Must Be Them Hormones
During an exam, a 14 yr old boy mentions he "can't seem to smell things very well". He denies associated allergies or upper respiratory symptoms. Formal testing confirms he's unable to smell.
Which of the following is most likely to be identified during additional evaluation?
A) Heterochromia
B) Left abducens (CN 6) palsy
C) Multiple cafe-au-lait spots
D) Testicular volume <4 mL
E) Marked ligament laxity & joint hyperextensibility
D) Testicular volume <4 mL
Which of the following is the most likely cause of cerebral palsy (CP)?
A) Low birth weight / prematurity
B) Perinatal birth asphyxia
C) Genetic abnormalities
D) Infection
E) Inborn error of metabolism
A) Low birth weight / prematurity
2 yr old is brought to the ED by EMS after being found unresponsive & "choking on his own vomit" in Dad's workshop. On exam, he's difficult to arouse & appears confused & disoriented. During evaluation for presumed ingestion, calcium oxylate crystals are noted in the urine.
Which of the following substances did he most likely ingest?
A) Salicylates
B) Imipramine
C) Digoxin
D) Ethylene glycol
E) Iron
D) Ethylene glycol
10 yr old presents w/ morning headaches, emesis, bitemporal hemianopsia & progressive behavior changes.
Which of the following is the most likely diagnosis?
A) Retinoblastoma
B) Glioblastoma multiforme
C) Craniopharyngioma
D) CNS leukemia
E) Histiocytosis
C) Craniopharyngioma
3 yr old boy presents w/ a "draining ear" for an indeterminate amount of time. On exam, a spherical whitish-gray, cystic-like mass is identified behind the left TM along the edge of the posterior-superior quadrant of the drum.
Which of the following is the most likely diagnosis?
A) Bony tumor originating from the mastoid air cells
B) Foreign body surrounded by keratin debris
C) Granulomatous tissue surrounding a displaced tympanostomy tube
D) Cholesteatoma
E) Periosteal new bone formation formation along the posterior border of the incus in response to chronic purulent otitis media
D) Cholesteatoma
The mom of 11 yr old twins asks about expected pubertal changes in her sons in the next several years.
Which of the following is most likely to occur first in the sequence of maturational events in boys?
A) Appearance of pubic hair
B) Appearance of facial hair
C) Completion of voice change
D) Eruption of the 3rd molars (wisdom teeth)
E) Appearance of axillary hair
A) Appearance of pubic hair
5 yr old presents w/ nighttime episodes of facial twitching & difficulty talking. The episodes evolve into generalized shaking at time. He is developmentally normal.
Which of the following pattern would you expect to see on EEG?
A) 3 Hz generalized spike & wave
B) 4-6 Hz polyspike & wave
C) Occipital sharp waves
D) Centrotemporal sharp waves
E) Hypsarrhythmia
D) Centrotemporal sharp waves
14 yr old presents to the ED w/ right arm pain after an injury in football practice. XR shows a Type 4 Salter Harris fracture of the distal radius.
Which of the following best describes a Type 4 Salter Harris fracture?
A) Fracture through the physis, adjacent metaphysis & epiphysis
B) Fracture through the physis & adjacent metaphysis
C) Significant damage only to the physis
D) A separation of the physis
E) Fracture through the physis & adjacent epiphysis
A) Fracture through the physis, adjacent metaphysis & epiphysis
17 yr old female presents w/ 3-4 mo hx of irregular menses, lower abdominal pain & "heaviness". As part of her workup, a plain XR of the abdomen shows calcifications in the area of the left ovary.
Which of the following is most likely associated w/ these findings?
A) Serous cystadenoma
B) Polycystic ovary syndrome
C) Mucinous cystadenoma
D) Mature cystic teratoma
E) Endometrioma
D) Mature cystic teratoma
5 yr old boy w/ trisomy 21 presents w/ cough & nasal discharge for several wks. The exam is normal with the exception of obvious halitosis & copious amounts of purulent, foul-smelling discharge from the right nare.
Which of the following is the most likely diagnosis?
A) Acute sinusitis
B) Streptococcosis
C) Secondarily infected nasal hematoma
D) Allergic rhinitis
E) Nasal foreign body
E) Nasal foreign body
Which of the following meets the diagnostic criteria for diabetes?
A) A fructosamine of 220 mmol/L
B) An oral glucose tolerance test with a level of 148 mg/dL at 2 hrs
C) A random blood glucose >140 mg/dL with signs & symptoms of diabetes, including polyuria, polydipsia & polyphagia
D) A hemoglobin A1c of 6.0%
E) A fasting blood glucose of 130 mg/dL
E) A fasting blood glucose of 130 mg/dL
18 yr old girl has a hx of a seizure disorder, which is currently well controlled on antiseizure therapy. During the visit, she also requests that she be placed on oral contraceptives.
Which of the following antiseizure medications could be used in conjunction with OCPs without interfering w/ the action of contraceptives?
A) Carbamazepine
B) Phenytoin
C) Keppra
D) Felbamate
E) Topiramate
C) Keppra
Which of the following is most consistent w/ a black widow spider bite?
A) Acute hepatic failure
B) Severe necrosis surrounding the site of the bite, associated w/ formation of a large eschar
C) Formation of a hemorrhagic vesicle at the site of the bite within 12-24 hrs of the bite
D) Onset of a generalized tonic-clonic seizure within 2-3 hrs of the bite
E) Severe generalized cramping pain within 30-60 min of the bite
E) Severe generalized cramping pain within 30-60 min of the bite
3 yr old boy presents w/ sudden onset of unilateral proptosis & periorbital ecchymosis (raccoon eyes). After additional workup, it's determined that his eye findings represent metastatic disease.
