Neurology
When is an upgoing plantar reflex normal?
Until 12 months
The most concerning physical finding in an infant with an acute respiratory infection or RAD exacerbation is:
Grunting
A 7-week-old, full-term girl has worsening jaundice that the parents first noticed 10 days ago. On her examination, she is well appearing and is noted to have a liver edge 4cm below her costal margin. Her direct bilirubin is 9. The most likely cause of her direct hyperbilirubinemia is which of the following:
Biliary atresia
A 5-day-old boy is brought in by his parents because of a white discharge from both of his nipples. He was a full-term infant, and mom had an uncomplicated pregnancy and delivery. He has been otherwise well. He is afebrile and has no masses, warmth or tenderness surrounding his nipples. This drainage is most suggestive of:
Normal newborn physiology
Which of the following cardiac effects are seen with TCA overdose?
All of the above
When does the palmar grasp reflex diminish?
a. 2 months
b. 4 months
c. 6 months
d. 1 year
4 months
16. The most common CXR finding in infants with bronchiolitis is:
Hyperinflation
All of the following are FALSE regarding intussusception EXCEPT:
Older children with intussusception are more likely to have an identifiable "lead point"
A 15-month-old boy is brought in to the ED by his parents after they had a hard time awakening him in the morning. He had been acting well the evening before, but because the family had brussel sprouts and liver for dinner, the patient skipped most of his meal. His bedside glucose is 28. All of the following are true EXCEPT:
This patient should be treated immediately with 1-2 cc/kg D50W
A 2-year-old presents to the emergency department (ED) with a history of vomiting and diarrhea that started abruptly on the morning of presentation. You note that the mother is pregnant during your physical exam of the child. The vital signs include: T 37° C, HR 110, BP 80/P, and SaO2 95% on room air. What is the mostly likely ingestion in this patient?
Iron
Simple febrile seizures are defined as all of the following Except:
Only two seizures in a 24 hour period
A 5-day-old full term girl born via spontaneous vaginal delivery presents to the ED with a few hours of fussiness and poor feeding. The mother also reports that the baby’s color is different. The mother denies any history of fever for the baby. Vital signs are as follows: temperature 36.5ºC, heart rate 180 bpm, respiratory rate 80 with a pulse oximetry that was unobtainable. On examination, the child is active and alert, fussy but consolable with a capillary refill time of greater than 3 seconds. Femoral pulses are weakly palpable, dorsalis pedis is not palpable, and auscultation of the heart reveals 3/6 systolic murmur over the precordium.
Which of the following emergency interventions will show immediate clinical improvement?
a. Intravenous PGE2 infusion
b. Intravenous ampicillin and cefotaxime
c. Intravenous normal saline bolus
d. Albuterol nebulizer and inhaled oxygen via 100% non rebreather.
Intravenous PGE2 infusion
A 5-year old girl presents with a purpuric rash on her abdomen and buttocks. She has also had diffuse abdominal and bilateral ankle pain. All of the following are TRUE statements about this disease EXCEPT:
Patients commonly progress to end-stage renal disease
An 8-year-old, previously healthy girl is brought in for evaluation of altered mental status. She is lethargic but is protecting her airway. She has a blood pressure of 80/40, a heart rate of 160, and respiratory rate is 50 and hyperpneic. Her electrolytes reveal a sodium of 132, a potassium of 4.8, chloride of 86, CO2 of 6 BUN 30, Cr 1.1, and a glucose of 660. Her pH is 7.06 with a PCO2 of 21 and a HCO3 of 6. Her base deficit is -22. Her urine has 4+ ketones.
Appropriate initial therapy for this patient includes:
Normal saline bolus, followed by half-normal saline with potassium at a maintenance
A 15-year-old male presents to ED in a coma with CPR in progress. A friend found him in the schoolyard. His friend confesses that the patient has been depressed over the past several days. His initial labs reveal hypocalcemia and a severe metabolic acidosis. The urine shows calcium oxalate crystals. What was the toxic ingestion?
Ethylene glycol
A 2-1/2 year old child has a 5 minute generalized tonic-clonic seizure with a fever of 102. Examination reveals a right otitis media, no nuchal rigidity and normal mental status one hour after the event. Neurodevelopmental status is normal. Family history is positive for maternal febrile seizures. This is the child's first seizure. Which of the following statements are true?
