Case Study: Questions 1-2 A 3 yr old boy is seen for a seizure 1 hour ago and lasting about 3 minutes. No prior medica

1. Case Study: (Questions 1-2)A 3 yr old boy is seen for a seizure 1 hour ago and lasting about 3 minutes. No prior medical history. He has had fever to 104F associated with an otitis for 2 days. His current neurologic exam is completely normal.

2. 1. You should: 2. The risk for a recurrent seizure would be: a) 5% b) 30% c) 60% d) 90%

3. 3. Idiopathic thrombocytopenic  purpura: a) Is caused by inadequate production of thrombocytes by the bone marrow b) Is a rapidly progressive, often fatal illness c) Is associated with deficiencies of clotting factors d) May be treated with IV immunoglobulins

4. 4. The most common etiology of childhood pneumonia is: a) Pneumococcus b) Viral c) Moraxella catarrhalis d) Mycoplasma pneumoniae

5. 5. Which children should definitely receive a yearly influenza vaccine? a) All children from birth to 6 months b) All children older than 12 years c) Asthmatic children d) Children with frequent otitis

6. 6. Which of the following is true regarding circumcision? a) Newborns don’t feel pain, so anesthesia is not recommended b) There may an increased risk of future penile cancer in circumcised males c) Overall incidence of UTI is very high in uncircumcised males d) Complications may include bleeding, infection and poor cosmetic outcome

9. 9. Which of the following is true  regarding physical growth? a) Newborns gain 3 gms/day b) Females grow faster than males c) At 2 years old, children are 50% of future adult height d) It is normal for toddlers to fall off their previous growth curve

10. 10. On a screening newborn exam, you note one pupil appears white while the other pupil appears red. You should  evaluate further for: a) Retinoblastoma b) Amblyopia c) Accomodative esotropia d) Extraocular muscle palsy

12. 12. A 16 yr old cheerleader is seen for  menstrual complaints. She has not had menses for 18 months.  Menarche was at age 12. HCG is  negative. Her height is 63” and  weight 90#; BMI=16. She should be evaluated for: a) Marfan’s syndrome b) Turner’s syndrome c) Anorexia nervosa d) Delayed puberty

14. 14. Which is true regarding children with infantile strabismus? a) Alteration of fixation between eyes is often seen b) Exotropia is the most common type c) Cover/uncover test is often normal d) Strabismus usually develops after one year of age

15. 15. Which of these statements  regarding constitutional growth delay is correct? a) Adult height is usually in the normal range b) Onset of puberty is usually early c) Bone age is usually normal for chronological age d) Growth curve falls off below normal growth curves

16. 16. The newborn nursery informs you about an infant that your partner delivered six hours ago. Which of these scenarios would require your immediate evaluation? a) The baby’s RR is 40; there are no retractions; baby is not cyanotic b) The infant has a blood glucose of 50 c) Mom is concerned that the infant doesn’t “look right” to her d) The baby is very “jittery” and seems to be jerky while lying in the isolette

29. 49. On a newborn exam, you notice that the infant has a maculopapular rash on its trunk, palms and soles, and  excessive congestion. You should suspect: a) Fetal alcohol syndrome b) Congenital syphilis c) Intrauterine cocaine exposure d) Toxoplasmosis

30. 50. A 38 week gestation newborn male appears jaundiced at 36 hours of life. Appropriate next steps include which of the following? a) Determine the maternal blood type and Rh status b) Start I.V. antibiotics c) Discontinue breast feeding d) Arrange for double exchange transfusion

34. 56. Which of the following behaviors is associated with the normal developmental tasks of adolescence? a) Disregard for authority b) Defining themselves sexually in relationship to others c) Decreased interest in activities and increased irritability d) Developing a more dependent and intertwined relationship with parents

35. 57. Which of the following would  indicate Tanner stage 2 sexual development in a male child? a) Facial hair b) Enlarging scrotum and testes c) Acne d) Darkly pigmented, slightly curly pubic hair

37. 59. A two-year old is seen 4 weeks after treatment for otitis media. A unilateral effusion is present, but no erythema. Appropriate management would be: a) An audiogram b) Decongestants c) A broader spectrum antibiotic d) Observation and follow-up

38. 60. A six-year-old comes in for a  nosebleed. Exam reveals oozing  from the right nostril and unexplained bruises. The most appropriate management is: a) Cauterize the affected area b) Contact Child Protective Services c) Observation, patient education d) Check a complete blood count

39. 61. A five-year-old is seen for a chronic cough over 2 months in duration. The cough is noted frequently in the day and not heard at night. Most likely cause is: a) Asthma b) GERD c) Psychogenic d) Allergies

42. 67. A three-month-old is seen for an upper respiratory infection with cough. Which of the following would suggest RSV? a) Exanthem b) Lack of nasal discharge c) Wheezing and retractions d) Unilateral rales

43. 68. Which statement about Sudden Infant Death Syndrome (SIDS) is false? a) It is more common in lower socioeconomic families b) SIDS has a 3:1 incidence in girls over boys c) There is an increased incidence among infants whose mothers smoke d) Siblings of SIDS victims are at a higher risk to die of SIDS than the general population

45. 70. Which of the following is true  regarding colic? a) Colic is common in toddlers b) Poor parenting skills are thought to be the main cause of colic c) The crying of colic tends to follow a time pattern d) Dicyclomine is recommended as a first-line treatment

46. 71. Which of the following is false regarding child abuse? a) Neglect results in more death than physical and sexual abuse combined b) Abuse should be considered when fractures occur in children before they are ambulating c) Most abused children are special- needs children d) