Funny neonates
A 3-week-old infant is brought to the physician by his mother because of a 1-week history of increasingly frequent vomiting. She says that at first he vomited occasionally, but now he vomits after every feeding. The vomitus is nonbilious and consists of breast milk. He has had fewer wet diapers during the past 2 days. He was born at term following an uncomplicated pregnancy and initially fed well. He appears lethargic and dehydrated. What is the most likely diagnosis?
What is pyloric stenosis
A healthy 5-year-old girl is seen by her usual PCP for a health maintenance visit and a murmur is noted on exam. A murmur had never been noted previously. She is a very healthy child with no cardiac or other symptoms. The murmur is described as a grade 2/6 systolic ejection murmur and there is radiation of the murmur to the lung fields. The second heart sound exhibits wide and fixed splitting. There is no click. Which of the following congenital heart defects is most likely to be the cause of the murmur in this child?
What is ASD
A 5-day-old neonate is brought to the emergency department by ambulance 20 minutes after he had sudden onset of irritability, diaphoresis, and profound dyspnea. The patient has not had fever or other symptoms of systemic illness. He was delivered vaginally at term without complications. Temperature is 37.0°C (98.6°F), pulse rate is 200/min, and respirations are 50/min. On physical examination, auscultation of the chest shows a grade 2/6 systolic ejection murmur that is heard best at the left upper sternal border and radiates to the left interscapular area. Palpation of the abdomen shows enlargement of the liver. Femoral pulses are absent bilaterally, and the lower extremities appear somewhat cyanotic compared with the upper extremities. No other abnormalities are noted. Which of the following is the most likely diagnosis?
What is CoA
A 2-week-old male newborn is brought to the office by his mother for routine well-child examination. The patient is breast-fed, and his mother follows a vegan diet. The mother says she plans to breast-feed until the patient reaches six months of age, and then she will introduce him to solid foods that conform to her vegan diet. On the basis of this information, the patient is at greatest risk for deficiency of which of the following vitamins?
What is B12
A 16-year-old boy is brought to the office because he has had decreasing performance in school over the past six months. During this time, the patient has become more irritable and irresponsible, has changed his group of friends, and has had decreasing personal hygiene. He was previously a high-achieving student, but his grades have slipped to the extent that he is failing several courses. Which of the following disorders is the most likely cause of this patient's symptoms?
What is substance abuse
A 32-week gestation newborn infant develops clinical jaundice on the second day of life. A total serum bilirubin is 22 mg/dl with a direct bilirubin of 0.8 mg/dl. The direct antiglobulin test is positive. No specific therapy is instituted. The following day the infant develops lethargy, poor feeding, vomiting and seizures. A total serum bilirubin is rechecked and is 32 mg/dl with a direct bilirubin of 1.0 mg/dl. Which of the following is the most likely cause of this infant's clinical condition?
What is Kernicterus
A 2-month-old male infant is brought to the physician for a well-child check. The parents report no concerns, and are pleased that the baby is sleeping well since they began placing him in the prone position for sleep. He is bottle fed an iron supplemented soy-based infant formula, and is receiving 3-4 ounces every 2-3 hours. Weight and length are at the 95th percentile.
What do the parents need to be counseled about?
What is sleeping prone
A 2-month-old male infant born with tetralogy of Fallot is brought to your office for a health supervision visit. The infant has been doing well, without any symptoms of his cardiac abnormality. His oxygen saturation before receiving immunizations today was 88% on room air. When vaccinations are administered, the infant has a prolonged crying episode and appears cyanotic. Upon recheck, his oxygen saturation is 70% and continues to drop into the 50% range, with visible worsening of his cyanosis and an increase in his respiratory rate from a baseline of 40 breaths/min to 70 breaths/min.
What is knee to chest position
A 6-year-old boy is brought to the office because he has had pain in his right knee for the past two days. The patient walks with a mild limp because of the pain. He has no history of trauma to the knee. He had cold symptoms one week ago but is otherwise healthy. Vital signs are within normal limits. Physical examination shows full range of motion of the right knee with limited internal rotation of the right hip. On laboratory studies, erythrocyte sedimentation rate is slightly elevated and white blood cell count is within normal limits. Anteroposterior and frog-leg x-ray studies of the right hip and knee show no abnormalities. Which of the following is the most likely cause of the pain in this patient's knee?
what is transient synovitis
A 14 year old is admitted due to severe acute gastroenteritis. On examination, she has ild tachycardia. Her weight is 40 kg. After fluid bolus, at what rate would you run the maintenance fluids ?
