I Have a Hair ... There
Ouch
Eat Your Vegetables
He's not my kid!
What the heck are you on?!
100
A mother brings in her 7-year-old daughter because she is worried that the little girl will go through puberty too early. The woman tells you that she reached menarche at 9 years of age, and this was a difficult experience. The child's father, on the other hand, had his growth spurt at the end of high school. Of the following, this girl is MOST likely to have early menarche if the physical examination reveals: A. a body mass index greater than the 85th percentile, B. adult body odor, C. breast tissue, D. facial acne, E. pubic hair
C. breast tissue **Bonus Question $200
100
A family comes to your office for consultation regarding a 3-week trip to India they are planning to take in 3 months. The children, a 9-year-old boy and a 7-month-old girl, are well, and their immunizations are up to date. Of the following, the MOST appropriate prophylaxis to provide in preparation for travel is: A. chloroquine for both children, B. hepatitis A vaccination for both children, C. measles vaccination for the girl, D. polio vaccination for the boy, E. typhoid vaccine for both children
C. measles vaccination for the girl
100
A 9-month-old exclusively breastfed baby presents with a seizure. A chest radiograph obtained to rule out aspiration pneumonia reveals rachitic changes of the ribs. Of the following, the MOST likely serum laboratory findings are: A. low calcium and elevated phosphorus, B. low calcium and low phosphorus, C. low calcium and normal phosphorus, D. normal calcium and elevated phosphorus, E. normal calcium and low phosphorus
B. low calcium and low phosphorus
100
***Double Jeopardy Obsessive compulsive disorder is a complex syndrome that may border on "normal areas" at some point. What is the most common obsession in children? What is the most common compulsion (aka "ritual") in children?
Obsession: dirt and germs Compulsion: repetitive cleaning or washing
100
A 16-year-old boy is brought to the emergency department because he had a seizure after returning home from being out with friends. His mother reports that he was agitated and aggressive when he first arrived home about 45 minutes ago and then became unresponsive and developed generalized extremity shaking that lasted for approximately 5 minutes. His friends reported that he "smoked weed," but they denied any other drug or substance use. In the emergency department, he is diaphoretic and difficult to arouse, his heart rate is 140 beats/min, his respiratory rate is 30 breaths/min, his blood pressure is 135/95 mm Hg, and his pupils are mid-sized, equal, and sluggishly reactive. Nystagmus is noted. Of the following, the MOST likely explanation for his symptoms is that: A. seizures are a common adverse effect of marijuana use, B. the marijuana was adulterated with phencyclidine, C. the patient has acute alcohol toxicity, D. the patient is exhibiting symptoms associated with Jimson weed exposure, E. the patient was inhaling gasoline in addition to smoking marijuana
B. the marijuana was adulterated with phencyclidine **Bonus Question 300 points
200
You are examining a 6-year-old boy during a health supervision visit. Physical examination reveals Sexual Maturity Rating 3 pubic hair and a phallus that appears androgen-stimulated (7 cm in stretched length). Of the following, the MOST important additional step to guide your laboratory investigation is: A. examination of testicular size, B. investigation of possible exposure to androgen, C. investigation of the age of puberty in family members, D. measurement of height and weight, E. skin examination for café au lait macules
A. examination of testicular size
200
What is the current recommended vaccine schedule for the use of pneumococcal vaccines in patients with sickle-cell disease and other hemoglobinopathies?
PCV-7 (or 13) at 2, 4, 6, and 12 months of age; and PPV23 at 2 and 5 years of age. **Bonus Question $200
200
Which of the following requires the highest protein requirement on a gram/kg/day basis? A. The newborn infant B. The adolescent having a growth spurt C. A 6-12 month-old infant D. A 4-6 year-old child E. An adult
A. The newborn infant
200
Jane Smith is a 10 y.o. child who has frequent temper tantrums. Sometimes her parents can't figure out how a "lovely child" turns into a holy terror" in less than a minute. Any little thing can set her off. Which of the following is true with regard to "time-out" as a tool for reducing temper tantrums? A. Time-out is instinctive for children. B. A warning that a time-out is coming is usually effective. C. Time-out has lost its usefullness when a child says she does not mind or even likes time-outs. D. After a time-out, it is best to remind the child of the incident to prevent further recurrences. E. The child needs to be quiet and physically in control by the end of the time-out or it is extended.