The risk of recurrence of a febrile seizure in this child is approximately 30%
A 9-year-old boy is brought to the pediatric ED by his mother because of fever to 103 degrees Fahrenheit associated with generalized malaise and fatigue. Upon further questioning, the mother reports the boy was seen by his pediatrician last week for low-grade fevers associated with muscle and joint soreness thought to likely be caused by a flu-like viral illness. The patient’s past medical history is significant only for a heart murmur caused by “a problem with one of his valves.” Vital signs are temperature 39.6ºC, heart rate 145, respiratory rate 38, blood pressure 102/56 and pulse oximetry 98%. Physical examination reveals a tired-appearing child with a loud systolic murmur heard best over the right upper sternal border.
What is the most common organism causing infective bacterial endocarditis in children?
a. Staphylococcus aureus
b. Viridans streptococcus
c. Streptococcus pyogenes (Group A Streptococcus)
d. Staphylococcus epidermidis
Staphylococcus aureus
A 2-month-old, otherwise healthy boy presents with several episodes of vomiting and no bowel movement for 4 days. His parents state that he has had difficulty passing his stools since birth. His abdomen is distended, and stool is palpable in the suprapubic region. His rectal examination reveals no fissures, and no stool is palpable on digital examination. He has a bowel movement after you remove your finger. Which of the following statements is TRUE about the most likely etiology of this patient's constipation?
Caused by an absence of parasympathetic ganglion cells in the intestine
A 3-year-old boy with a fever and altered mental status had bacterial meningitis diagnosed after a lumbar puncture in the ED and has been started on appropriate antibiotics. His serum sodium is
118 mEq/l. While awaiting the pediatric transport team, this child has a seizure. All of the following statements are true EXCEPT:
Hypertonic saline should be rapidly administered until the serum sodium is corrected to
the normal range.
An 18-month-old boy was playing in the garage and 20 minutes later was found by his parents vomiting and gagging. They bring him to the ED 30 minutes after the incident. Vital signs include: HR 130, BP 90/50, SaO2 93% on RA, RR 50. He is tachypneic and coughing on physical exam. What is the next most appropriate step in treatment before getting a CXR?
Give supplemental O2
Which of the following causes of gastroenteritis have been associated with seizures?
Shigella
An 8-year-old obese boy presents to the ED with a history of intense retrosternal chest pain and difficulty breathing on exertion for several hours. Past medical history is significant for asthma for which patient receives albuterol nebulizations as needed with daily inhaled fluticasone and oral montelukast. He has been hospitalized twice in the past for asthma and once for Kawasaki disease at the age of 4. Vital signs are as follows: temperature 37ºC, heart rate 144 bpm, respiratory rate 36, and pulse oximetry 95% on room air. On physical examination, he is diaphoretic with capillary refill time less than 2 seconds, and normal heart sounds with no murmur auscultated. Respiratory examination revealed no wheezing and no intercostal retractions.
What is the next best step in management of this patient?
a. Inhaled albuterol nebulizer treatment, nasal cannula oxygen, oral corticosteroids, chest x-ray
b. Reassurance, breathing in a paper bag, oral lorazepam
c. Morphine, inhaled oxygen, sublingual nitroglycerine, aspirin, chest x-ray, ECG, cardiac enzymes, and cardiology consult
d. Chest x-ray, intravenous antibiotics, and admission to general pediatrics
Morphine, inhaled oxygen, sublingual nitroglycerine, aspirin, chest x-ray, ECG, cardiac enzymes, and cardiology consult
A 6-day-old girl presents with a three-hour history of bilious emesis and rectal bleeding. Initially she was quite irritable but is now lethargic. Her abdomen is distended. An abdominal obstruction series shows a dilated stomach and small intestine, but a paucity of gas in the colon. The next step in management of this patient should be which of the following:
Surgical intervention
Risk factors associated with the development of cerebral edema in a patient with DKA include all of the following except:
Hypercapnia
A 16-year-old male with a history of bipolar disorder presents via EMS with confusion, nausea, vomiting, and ataxia noted this morning by his mother. His vital signs include: T 36.9° C, HR 100, BP 110/70, and SaO2 96% on room air. On physical exam, you note the patient to have a resting tremor with myoclonus. Which drug do you suspect is causing his condition?
Lithium