealed evidence of chronic cholestasis and a paucity of interlobular bile ducts.
Which of the following musculoskeletal findings is most likely to be identified during further evaluation of this patient?
A Butterfly vertebrae
B Hypermobility of the large and small joints
C Unilateral absence of the radius
D Lumbosacral scoliosis
E Fused cervical vertebrae
A Butterfly vertebrae
The parents of a 12-year-old boy with a history of obsessive-compulsive disorder express their continued concern about what they describe as a characteristic, repetitive “grunting and sniffing sound” that their son makes multiple times a day. He also has a long-standing (at least 2-year) history of intermittent episodes of eye blinking, facial grimacing, shoulder shrugging, and head jerking. During the office visit and physical examination, a repetitive vocal tic is noted. You suspect Tourette syndrome.
Which one of the following symptoms supports this diagnosis?
A Presence of obsessive-compulsive disorder
B Multiple motor and vocal tics lasting > 1 year
C Initial onset of vocal or motor tics at 10 years of age
D Tics that involve repeatedly shrugging his shoulders
E Multiple vocal tics lasting > 3 months
B Multiple motor and vocal tics lasting > 1 year
Diagnostic criteria:
1. At least 2 motor tics and at least 1 vocal (phonic) tic have been present, not necessarily at the same time.
2. Tics may wax and wane in frequency but have occurred for more than 1 year.
3. Tics started to appear before the age of 18.
4. Tics are not caused by the use of a substance or other medical condition.
A 17-year-old girl is transported to the emergency department after her friends found her in a hotel room crying hysterically that she “might have been raped.” Earlier in the evening, the patient and several friends attended a “hotel party” after a school dance.
On physical examination, there is evidence of vaginal bleeding and several vaginal lacerations. The patient has no recollection of the events of the evening soon after arriving at the hotel. There is concern that she may have inadvertently ingested a drug.
Which of the following substances was most likely used on this victim?
A Chlorpromazine
B Risperidone
C Nembutal
D Diphenhydramine
E Gamma-hydroxybutyrate
E Gamma-hydroxybutyrate
Rape drugs: MDMA, Ketamine, metamphetamine
A 17-year-old male expresses concern about worsening acne. Two months ago, he began treatment with a topical retinoid and oral doxycycline. He states that he has been compliant with his medical regimen, and is frustrated by lack of improvement. His parents also express concern that the patient has recently become more irritable, and he will “fly off the handle at a moment’s notice.” They recently discovered several bottles of pills in his room, which he admitted to ordering online after he read statements that they would increase muscle strength and size to better prepare him for the upcoming football season.
Which of the following laboratory findings is most likely to be identified during further evaluation of this patient?
A Elevated serum transaminases
B Increased serum prolactin
C Leukopenia
D Megaloblastic anemia
E Increased serum high-density lipoproteins
A Elevated serum transaminases