ABP practice questions
A 13 1/2-year-old boy is undergoing evaluation because of lack of pubertal
development. His father was a "late bloomer." On physical examination, he
looks young for his age. Height is at the 10th percentile and weight is at the
25th percentile. He has no axillary hair; sexual maturity rating is stage 2 for
pubic hair. His penis appears prepubertal, and the testes are 2.5 cm in length
bilaterally. Which of the following is the most appropriate management for this
patient?
Schedule follow up in 6 months because he is not showing signs of puberty
yet as testicles haven't enlarged.
A 4-month-old girl with a large eyelid hemangioma is being treated with oral
propranolol therapy. She has been taking the medication for 1 week, and the
dosage was increased 3 days ago. Her parents report that she has just begun
sleeping 10 hours at night and that it has been more difficult to wake her for
the last two mornings, but she has been fine the rest of the day. Which of the
following side effects would be important to consider in this patient?
Hypoglycemia
A 3-year-old boy had a respiratory tract infection 4 weeks ago, with symptoms
of rhinorrhea, cough, and low-grade fever. These symptoms resolved
completely. Over the past week, the boy has been less playful and has had an
occasional limp. Physical examination reveals mild swelling of the left elbow,
right knee, and right ankle. The boy withdraws when these joints are
examined. All other physical findings are normal, as are results of a complete
blood count and urinalysis. Erythrocyte sedimentation rate is slightly
increased. X-ray studies of the affected joints show joint effusions but no bone
lesions. Which of the following is the most appropriate next step in this
situation?
Treatment with NSAIDS
,Which of the following would be detected by brain-stem evoked auditory
response but not by the otoacoustic emission devices used for neonatal
hearing screening examinations?
Auditory neuropathy
Results of ophthalmologic examination in a 5-year-old child who wears
glasses shows a best corrected vision of 20/20 in the right eye and 20/40 in
the left eye. Which of the following is the most likely cause of these disparate
results?
unequal refractive error
A 4-month-old boy was recently placed in custodial care because of parental
neglect, and the foster parents are concerned because he appears ill and has
a frequent dry cough. His medical history includes negative results of neonatal
screening for human immunodeficiency virus. Physical examination reveals a
3.1-kg boy who is severely malnourished. Temperature is 38.2°C, pulse rate is
120/min, and respiratory rate is 55/min. Hemoglobin oxygen saturation in
room air is 87%. Intercostal retractions are noted. Peripheral leukocyte count
is 5400/mm3, with a predominance of lymphocytes and no immature
granulocytes. X-ray study of the chest reveals diffuse interstitial and alveolar
infiltrates.Which of the following pathogens is most likely to be responsible for
this boy's respiratory symptoms?
Pneumocystis jiroveci
,A pregnant woman who has untreated hypertension is at increased risk for
giving birth to an infant with which of the following abnormalities?
low birth weight
A 10-year-old girl has had type 1 diabetes for 3 years. During a hiking outing
with her school classmates, she reports feeling "shaky." When her teacher
measures the girl's blood glucose concentration, the glucose meter reads "52
mg/dL." The teacher then phones for advice. Which of the following is the
most appropriate recommendation if it is more than 2 hours until the girl's next
scheduled meal or snack?
Give the girl a 15g glucose tablet and a protein and carbohydrate snack
A 14-year-old boy is experiencing shortness of breath and chest pain. His
medical history includes an episode of near syncope following a basketball
game 2 weeks ago. Family history is unremarkable. The patient appears pale
and diaphoretic but is fully coherent. Pulse rate is 220/min, respiratory rate is
30/min, and blood pressure is 105/64 mm Hg. Which of the following is the
most likely diagnosis?
Supraventricular tachycardia
A 10-year-old, 34-kg boy who had been camping is brought to the emergency
department because of the inability to walk, a loss of limb coordination, and a
tingling sensation of the extremities. Temperature is 37°C, pulse rate is
100/min, respiratory rate is 32/min, and blood pressure is 99/69 mm Hg.
