Aquifer Peds
While Tyler was in the newborn nursery, his parents were told that the initial exam was
normal, with no murmur noted. They ask why the murmur was not noted in the nursery.
- ✔️✔️There is elevated pulmonary vascular resistance in a newborn
What medications might be effective at improving Tyler's symptoms of heart failure? -
✔️✔️Furosemide, digoxin, elanapril
A 5-week-old infant is brought to the pediatrician for failure to thrive with a history of
prolonged feeding time and tachypnea. What other features does this infant most likely
have? - ✔️✔️Hyperdynamic precordium with holosystolic murmur
Which of his vital signs is abnormal? Choose the single best answer. - ✔️✔️RR
What do you hear in the audio of Tyler's heart sounds? Choose the single best answer.
- ✔️✔️Holosystolic murmur
Based on what you know about the patient so far, write a one- to three-sentence
summary statement to communicate your understanding of the patient to other
providers. - ✔️✔️Tyler is a 6-week-old former term infant who has recent onset of
progressive dyspnea with feedings, diaphoresis, and poor weight gain (having only
gained 300 grams from his birth weight). He is acyanotic with a normal temperature, but
exam reveals tachypnea, an active precordium, Grade III holosystolic murmur, and
hepatomegaly.
With your summary statement in mind, what etiologies now remain in your differential
diagnosis? - ✔️✔️CHF
What is the most common cause of a murmur in childhood? Choose the single best
answer - ✔️✔️Innocent murmur
What congenital heart defects are more likely to be detected in school-age children than
in neonates? Select all that apply. - ✔️✔️ASD, bicuspid aortic valve
Which of these sounds most like Tyler's murmur? Choose the single best answer. -
✔️✔️VSD
What is your assessment of Tyler's feeding? Choose the single best answer. -
✔️✔️The feeding history suggests a problem with Tyler's ability to feed adequately.
,What would you tell the mother now, in answer to her question? Choose the single best
answer. - ✔️✔️I am concerned that Tyler's feedings do not seem to be going well. Can
I ask you a few more questions about Tyler to help us find out if there is a problem?
Based on the history, it sounds as if Tyler is having some real difficulties with his feeds.
Which of the following might be causing Tyler's difficulty feeding, respiratory distress,
and diaphoresis? Select all that apply. - ✔️✔️CHD/CHF, respiratory infection, sepsis,
metabolic disorder
What other common congenital heart defects can present with signs of congestive heart
failure and a murmur? Select all that apply. - ✔️✔️Aortic stenosis, Coarctation of Aorta,
PDA
Which of these diagnostic tests should you order to help you assess Tyler's clinical
status? Select all that apply. - ✔️✔️ECG, Echo, CXR
This is the chest x-ray you ordered on Tyler. What do you think this film shows? Choose
the single best answer. - ✔️✔️Increased heart size, increased pulmonary vascular
markings
You have accepted a part-time tutoring job for first-year medical students. One of your
students asks if you would please clarify the details of normal fetal circulation. Which of
the following best describes the path oxygenated blood takes to reach the fetal brain? -
✔️✔️RA > foramen ovale > LA > LV > systemic circulation
A 5-year-old boy is noted to have a grade II systolic murmur and a widely split S2
murmur on cardiac exam. His vital signs are stable and he has been asymptomatic.
Which of the following statement is accurate regarding this child's presentation and
likely condition? - ✔️✔️This patient's murmur is caused by excessive flow through the
pulmonary outflow tract and should be evaluated
A 6-week-old infant presents to your office for a check-up. The baby was born full-term
by NSVD to a 29-year-old G1P0 mother with no complications. Mother states the baby
was feeding well until a week ago, when he developed increased sleepiness, prolonged
feeding, and greater duration between feeds. His mother notes he stops to take breaks
during feeds because he seems to be trying to catch his breath. He has four to six wet
diapers per day and stools three or four times per day. Vital signs: Temperature is 37.6
C (99.7F), respiratory rate is 68 breaths/minute, pulse is 138 beats/minute, blood
pressure is 88/58 mmHg, and oxygen saturation is 98%. The physical examination is
notable for increased respiratory effort and retractions, and, upon cardiac examination,
a murmur with a hyperactive precordium and no cyanosis. Abdominal exam reveals a
liver edge palpable to 4 cm below the right costal margin. Which condition wo -
✔️✔️ASD
,After reviewing the chart, what are some of the important details that you already know
about Sunita? - ✔️✔️Chronic cough, Sunita's age, new to the practice and presently on
no meds, appropriate growth parameters, normal vitals
Based on what you know about Sunita, what other elements in the history would you
like to specifically ask about? - ✔️✔️History of eczema, nasal congestion, palpitations,
presence of fever, vomiting
Based on what you know about the patient so far, write a one- to three-sentence
summary statement to communicate your understanding of the patient to other
providers. - ✔️✔️Sunita is a 6-year-old girl with chronic nasal congestion and a history
of eczema who presents with a chronic cough that is often worse at night, with exercise,
and with exposure to cold air. She has no fever, shortness of breath, or history of
wheezing, but has a family history of asthma.
Now that you have completed Sunita's physical exam, you consider what information
you will present to Dr. Law. Based on Sunita's history and physical findings, what do
you think are the most likely diagnoses? Select all that apply. - ✔️✔️Asthma, allergies
Which of the following tests would be most useful in establishing a diagnosis of asthma
for Sunita? Choose the single best answer. - ✔️✔️Spirometry
Based on your reading about asthma and thinking about the history and exam findings
from your time with Sunita, how would you classify her asthma? - ✔️✔️Moderate
persistent
Based on your classification, which of the following medications could be used in
treatment? - ✔️✔️All of the above
A 4-year-old male who lived internatinally presents with his mother to your general
pediatrics clinic. His mother reports that he has a chronic nonproductive cough during
the day and night, mild wheezing for one month and failure to gain weight (his weight
has dropped from the 50th to the 10th percentile for his age). He does not have high
fevers, rhinorrhea, congestion or night sweats. Which of the following are the next best
diagnostic tests? - ✔️✔️Chest X-ray and tuberculin skin test
An 11-year old boy presents to the clinic with wheezing. His mother states that in the
past he has used inhaled albuterol and it has helped with wheezing and shortness of
breath. His mother also reports that the patient experiences shortness of breath three
times a week and is awakened at night by these symptoms once a week. What is the
most appropriate outpatient therapy at this time? - ✔️✔️Low dose inhaled
corticosteroids and albuterol rescue inhaler as needed
A 4-year-old patient presents with several months of cough. Mom also reports a history
of red skin patches, which are pruritic, and allergies to peanuts, eggs, and mangoes.
, Which of the following would most likely be characteristic of the cough that this patient
would present with? - ✔️✔️Worse at night
A 9-year-old boy presents to your clinic with discoloration under his eyes, persistent
cough, and skin rashes. He has struggled with these concerns over the past three years
but recently his symptoms have gotten worse, affecting him every other day. He is
afebrile. He is found to have wheezing on physical exam and increased lung volume
bilaterally on chest x-ray. What would be the most appropriate treatment for him? -
✔️✔️Short acting inhaled beta agonist PRN with daily low dose inhaled corticosteroid
A previously healthy 10-year-old boy comes to the clinic with a chief concern of
progressive cough for three days that began gradually. His cough is described as
productive with whitish sputum. His mother reports that he has been febrile up to 101.5
F daily. She thinks he is fatigued and has not eaten well in the past several days. He
has no throat pain, vomiting, or diarrhea on review of systems. On exam, there is air
passage throughout all lung fields, with crackles in the lower right lung field, but no other
abnormal sounds. Which of the following would you likely find in your evaluation? -
✔️✔️Alveolar consolidation in the right lower lobe on chest radiograph
Is this typical speech development for an 18-month-old? Choose the single best
answer. - ✔️✔️No
Based on the history you have gathered so far, is it appropriate for Rebecca to be
receiving antihistamines/decongestants for her symptoms? Choose the single best
answer. - ✔️✔️No
Based on what you know about the patient so far, write a one-to-three sentence
summary statement to communicate your understanding of the patient to other
providers. - ✔️✔️Rebecca is a fully immunized 18-month-old girl with acute onset of
fever and ear tugging following three days of URI symptoms who has a history of
language delay, past otitis media, daycare, and smoke exposure
Considering the key findings in the history, which of the following would you include in
your differential diagnosis at this point? Select all that apply. - ✔️✔️Otitis media,
pneumonia, sinusitis, URI
Think about the order in which you will conduct your examination of Rebecca to achieve
the best results. Which of the following will be the last step in your exam sequence?
Choose the single best answer. - ✔️✔️Eyes/oral cavity
In which position(s) could the child rest while you examine her ears? Select all that
apply. - ✔️✔️All of above
Of the descriptions below, which best describes Rebecca's left ear? Choose the single
best answer. - ✔️✔️White/red, reduced mobility, opaque, bulging
While Tyler was in the newborn nursery, his parents were told that the initial exam was
normal, with no murmur noted. They ask why the murmur was not noted in the nursery.
- ✔️✔️There is elevated pulmonary vascular resistance in a newborn
What medications might be effective at improving Tyler's symptoms of heart failure? -
✔️✔️Furosemide, digoxin, elanapril
A 5-week-old infant is brought to the pediatrician for failure to thrive with a history of
prolonged feeding time and tachypnea. What other features does this infant most likely
have? - ✔️✔️Hyperdynamic precordium with holosystolic murmur
Which of his vital signs is abnormal? Choose the single best answer. - ✔️✔️RR
What do you hear in the audio of Tyler's heart sounds? Choose the single best answer.
- ✔️✔️Holosystolic murmur
Based on what you know about the patient so far, write a one- to three-sentence
summary statement to communicate your understanding of the patient to other
providers. - ✔️✔️Tyler is a 6-week-old former term infant who has recent onset of
progressive dyspnea with feedings, diaphoresis, and poor weight gain (having only
gained 300 grams from his birth weight). He is acyanotic with a normal temperature, but
exam reveals tachypnea, an active precordium, Grade III holosystolic murmur, and
hepatomegaly.
With your summary statement in mind, what etiologies now remain in your differential
diagnosis? - ✔️✔️CHF
What is the most common cause of a murmur in childhood? Choose the single best
answer - ✔️✔️Innocent murmur
What congenital heart defects are more likely to be detected in school-age children than
in neonates? Select all that apply. - ✔️✔️ASD, bicuspid aortic valve
Which of these sounds most like Tyler's murmur? Choose the single best answer. -
✔️✔️VSD
What is your assessment of Tyler's feeding? Choose the single best answer. -
✔️✔️The feeding history suggests a problem with Tyler's ability to feed adequately.
,What would you tell the mother now, in answer to her question? Choose the single best
answer. - ✔️✔️I am concerned that Tyler's feedings do not seem to be going well. Can
I ask you a few more questions about Tyler to help us find out if there is a problem?
Based on the history, it sounds as if Tyler is having some real difficulties with his feeds.
Which of the following might be causing Tyler's difficulty feeding, respiratory distress,
and diaphoresis? Select all that apply. - ✔️✔️CHD/CHF, respiratory infection, sepsis,
metabolic disorder
What other common congenital heart defects can present with signs of congestive heart
failure and a murmur? Select all that apply. - ✔️✔️Aortic stenosis, Coarctation of Aorta,
PDA
Which of these diagnostic tests should you order to help you assess Tyler's clinical
status? Select all that apply. - ✔️✔️ECG, Echo, CXR
This is the chest x-ray you ordered on Tyler. What do you think this film shows? Choose
the single best answer. - ✔️✔️Increased heart size, increased pulmonary vascular
markings
You have accepted a part-time tutoring job for first-year medical students. One of your
students asks if you would please clarify the details of normal fetal circulation. Which of
the following best describes the path oxygenated blood takes to reach the fetal brain? -
✔️✔️RA > foramen ovale > LA > LV > systemic circulation
A 5-year-old boy is noted to have a grade II systolic murmur and a widely split S2
murmur on cardiac exam. His vital signs are stable and he has been asymptomatic.
Which of the following statement is accurate regarding this child's presentation and
likely condition? - ✔️✔️This patient's murmur is caused by excessive flow through the
pulmonary outflow tract and should be evaluated
A 6-week-old infant presents to your office for a check-up. The baby was born full-term
by NSVD to a 29-year-old G1P0 mother with no complications. Mother states the baby
was feeding well until a week ago, when he developed increased sleepiness, prolonged
feeding, and greater duration between feeds. His mother notes he stops to take breaks
during feeds because he seems to be trying to catch his breath. He has four to six wet
diapers per day and stools three or four times per day. Vital signs: Temperature is 37.6
C (99.7F), respiratory rate is 68 breaths/minute, pulse is 138 beats/minute, blood
pressure is 88/58 mmHg, and oxygen saturation is 98%. The physical examination is
notable for increased respiratory effort and retractions, and, upon cardiac examination,
a murmur with a hyperactive precordium and no cyanosis. Abdominal exam reveals a
liver edge palpable to 4 cm below the right costal margin. Which condition wo -
✔️✔️ASD
,After reviewing the chart, what are some of the important details that you already know
about Sunita? - ✔️✔️Chronic cough, Sunita's age, new to the practice and presently on
no meds, appropriate growth parameters, normal vitals
Based on what you know about Sunita, what other elements in the history would you
like to specifically ask about? - ✔️✔️History of eczema, nasal congestion, palpitations,
presence of fever, vomiting
Based on what you know about the patient so far, write a one- to three-sentence
summary statement to communicate your understanding of the patient to other
providers. - ✔️✔️Sunita is a 6-year-old girl with chronic nasal congestion and a history
of eczema who presents with a chronic cough that is often worse at night, with exercise,
and with exposure to cold air. She has no fever, shortness of breath, or history of
wheezing, but has a family history of asthma.