E. The child needs to be quiet and physically in control by the end of the time-out or it is extended.
200
A 2-year-old boy is brought to the emergency department after his father found the boy in the garage gagging, coughing, and drooling profusely. His parents report that he had opened a number of containers, but they are unable to recall the names of the products. On physical examination, the boy is awake and crying, his heart rate is 160 beats/min, his respiratory rate is 24 breaths/min, he has clear lung sounds, and his blood pressure is 100/60 mm Hg. He has reactive, mid-sized pupils and white eschars on his tongue and soft palate. Shortly after his examination, he begins to vomit. Of the following, the MOST likely cause of this patient's symptoms is: A. antifreeze, B. drain cleaner, C. gasoline, D. glyphosophate weed killer, E. organophosphate insecticide
B. Drain Cleaner
300
A 19 year old female wishes to begin oral contraceptives. Which one of the following medications, when co-administered with an OCP, is most conclusively associated with interference with contraceptive effectiveness? A. Trimethoprim-Sulfamethoxazole B. Fluoxetine C. Ciprofloxacin D. Hydrochlorothiazide E. Carbamazepine
E. Carbamazepine
300
A 17 month old boy presents for routine health maintenance visit. Review of his immunization records indicates that he should receive MMR vaccination. Which of the following is a contraindication to admistering this vaccine? A. Administration of IVIG 2 months earlier for treatment of ITP B. Daily inhaled steroids for control of asthma C. History of anaphylactic reaction to baker's yeast D. Household member with HIV/AIDS E. Daily therapy with valproic acid for control of a seizure disorder
A. Administration of IVIG 2 months earlier for treatment of ITP
300
Name 2 symptoms of Vitamin A deficiency
Nightblindness, corneal opacities, dry eyes, growth failure, increased susceptibility to infection
300
How do you treat night terrors?
Parental Reassurance. Do not wake the child up during the attack.
300
Which of the following findings on physical examination is associated with chronic marijuana use? A. Gynecomastia B. Bradycardia C. Hepatosplenomegaly D. Hypertrichosis on the face and trunk E. Purplish striae on the abdomen and thighs
A. Gynecomastia
400
Between which two Tanner stages does a female undergo her "growth spurt (a.k.a. Peak height velocity)?"
Tanner stage 2-3 Bonus Question (2 parts)**
400
A 10 year old boy has not received any immunizations. He is currently healthy. There is no history of varicella infection. Which vaccines should he receive today? A. Hepatitis B, MMR, Tdap, IPV, Hepatitis A, Varicella B. Hepatitis B, MMR, Tdap, IPV, HiB, Hepatitis A, Varicella C. Hepatitis B, MMR, DTap, IPV, HiB, Hepatitis A, Varicella D. Hepatitis B, MMR, DTap, IPV, Hepatitis A, Varicella E. Hepatitis B, MMR, DTap, IPV, HiB, PCV-13, Hepatitis A, Varicella
A. Hepatitis B, MMR, Tdap, IPV, Hepatitis A, Varicella **Bonus Question $400
400
Name 3 substances that you must give as supplementation to a child with a strict vegan diet.
Vitamin B12, iron, calcium, Zinc
400
At what age range, if at all, is head banging normal?
8 months - 4 years
400
A 16 year old girl presents to the ED after the principal at her school noted her to be "acting like she was high again." She is suspected of chronicallly abusing barbiturates. Assuming that she ingested barbiturates within a few hours of presentation to the ED, which of the following eye findings is most likely to be identified upon further evaluation of this patient? A. Conjunctival Injection B. Papilledema C. Dilated pupils D. Lateral Nystagmus E. Horizontal and/or vertical nystagmus
D. Lateral Nystagmus
500
You are examining a 6-year-old girl at her annual health supervision visit. She has Sexual Maturity Rating 3 pubic hair, but no axillary hair. Her mother notes that the child has had an adult body odor for about 6 months. You cannot detect breast tissue, and she does not have clitoromegaly. Her growth has remained at the 50th percentile. Of the following, the MOST important test to perform at this time is: A. bone age radiography, B. magnetic resonance imaging of the head, C. pelvic ultrasonography, D. serum estradiol measurement, E. serum testosterone measurement
A. bone age radiography
500
Which of the following vaccines are usualy given as subcutaneous injections? A. MMR, IPV, varicella B. MMR, DTap, varicella C. MMR, DTap D. MMR, DTap, IPV E. DTap, IPV, PCV
A. MMR, IPV, varicella
500
The loss of which area of subcutaneous fat indicates long lasting, severe malnutrition?
Buccal Fat Pads
500
At what age range, if at all, is cross dressing normal?
Children <5 years of age
500
A 16 year old boy is transported to the ED after he was found in a confused state whyle lying on the bathroom floor at his high school. He appears disoriented and complains of headache, shortness of breath, and dizziness. He is noted to have tachycardia and bluish discoloration of the skin and mucous membranes. Arterial blood, which appears reddish-brown in color, reveals a normal PaO2. Which of the following substances is the likely cause of his symptoms? A. Marijuana B. LSD C. PCP D. Methamphetamine E. Amyl Nitrite
E. Amyl Nitrite
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