Hemoglobin oxygen saturation is 98% (room air). Cardiac rhythm is regular
and there are no murmurs. The chest is clear to auscultation, and there is no
organomegaly. Neurologic examination shows decreased tone in the legs,
with proximal and distal strength of 2/5. Ankle and knee jerk reflexes are
, absent. Which of the following additional physical findings will help establish a
diagnosis?
A wood tick attached to the scalp
A 24-hour-old, full-term infant has hypoglycemia and hypocalcemia. The
infant's mother received no prenatal care. Following the administration of
glucose and calcium gluconate, the infant's serum glucose and calcium
concentrations normalize. At 48 hours of age, the infant has abdominal
distention and bilious vomiting and has not passed meconium. Which of the
following is the most likely cause of this infant's symptoms?
Hypoplastic left colon syndrome- because the infant's mother has untreated
diabetes hence the hypoglycemia and hypocalcemia and gestational diabetes
mellitus is related to hypoplastic left colon syndrome
A 5-year-old boy has a 2-year history of gradually worsening constipation.
Development has progressed normally, but the patient's height has decreased
from the 60th percentile to the 25th percentile; weight has remained at the
50th percentile during the past 2 years. Height age is 3 1/2 years. He has
gradually become lethargic, and a sallow, pale skin color has developed. The
abdomen has become somewhat protuberant. Stools are produced
infrequently and are hard and large.
Physical examination confirms the patient's small size; pale, sallow skin; and
lethargic appearance. Pulse rate is 60/min. The thyroid gland is not palpable.
The abdomen is soft and protuberant with no palpable masses. Deep tendon
reflexes show slow return.
Laboratory Findings Hemoglobin 9.2 g/dL Serum thyroid-stimulating hormone
(TSH) 140 μU/mL (normal 0.6 to 5.5 μU/mL) Serum thyroxine (total) 1.2 ng/dL
A 13 1/2-year-old boy is undergoing evaluation because of lack of pubertal
development. His father was a "late bloomer." On physical examination, he
looks young for his age. Height is at the 10th percentile and weight is at the
25th percentile. He has no axillary hair; sexual maturity rating is stage 2 for
pubic hair. His penis appears prepubertal, and the testes are 2.5 cm in length
bilaterally. Which of the following is the most appropriate management for this
patient?
Schedule follow up in 6 months because he is not showing signs of puberty
yet as testicles haven't enlarged.
A 4-month-old girl with a large eyelid hemangioma is being treated with oral
propranolol therapy. She has been taking the medication for 1 week, and the
dosage was increased 3 days ago. Her parents report that she has just begun
sleeping 10 hours at night and that it has been more difficult to wake her for
the last two mornings, but she has been fine the rest of the day. Which of the
following side effects would be important to consider in this patient?
Hypoglycemia
A 3-year-old boy had a respiratory tract infection 4 weeks ago, with symptoms
of rhinorrhea, cough, and low-grade fever. These symptoms resolved
completely. Over the past week, the boy has been less playful and has had an
occasional limp. Physical examination reveals mild swelling of the left elbow,
right knee, and right ankle. The boy withdraws when these joints are
examined. All other physical findings are normal, as are results of a complete
blood count and urinalysis. Erythrocyte sedimentation rate is slightly
increased. X-ray studies of the affected joints show joint effusions but no bone
lesions. Which of the following is the most appropriate next step in this
situation?
Treatment with NSAIDS
,Which of the following would be detected by brain-stem evoked auditory
response but not by the otoacoustic emission devices used for neonatal
hearing screening examinations?
