Preventative Medicine
A 4-year-old male is brought in by his parents who are concerned about lead exposure. He lives in a home built in 1950. His capillary lead level is $46μg/dL. A venous lead level is obtained and returns at 45μg/dL. What is the most appropriate next step in management?
Oral Succimer
An obese 13-year-old male presents with a 3-week history of dull aching pain in his right knee and a slight limp. He denies recent trauma. On examination, he is noted to walk with his right foot externally rotated. He has limited internal rotation of the right hip. Which of the following is the most appropriate management step?
Immediate Non-weight Bearing
A 6-year-old male presents with a 2-week history of nocturnal perianal itching. You perform a 'tape test' in the office. Which of the following is the treatment of choice?
Albendazole or Pyrantel pamoate
A 16-year-old male is evaluated for a sports physical. His blood pressure is 135/85mmHg (> 95th percentile). He has no symptoms. What is the most appropriate next step?
Remeasure in 2 weeks
A 3-year-old male presents with high fever, barking cough, and inspiratory stridor at rest. He received one dose of dexamethasone at an urgent care 2 hours ago but his stridor has persisted. What is the most appropriate next step in management
Nebulized Racemic
A 12-month-old female is evaluated for her well-child visit. She is not yet walking. She can pull to stand and cruise along furniture. She has a pincer grasp and can say 'mama' and 'dada' specifically. Which of the following is the most appropriate action?
Reassurance
A 16-year-old male runner presents with pain on the lateral aspect of his left knee. The pain is worse when running downhill. On exam, there is tenderness over the lateral femoral condyle. There is no joint effusion, and the McMurray test is negative. What is the most likely diagnosis?
ITB syndrome
A term male neonate is noted at birth to have scattered pustules on a non-erythematous base over the forehead and chin. Several hyperpigmented macules with a fine collarette of scale are also present on the trunk. A Wright stain of a pustule reveals numerous neutrophils and no organisms. Which of the following is the most likely diagnosis?
Transient neonatal pustular melanosis (TNPM).
A 17-year-old female presents for a routine exam. She is sexually active with one male partner. They use condoms 'most of the time.' She has no symptoms. According to current screening guidelines, which of the following is indicated
GC NAT
A 2-year-old child presents with a 2-day history of low-grade fever and a new rash. The rash consists of erythematous, 'slapped-cheek' appearance on the face and a lacy, reticulated rash on the trunk and extremities. What is the most important counseling point for the family?
Child is no longer contagious, but before the rash appeared no contact with pregnant individuals
A 9-month-old infant is brought in for a well-visit. The mother asks about the flu vaccine. Which of the following is correct regarding the influenza vaccine for this child, assuming this is his first time receiving it
2 doses 4 weeks apart
A 14-year-old girl is found to have a Cobb angle of 22 on a standing PA radiograph of the spine. She is pre-menarcheal and has a Risser stage of 1. What is the most appropriate management?
The most appropriate management is bracing with a rigid thoracolumbosacral orthosis (TLSO)
A 4-year-old child presents with 8 café-au-lait macules all 10mm in diameter, axillary freckling, and two Lisch nodules on slit-lamp exam. According to the revised diagnostic criteria, which of the following findings would also confirm the diagnosis of Neurofibromatosis Type 1 (NF1)?
Heterozygous NF1 gene
A 15-year-old female with Anorexia Nervosa is hospitalized for bradycardia and orthostasis. On day 2 of nutritional rehabilitation, her serum phosphorus level drops from 3.8 mg/dL to 2.1 mg/dL. What is the primary hormone responsible for this shift?
Insulin
A 4-year-old girl is noted to have breast bud development (Tanner II) and a small amount of pubic hair. Her growth velocity has increased from the 50th to the 95th percentile over the last year. Bone age is 6 years. What is the most likely initial finding on laboratory workup?
Elevated LH after GnRH stimulation
An 8-year-old male presents with persistent bedwetting. He has never been dry at night. He has no daytime accidents, no snoring, and no constipation. Physical exam and urinalysis are normal. What is the most effective long-term treatment for this condition?
Bedwetting Alarms
A 2-year-old girl is brought in with a 1-day history of refusing to move her right arm. She was playing with her older brother, who pulled her up by the wrist to help her over a step. She is holding her arm slightly flexed and pronated. There is no swelling or bruising. What is the most appropriate management?
supination-flexion reduction maneuver (or hyperpronation maneuver)
An 8-week-old female infant presents with a large, segmental, bright red plaque covering the entire left side of her face, including the eye and mandible. Which of the following is the most appropriate initial screening study for this patient?
MRI/MRA Head and neck
A 16-year-old male athlete presents for a sports physical. He reports no symptoms but his father died suddenly at age 32. On exam, you hear a grade 2/6 systolic murmur that increases in intensity when moving from a squatting to a standing position. What is the most likely pathophysiological mechanism for this change in murmur?
Decreased LV volume
A 15-month-old male is brought in for a febrile seizure that lasted 3 minutes. He is now at his baseline and has a normal neurologic exam. He has a history of one prior UTI. Which of the following is an AAP-recommended indication for a voiding cystourethrogram (VCUG)?
Abnormal Rental US
or
2nd Febrile UTI
or Atypical or complex clinical situations
A 2-year-old child who was previously meeting all milestones is brought in because he has stopped using two-word phrases over the last 3 months. He now only grunts to communicate but maintains good eye contact and social smiling. His hearing screen is normal. What is the most likely diagnosis?
Landau-Kleffner syndrome
A 16-year-old female athlete presents with amenorrhea for 6 months. She runs cross-country and has lost 10 lbs recently. Which of the following lab findings would be most consistent with Functional Hypothalamic Amenorrhea?
Low serum estradiol level (E2 <50 pg/mL) with low or low-normal LH and normal FSH — the hallmark pattern of hypogonadotropic hypogonadism.
A 2-year-old child with severe atopic dermatitis is brought to the clinic for a 'painful rash.' On exam, the child is febrile 101.8^F and irritable. You observe numerous 'punched-out' hemorrhagic erosions and monomorphic vesicles superimposed on areas of active eczema on the neck and chest. What is the most appropriate immediate management?
Systemic acyclovir
A 15-year-old female presents for evaluation of irregular menses. She had menarche at age 13, but periods occur every 60 to 90 days. Physical exam reveals a BMI 29 kg/m2, mild hirsutism on the upper lip, and inflammatory acne on the back. Pregnancy test is negative. Which of the following is the most appropriate next step to confirm the most likely diagnosis?
Total Testosterone
A 5-year-old male with a history of sickle cell disease presents with an acute onset of limping and right hip pain. He is febrile to 101.5^F. Ultrasound shows a small joint effusion. What is the most likely pathogen?
Salmonella