What is 80 mL/hr
A 3-week-old male infant presents with a history of projectile vomiting for the last 3 days. The family history is notable for several family members with a history of the same condition in infancy. His current weight is the same as his birth weight. Which of the following is the MOST likely abnormality in the infant's electrolytes?
What is Hypochloremic metabolic alkalosis
You are called to the nursery to evaluate a full-term male newborn noted by the nurses to have apneic episodes and poor feeding. The pregnancy was remarkable for polyhydramnios and abnormal prenatal ultrasonography showing a single umbilical artery, suspected congenital heart defect, and intrauterine growth retardation. Maternal serum quadruple screening at midtrimester revealed low levels of human chorionic gonadotropin and unconjugated estriol. On physical examination, the newborn is small for gestational age with dysmorphic features. He has a small head, eyes, and mouth with low-set malformed ears; micrognathia; rocker bottom feet; a systolic ejection murmur; and generalized hypotonia. His hands are clenched with over lapping fingers.
What is trisomy 18
A 16-year-old adolescent collapses while playing basketball. He had been running down the court when it happened and injured his right hand when he fell. He is now awake and reports that he felt short of breath and had chest pain before the event. The adolescent denies any history of palpitations, but he has felt short of breath in the past with exercise and was prescribed an albuterol inhaler, which he did not use today. His father passed away, reportedly from a severe asthma attack, when the adolescent was 6 years of age. Other family members had died at a young age. There is no family history of seizures or congenital deafness. The adolescent is taken to the emergency department.
What is HCOM
A 2-week-old female neonate is brought to your office for an urgent visit because bright red blood was noted in her stool this morning. She was born at term by spontaneous vaginal delivery after an uncomplicated prenatal course. She was breastfed and began receiving standard infant formula supplementation because of poor weight gain in the first week after birth. Her parents report that she has had increasing fussiness over the past week. They deny fever or rash.
Of the following, the MOST likely cause for this neonate’s presenting symptoms is
What is Cow milk protein allergy
. You are seeing a 16-year-old girl in the teen health clinic for fever and abdominal pain. She reports a history of a white vaginal discharge. On abdominal examination the bowl sounds are hypoactive and there is bilateral lower quadrant tenderness with guarding. There are palpable 0.5 cm inguinal lymph nodes bilaterally. Pelvic exam reveals pain on lateral motion of the cervix. Which of the following physical examination findings is most suggestive of pelvic inflammatory disease?
What is cervical motion tenderness
A 2-week-old baby has a murmur noted which was not noted previously. The echocardiogram reveals a large VSD. What ONE circulatory change explains why the murmur was not noted on the newborn exam
What is High pulmonary vascular resistance
A girl is brought to your office for a health supervision visit. When you enter the room, the patient is walking, stoops to pick up an object on the floor, and hands it to her father. She has 2 to 3 words and points to objects that she wants her father to notice. Her father reports that she is unable to climb steps and cannot point to any body parts when asked.
What is 12 months
A 3-year-old boy is brought to the office by his parents as a new patient for well-child examination. Height is in the third percentile, and weight is in the first percentile. During the interview, the parents say that the patient has been treated multiple times since infancy because of sinus infections and pneumonia. They also note that his stools are generally loose, greasy, and mucousy. During physical examination, the patient coughs frequently. No other abnormalities are noted. Which of the following studies is most effective to determine the diagnosis in this patient?
What is CF
A 16-year-old black adolescent is brought to your clinic for polyuria and polydipsia that has become bothersome over the past 2 weeks. Her mother has type 2 diabetes diagnosed at 35 years of age, and she is worried that her daughter has diabetes. The patient is otherwise healthy and is not taking any medication. Vital signs show a temperature of 37°C, blood pressure of 130/88 mm Hg, heart rate of 98 beats/min, respiratory rate of 18 breaths/min, weight of 90 kg (> 95th percentile), height of 165 cm (65th percentile), and a body mass index of 33 kg/m2 (> 95th percentile). Physical examination reveals acanthosis nigricans over the nape of her neck and both axillae. Laboratory studies are shown:
Plasma glucose : 320 mg/dL (17.8 mmol/L)
Bicarbonate : 28 mEq/L (28 mmol/L)
Blood urea nitrogen: 12 mg/dL (4.3 mmol/L)
Creatinine: 0.5 mg/dL (44 μmol/L)
Hemoglobin A1c : 11%
Urinalysis: Positive glucose, negative ketones
What is Insulin therapy
. A 15-year-old female presents to the urgent care clinic with 2 days of increasing headache that now she rates as an 8 / 10 on the pain scale. She has vomited several times today. She reports intense pain over her "entire head." She has never had headaches previously. She denies any recent trauma. Her past medical history is significant for acne for which she is taking minocycline. Her physical exam is notable for an obese adolescent in obvious pain, but with normal vital signs. Her fundoscopic exam reveals papilledema. She has a normal neurological exam otherwise. The remainder of her exam is unremarkable. Which of the following is the likely cause of the patient's headache?
Pseudotumor cerebri
You are called to the cesarean delivery of a 39-year-old gravida 1, para 0 woman with a history of obesity and fibroids with chorioamnionitis. Maternal laboratory tests were significant for blood type O positive and negative for group B Streptococcus. She was admitted for induction of labor because of preeclampsia. She developed a temperature of 39.3°C associated with uterine tenderness and was begun on vancomycin, clindamycin, and gentamicin. The duration of rupture of membranes was 8 hours. A live female neonate is delivered without assistance. The neonate’s vital signs show a temperature of 37.1°C, heart rate of 156 beats/min, respiratory rate of 40 breaths/min, and a blood pressure of 70/42 mm Hg. She is alert with good tone and no respiratory distress.
What is obtain blood culture, complete blood cell count, and start ampicillin and gentamicin
A male infant is brought to your office for a health supervision visit. He was born at term and has been healthy since birth. While performing the physical examination, you assess the developmental milestones he has achieved. The infant smiles responsively and vocalizes with vowel sounds, but does not squeal or laugh. He can track an object horizontally to midline and sometimes past midline. You note a mild head lag when you pull him to the sitting position from supine, and he makes an effort to hold his head midline when held upright. When placed in the prone position, he is able to lift his head up to 45 degrees. The infant’s hands are open and relaxed much of the time, and he will hold an object placed in his hand. He is not yet reaching for objects, nor bringing his hands to the midline. HOw old am I?
What is 2 months
A 2-year-old girl is brought to the office by her parents after blood was noticed in her urine. The parents say the patient has had intermittent abdominal pain during the past two months but has been otherwise well. On physical examination, the abdomen is slightly distended and a mass is palpated in the right upper quadrant. Results of urinalysis are positive for blood and protein. Which of the following is the most likely diagnosis?
What is wills tumor
A 15-year-old adolescent girl presents to your office with her mother. She has been experiencing intermittent crampy abdominal pain that is generalized and lasts for several hours. There is no association with eating, voiding, or defecation. The adolescent denied nausea, vomiting, and diarrhea. She passes stools daily without difficulty, with intermittent bright and dark red blood. Her mother reported no family history of food allergy, celiac disease, or constipation. Her father has been diagnosed with a polyposis syndrome.
On physical examination, the adolescent’s temperature is 37.5°C, heart rate is 90 beats/min, respiratory rate is 17 breaths/min, and blood pressure is 105/75 mm Hg. She is alert and well nourished. Her abdomen is soft, flat, and nontender, with no palpable mass and normal bowel sounds. Her rectal examination is normal, without hemorrhoid or fissures. You note brown macules on her lips, tongue, and hands. The remainder of her physical examination is unremarkable. Her labs are as follows
Hb : 10
Plt: 220
Stool Occult blood: Positive
What is Peutz-Jeghers syndrome
What are the 4 stages of puberty in females?
thelarche, pubarche, peak height velocity, menarche