2024 PACKRAT Pediatrics | Actual Questions and Verified Answers ( Included ) 100% Correct

PACKRAT Pediatrics 1. A 10 year-old female experiences fever and polyarthralgia. On examination you note a new early diastolic murmur. Laboratory results are positive for antistreptolysin O. The patient has no known drug allergies. Which of the following is the recommended prophylaxis for this condition? A. Doxycycline B. Erythromycin C. Benzathine penicillin G D. Trimethoprim/sulfamethoxazole: Answer (u) A. Doxycycline and Bactrim are not indicated for the prophylaxis of recurrent rheumatic fever. (u) B. Erythromycin is considered second line for prophylaxis of recurrent rheumatic fever in a patient with a penicillin allergy. (c) C. Recurrences of rheumatic fever are most common in patients who have had carditis during their initial episode and in children. The preferred method of prophylaxis is Benzathine penicillin G every four weeks. 2. A 12 year -old boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Examination of the heart reveals an ejection click and accentuation of the second heart sound. Femoral pulses are weak and delayed compared to the brachial pulses. Blood pressure obtained in both arms is elevated. Chest x -ray reveals rib notching. Which of the following is the most likely diagnosis? A. abdominal aortic aneurysm B. pheochromocytoma C. coarctation of the aorta D. thoracic outlet syndrome: Answer (u) A. Abdominal aortic aneurysm is usually asymptomatic until the patient has dissection or rupture. It is uncommon in a child. (u) B. Pheochromocytoma classically causes paroxysms of hypertension due to catecholamine release from the adrenal medulla, but does not cause variations in blood pressure in the upper and lower extremities. (c) C. Coarctation is a discrete or long segment of narrowing adjacent to the left subclavian artery. As a result of the coarctation, systemic collaterals develop. X-ray findings occur from the dilated and pulsatile intercostal arteries and the "3" is due to the coarctation site with proximal and distal dilations. (u) D. Thoracic outlet syndrome occurs when the brachial plexus, subclavian artery, or subclavian vein becomes compressed in the region of the thoracic outlet. It is the most common cause of acute arterial occlusion in the upper extremity of adults under 40 years old. 3. A 12 month -old child with tetralogy of Fallot is most likely to have which of the following clinical features? A. Chest pain B. Cyanosis C. Convulsions D. Palpitations: Answer (u) A. Chest pain is not a feature of tetralogy of Fallot. (c) B. Cyanosis is very common in tetralogy of Fallot. (u) C. Convulsions are occasionally seen as part of severe hypoxic spells in infancy rather than a feature of tetralogy of Fallot. (u) D. Palpitations are uncommon in tetralogy of Fallot. 4. An 8 -year-old boy is brought to a physician because of palpitation, fatigue, and dyspnea. On examination, a continuous machinery murmur is heard best in the second left intercostal space and is widely transmitted over the precordium. The most likely diagnosis is A. ventricular septal defect. B. atrial septal defect. C. congenital aortic stenosis. D. patent ductus arteriosus.: Answer (u) A. VSD causes a holosystolic murmur rather than a continuous machinery -like murmur. (u) B. ASD causes a fixed split S2 rather than a continuous systolic heart murmur. (u) C. Congenital aortic stenosis causes a crescendo -decrescendo systolic murmur heard best in the second intercostal space. (c) D. Patent ductus arteriosus is classically described in children as a continuous machinery -type murmur that is widely transmitted across the precordium. 5. A 3-year-old boy is seen in the office with a 5-day history of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips, and cervical adenopathy. Antistreptolysin A (ASO) titer and throat culture are negative. The most serious systemic complication associated with this disorder is A. renal. B. cardiac. C. pulmonary. D. hepatic.: Answer (c) B. The patient most likely has Kawasaki syndrome. The major complication with this disorder is coronary artery aneurysms, which are reported in up to 20% of affected children. The etiology of this disorder is uncertain, although a bacterial toxin with super antigen properties may be involved. (u) D. Children with Kawasaki syndrome may have associated hydrops of the gallbladder, but liver involvement is not part of this disorder. 6. A 9 year -old presents with increasing shortness of breath while playing basketball recently. On examination, radial pulses are exaggerated while femoral pulsations are weak. Chest radiograph shows rib notching and a mildly enlarged heart. Which of the following is the most likely diagnosis for this patient? A. Atrial septal defect B. Coarctation of the aorta C. Patent ductus arteriosus D. Tetralogy of Fallot: Answer (u) A. See B for explanation. (c) B. In older children, the ECG and chest x-ray usually show left ventricular hypertrophy and a mildly enlargedheart. Rib notching may also be seen in older children (>8 years old) with large collaterals. (u) C. See B for explanation. (u) D. See B for explanation. 7. A 16 year -old athlete with no past medical history collapses after running 50 yards down the field. He is unresponsive, pulseless and cyanotic.Which of the following is the most likely cause of this student's collapse? A. Hypertrophic cardiomyopathy B. Myocardial infarction C. Pulmonary embolism D. Reactive airway disease: Answer (c) A.This presentation is consistent with hypertrophic cardiomyopathy which may initially be difficult to diagnose.Infants but not older children frequently present with signs of CHF. Older children may be asymptomatic, with sudden death as the initial presentation (u) B. See A for explanation. (u) C. See A for explanation. (u) D. See A for explanation. 8. A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x -ray reveals interstitial infiltrates and a cold agglutinin titer was negative. Which of the following is the most likely diagnosis? A. acute bronchitis B. viral pneumonia C. mycoplasma pneumonia D. pneumococcal pneumonia: Answer (u) A. While the patient's clinical symptoms of dry cough and rhonchi support this diagnosis, the chest x -ray would be normal or only show a mild increase in bronchovascular markings, not infiltrates. (c) B. The patient's clinical symptoms as well as chest x-ray findings and negative cold agglutinin titer are most consistent with viral pneumonia. (a) C. While the gradual onset of symptoms suggest mycoplasma, the negative cold agglutinin titer makes this less likely. (u) D. In older children the signs and symptoms of pneumococcal pneumonia are similar to an adult and consist of an abrupt onset of cough, fever and chills. The chest x -ray would reveal a lobar consolidation, not interstitial, picture. 9. A 3 month -old male presents with a hoarse cough and thick purulent rhinorrhea for the past 2 days. The mother noted that yesterday he appeared to get worse and seemed to have increasing problems breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-ray reveals hyperinflation with diffuse interstitial infiltrates. Which of the following is the most appropriate intervention?