Now that you have completed Sunita's physical exam, you consider what information
you will present to Dr. Law. Based on Sunita's history and physical findings, what do
you think are the most likely diagnoses? Select all that apply. - ✔️✔️Asthma, allergies
Which of the following tests would be most useful in establishing a diagnosis of asthma
for Sunita? Choose the single best answer. - ✔️✔️Spirometry
Based on your reading about asthma and thinking about the history and exam findings
from your time with Sunita, how would you classify her asthma? - ✔️✔️Moderate
persistent
Based on your classification, which of the following medications could be used in
treatment? - ✔️✔️All of the above
A 4-year-old male who lived internatinally presents with his mother to your general
pediatrics clinic. His mother reports that he has a chronic nonproductive cough during
the day and night, mild wheezing for one month and failure to gain weight (his weight
has dropped from the 50th to the 10th percentile for his age). He does not have high
fevers, rhinorrhea, congestion or night sweats. Which of the following are the next best
diagnostic tests? - ✔️✔️Chest X-ray and tuberculin skin test
An 11-year old boy presents to the clinic with wheezing. His mother states that in the
past he has used inhaled albuterol and it has helped with wheezing and shortness of
breath. His mother also reports that the patient experiences shortness of breath three
times a week and is awakened at night by these symptoms once a week. What is the
most appropriate outpatient therapy at this time? - ✔️✔️Low dose inhaled
corticosteroids and albuterol rescue inhaler as needed
A 4-year-old patient presents with several months of cough. Mom also reports a history
of red skin patches, which are pruritic, and allergies to peanuts, eggs, and mangoes.
, Which of the following would most likely be characteristic of the cough that this patient
would present with? - ✔️✔️Worse at night
A 9-year-old boy presents to your clinic with discoloration under his eyes, persistent
cough, and skin rashes. He has struggled with these concerns over the past three years
but recently his symptoms have gotten worse, affecting him every other day. He is
afebrile. He is found to have wheezing on physical exam and increased lung volume
bilaterally on chest x-ray. What would be the most appropriate treatment for him? -
✔️✔️Short acting inhaled beta agonist PRN with daily low dose inhaled corticosteroid
A previously healthy 10-year-old boy comes to the clinic with a chief concern of
progressive cough for three days that began gradually. His cough is described as
productive with whitish sputum. His mother reports that he has been febrile up to 101.5
F daily. She thinks he is fatigued and has not eaten well in the past several days. He
has no throat pain, vomiting, or diarrhea on review of systems. On exam, there is air
passage throughout all lung fields, with crackles in the lower right lung field, but no other
abnormal sounds. Which of the following would you likely find in your evaluation? -
✔️✔️Alveolar consolidation in the right lower lobe on chest radiograph
Is this typical speech development for an 18-month-old? Choose the single best
answer. - ✔️✔️No
Based on the history you have gathered so far, is it appropriate for Rebecca to be
receiving antihistamines/decongestants for her symptoms? Choose the single best
answer. - ✔️✔️No
Based on what you know about the patient so far, write a one-to-three sentence
summary statement to communicate your understanding of the patient to other
providers. - ✔️✔️Rebecca is a fully immunized 18-month-old girl with acute onset of
fever and ear tugging following three days of URI symptoms who has a history of
language delay, past otitis media, daycare, and smoke exposure
Considering the key findings in the history, which of the following would you include in
your differential diagnosis at this point? Select all that apply. - ✔️✔️Otitis media,
pneumonia, sinusitis, URI
Think about the order in which you will conduct your examination of Rebecca to achieve
the best results. Which of the following will be the last step in your exam sequence?
Choose the single best answer. - ✔️✔️Eyes/oral cavity
In which position(s) could the child rest while you examine her ears? Select all that
apply. - ✔️✔️All of above
Of the descriptions below, which best describes Rebecca's left ear? Choose the single
best answer. - ✔️✔️White/red, reduced mobility, opaque, bulging