Auditory neuropathy
Results of ophthalmologic examination in a 5-year-old child who wears
glasses shows a best corrected vision of 20/20 in the right eye and 20/40 in
the left eye. Which of the following is the most likely cause of these disparate
results?
unequal refractive error
A 4-month-old boy was recently placed in custodial care because of parental
neglect, and the foster parents are concerned because he appears ill and has
a frequent dry cough. His medical history includes negative results of neonatal
screening for human immunodeficiency virus. Physical examination reveals a
3.1-kg boy who is severely malnourished. Temperature is 38.2°C, pulse rate is
120/min, and respiratory rate is 55/min. Hemoglobin oxygen saturation in
room air is 87%. Intercostal retractions are noted. Peripheral leukocyte count
is 5400/mm3, with a predominance of lymphocytes and no immature
granulocytes. X-ray study of the chest reveals diffuse interstitial and alveolar
infiltrates.Which of the following pathogens is most likely to be responsible for
this boy's respiratory symptoms?
Pneumocystis jiroveci
,A pregnant woman who has untreated hypertension is at increased risk for
giving birth to an infant with which of the following abnormalities?
low birth weight
A 10-year-old girl has had type 1 diabetes for 3 years. During a hiking outing
with her school classmates, she reports feeling "shaky." When her teacher
measures the girl's blood glucose concentration, the glucose meter reads "52
mg/dL." The teacher then phones for advice. Which of the following is the
most appropriate recommendation if it is more than 2 hours until the girl's next
scheduled meal or snack?
Give the girl a 15g glucose tablet and a protein and carbohydrate snack
A 14-year-old boy is experiencing shortness of breath and chest pain. His
medical history includes an episode of near syncope following a basketball
game 2 weeks ago. Family history is unremarkable. The patient appears pale
and diaphoretic but is fully coherent. Pulse rate is 220/min, respiratory rate is
30/min, and blood pressure is 105/64 mm Hg. Which of the following is the
most likely diagnosis?
Supraventricular tachycardia
A 10-year-old, 34-kg boy who had been camping is brought to the emergency
department because of the inability to walk, a loss of limb coordination, and a
tingling sensation of the extremities. Temperature is 37°C, pulse rate is
100/min, respiratory rate is 32/min, and blood pressure is 99/69 mm Hg.
Hemoglobin oxygen saturation is 98% (room air). Cardiac rhythm is regular
and there are no murmurs. The chest is clear to auscultation, and there is no
organomegaly. Neurologic examination shows decreased tone in the legs,
with proximal and distal strength of 2/5. Ankle and knee jerk reflexes are
, absent. Which of the following additional physical findings will help establish a
diagnosis?
A wood tick attached to the scalp
A 24-hour-old, full-term infant has hypoglycemia and hypocalcemia. The
infant's mother received no prenatal care. Following the administration of
glucose and calcium gluconate, the infant's serum glucose and calcium
concentrations normalize. At 48 hours of age, the infant has abdominal
distention and bilious vomiting and has not passed meconium. Which of the
following is the most likely cause of this infant's symptoms?
Hypoplastic left colon syndrome- because the infant's mother has untreated
diabetes hence the hypoglycemia and hypocalcemia and gestational diabetes
mellitus is related to hypoplastic left colon syndrome
A 5-year-old boy has a 2-year history of gradually worsening constipation.
Development has progressed normally, but the patient's height has decreased
from the 60th percentile to the 25th percentile; weight has remained at the
50th percentile during the past 2 years. Height age is 3 1/2 years. He has
gradually become lethargic, and a sallow, pale skin color has developed. The
abdomen has become somewhat protuberant. Stools are produced
infrequently and are hard and large.
Physical examination confirms the patient's small size; pale, sallow skin; and
lethargic appearance. Pulse rate is 60/min. The thyroid gland is not palpable.
The abdomen is soft and protuberant with no palpable masses. Deep tendon
reflexes show slow return.
Laboratory Findings Hemoglobin 9.2 g/dL Serum thyroid-stimulating hormone
(TSH) 140 μU/mL (normal 0.6 to 5.5 μU/mL) Serum thyroxine (total) 1.2 ng/dL