Which of the following neoplasms are most likely to metastasize to the eye?
A) Neuroblastoma
B) Wilms Tumor
C) Ewing Sarcoma
D) Osteosarcoma
E) Acute Lymphoblastic Leukemia
A) Neuroblastoma
5 yr old presents w/ chronic cough. Cough & nasal congestion have been present x6 months, worse when she first awakens or is lying down. Mom has also noted significant halitosis in the mornings. No fevers, headaches or wheezing. Cough usually sounds productive, but have not seen sputum. Lung auscultation is normal on exam.
What is the most appropriate therapy?
A) Initiation of inhaled corticosteroids
B) Trial of proton pump inhibitor
C) Antitussive therapy
D) Initiation of antibiotic therapy for 2-4 wks
E) Trial of topical nasal corticosteroids
D) Initiation of antibiotic therapy for 2-4 wks
9 yr old presents to the ED w/ nausea, recurrent vomiting, malaise & extreme fatigue. Per Mom, she's lost 7 lbs in the last wk. On exam, orthostatic hypotension is noted, as well as dry mucus membranes, "sunken eyes" & evidence of generalized hyperpigmentation.
Which of the following is most likely to be identified on further evaluation?
A) Hypernatremia
B) Peaked T waves & prolonged PR interval
C) Hyperglycemia
D) Flattened T waves & ST segment depression
E) Decreased levels of ceruloplasmin
B) Peaked T waves & prolonged PR interval
6 mo old girl is admitted for evaluation of progressively poor feeding & lethargy. On exam, she's drooling excessively, has bilateral ptosis & hypotonia of the neck, upper extremities & trunk.
In addition to observing for early signs of respiratory failure, which of the following additional therapies is recommended?
A) Botulism antitoxin (IgG)
B) Gentamicin
C) Piperacillin/Tazobactam
D) Metronidazole
E) Supportive care only
A) Botulism antitoxin (IgG)
15 yr old boy was struck in the R eye w/ a baseball during practice & immediately complained of eye pain & diplopia. On exam, no evidence of blood in the anterior chamber, proptosis or extrusion of contents. On CT, an isolated fracture of the orbital floor is noted.
Which of the following findings is most likely to be noted?
A) Retinal hemorrhages
B) Limitation of right upward gaze
C) Retinal coloboma
D) Limitation of right downward gaze
E) CSF rhinorrhea
B) Limitation of right upward gaze
Which of the following regarding acute leukemia in childhood is correct?
A) It is the second most common form of cancer in children
B) The peak incidence is in children 2-5 yrs old
C) The most common form of leukemia in children is acute myeloid leukemia
D) It is more common in African American children
E) The overall survival for patients w/ ALL is approximately 30%
B) The peak incidence is in children 2-5 yrs old
15 yr old boy presents to the ED w/ increasing ear pain after a wrestling match several hrs ago. He reports immediate onset of pain after his ear protectors were "torn off" by his opponent. A 1.5cm fluctuant, purplish-red, tender mass is noted in the anterior superior portion of the auricle; external canal & TM are normal.
In addition to symptomatic tx of the pain, what is the most appropriate next step?
A) Conservative treatment w/ pressure dressing to the area of the mass
B) Conservative treatment w/ warm compresses to the area of the mass
C) Drainage followed by pressure dressing
D) Conservative treatment w/ pressure dressing & ice to the area of the mass
E) Ice the area of the mass & begin antimicrobial prophylaxis with Cephalexin
C) Drainage followed by pressure dressing
Parathyroid hormone (PTH) is normal in which of the following?
A) Renal rickets (renal osteodystrophy)
B) Vitamin D dependent rickets
C) Hypophosphatemic rickets
D) Rickets due to deficiency of 1-OH
E) Rickets due to deficiency of 25-OH
C) Hypophosphatemic rickets
13 yr old child comes in w/ hx of several wks of increasing headaches & vomiting. He is afebrile & has no hx of infection. His symptoms worsen w/ lying flat. He complains of double vision.
Which of the following cranial nerve abnormalities might you discover w/ this disease?
A) 4th nerve palsy
B) 8th nerve palsy
C) 10th nerve palsy
D) 7th nerve palsy
E) 6th nerve palsy
E) 6th nerve palsy
17 yr old male is admitted from the ED after ingesting an unknown quantity of aspirin in an apparent suicide attempt. Lab findings include a salicylate level of 64. You start a medicine to increase the excretion of salicylate.
Which of the following complication is known to interfere with efforts at urine alkalinization?
A) Hyponatremia
B) Hypophosphatemia
C) Hypokalemia
D) Hypochloremia
E) Hypocalcemia
C) Hypokalemia
2 yr old presents w/ a mass in his abdomen found during a bath. On exam, BP is 120/75; you palpate a large, firm mass in the RUQ. Weight & height are over the 95%ile, and specifically he has a large tongue. You measure the R leg and note it's 2cm longer than the L leg. A U/A shows microscopic hematuria.
Which of the following is the most likely diagnosis?
A) Hepatoblastoma
B) Pheochromocytoma
C) Pleuropulmonary blastoma
D) Wilms tumor
E) Renal cell carcinoma
D) Wilms tumor
On exam, a 2 yr old boy is found to have a discrete, cystic, pea-sized mass w/ an overlying pore midway along the anterior margin of the right SCM muscle.
What is the most likely diagnosis?
A) Branchial cleft cyst
B) Dermoid cyst
C) Epidermal cyst
D) Dermatofibroma
E) Thyroglossal duct cyst
A) Branchial cleft cyst