PEDS Rosh Boost Exam Questions And Answers With Verified Solutions

% BSA affected in SJS and TEN? - Answer-SJS < 10% BSA TEN > 30% BSA 12 month old pt comes in and the mother reports that the child has sudden flexion and stiffening of the neck, limbs, and trunk followed by gradual extension and relaxation. These jerking spells have become more frequent and occur in clusters throughout the day. The baby will cry briefly after the spells and then become sleepy. What is dx? - Answer-Infantile spasm A 10-year-old girl presents to clinic due to a generalized rash. History reveals that four days prior the onset of rash she was noted to have low-grade fever, runny nose, cough, and conjunctival congestion. The rash is characterized as red, maculopapular eruptions which were noted to first appear on the forehead before spreading downward to the extremities. The physical examination reveals a weaklooking girl with anicteric sclerae, pink conjunctivae, cervical and occipital lymphadenopathy, harsh breath sounds, adynamic precordium, no heart murmur, soft non-tender abdomen, full equal pulses, capillary return time of less than two seconds, and maculopapular rashes on the lower trunk and extremities with brawny desquamation on the upper trunk. Further history reveals that she is missing some of her immunizations. What is the most likely diagnosis? - Answer-Measles A 12-month-old boy presents with two days of nasal congestion, red eyes, and fever. On examination, he has bilateral purulent conjunctivitis and purulent nasal discharge. Both tympanic membranes are erythematous, bulging, and dull with limited mobility. What therapy is indicated? - Answer-Amoxicillinclavulonate (augmentin) *d/t bilateral AOM w/ h. flu A 12-year-old boy presents with his mother for his annual physical exam The mother states she is concerned that her son is very short compared to the rest of his classmates, while just a few years ago his height seemed comparable to his peers. She says he sits for long periods of time, does not want to play sports, and tires easily. He complains of being cold all the time. On physical exam, a diffusely enlarged thyroid gland is noted. His serum thyroid stimulating hormone (TSH) and serum free thyroxine (T4) are tested. What levels of TSH and T4 would indicate primary hypothyroidism as the cause of his symptoms? - Answer-- High TSH - Low FT4A 12-year-old girl presents to the primary care physician for her first physical following her international adoption. She is feeling well, but her mother was recently diagnosed with fulminant hepatitis B. What test findings would indicate the child is immune to hepatitis B due to vaccination? - Answer-Anti-HBs POSITIVE and HBsAg NEGATIVE A 16-year-old boy presents with mild left-sided hearing loss following a scuba diving trip. He also noticed reddish discharge from the left ear but denies vertigo or facial muscle weakness. On physical exam, there is a perforation of his left tympanic membrane. What is the appropriate management of this patient? - Answer-Ofloxacin otic drops (b/c occurred under water) A 2-year-old boy presents to the ED with a three-day history of increasing fussiness, decreased appetite, and intermittent non-bloody, non-bilious vomiting. He has not had any sick contacts, but he recently visited relatives who live in an old home currently undergoing renovations. His mother is concerned he may have been exposed to lead paint. What is the best test to confirm the diagnosis? - Answer-VENOUS blood lead level A 2-year-old boy, who is up to date with his vaccinations, presents in mild respiratory distress with noticeable inspiratory stridor and a barking cough on exam. His parents report his symptoms seemed to improve with exposure to the cold outside air. What is the most likely pathogen responsible for the patient's presentation? - Answer-Parainfluenza virus (Croup) A 3-day-old term infant presents to the pediatrician for his first health check. There were no complications during delivery, and the infant is breastfeeding well per his mother. What supplement is recommended for the infant? - Answer-Vitamin D (BM is deficient in Vita D) * why vitamin D drops or mom can take pills for baby to get through BM A 3-year-old boy presents to your clinic due to his mother's concerns about the patient having intermittent fevers, fatigue, bruising without injury and a pale appearance. Physical exam reveals a palpable liver and spleen, and pale conjunctiva. Initial laboratory testing reveals elevated white blood cell count and lymphoblasts on the peripheral smear. Which of the following is used to confirm the diagnosis? - Answer-Bone marrow aspiration and biopsy A 4-year old boy presents to the office for his well-child examination. Upon listening to his heart, you hear a soft murmur. Which of the following features would be concerning for a pathologic murmur? - Answer-Widely spit and fixed S2A 4-year-old girl presents with a three day history of malaise, fever of 40o C, cough and coryza. She then developed an erythematous maculopapular rash that started on the face before spreading to the trunk and lower body. Her immunization record shows that aside from an initial dose of hepatitis B vaccine given at delivery, no other vaccinations have been given. On physical examination, the patient is weaklooking and febrile with a generalized maculopapular rash, watery nasal discharge, white pinpoint lesions on bright red mucosa opposite the lower molars, and occasional crackles upon auscultation. What is the most likely diagnosis? - Answer-Rubeola (koplik spots and rash that starts on face and spreads) *Rubeola (measles) can't face the FCC A 5-week-old boy presents with his father to the emergency room because of a ten day history of vomiting that has become more frequent and more forceful. The vomitus is not bile stained. The infant sucks vigorously and is active, but he is observed to be losing weight. There are no other symptoms noted. Abdominal examination reveals a small, olive-shaped mass upon palpation. What is the most likely diagnosis? - Answer-Pyloric stenosis A 5-year-old girl presents to clinic with a low grade fever and rash. Initially, she had mild nasal congestion, low energy, and decreased oral intake, but then developed a rash that involved both of her cheeks. Now has a fine, lacy rash over her arms and legs. What is the most likely diagnosis? - AnswerErythema Infectiosum * The Red 5th grader at the wrong PB-19 sandwich and was slapped in the cheeks. A child with short stature, decreased height velocity, and delayed deep tendon reflexes may be suffering which endocrine abnormality? - Answer-Hypothyroidism A five-year-old boy has a height which is 2.1 standard deviations below normal for his age. His height velocity is six centimeters per year. When calculated, the boy's projected height is 2.2 standard deviations below the mid-parental height. His parents state he has been in good health and no abnormalities are found on physical exam other than short stature. Which of the following is the most appropriate next step in evaluation of this boy's short stature? - Answer-Radiographs of left wrist and hand to determine bone age A full term boy is delivered via Cesarean section to a 34-year-old G1P0 mother. He has good Apgar scores and weighs 2.7 kilograms. Initial physical examination reveals normal findings. An hour after initially breastfeeding, the boy begins to vomit green-tinged milk. He has recurrent bilious vomiting one hour later. On repeat physical examination, he is found to have tachypnea, clear breath sounds and a nondistended abdomen. A nasogastric tube is passed and 30 mL of bilious fluid is aspirated. What is the most likely diagnosis? - Answer-Duodenal atresia A three-week-old infant presents to the clinic with his parents who state he is not gaining weight and is feeding poorly. Cardiac auscultation and exam reveal a 2/6 mid-frequency holosystolic murmur heard best at the fourth left intercostal space, a diastolic rumble, and a prominent apical impulse displaced laterally. Tachypnea and tachycardia are also noted. Which of the following is the most likely diagnosis? - Answer-Large ventricular septal defect Abx tx for epiglottitis? - Answer-Ceftriaxone or cefotaxime Abx tx for mastoiditis? - Answer-Vancomycin and Ceftriaxone Abx tx for outpt cystitis in > 2 month old? - Answer-1. cephalosporin: Cefixime, cefdinir (NOT w/ PCN allergy) 2. Trimethoprim-sulfamethoxazole abx tx for peritonsillar abscess? - Answer-Amoxicillin-clavulonate or Clindamycin An 18-month-old boy presents with a one-week history of upper respiratory congestion and low-grade fever. His parents report noisy breathing increasing over the last 24 hours, and a loud "seal-like" barking cough. He has no significant past medical history. What else, if reported in the history given by parents, is most consistent with your suspected diagnosis? - Answer-Inspiratory stridor Conductive hearing loss weber and rinne test findings? - Answer-Weber: heard in bad ear Rinne: conductive > air Development is intimately related to the maturation of what body organ system? - Answer-Nervous system first line tx for allergic rhinitis? - Answer-- H2RA: cetirizine or loratidine - Intranasal glucocorticoid: Fluticasone, beclomethasone, or mometasoneFirst line tx for androgenic alopecia? - Answer-- Finasteride (inhibits dihydrotestosterone) First line tx for tinea corporis? - Answer-Clotrimazole (or topical antifungal) For which vaccine is a history of egg allergy considered a precaution? - Answer-Influenza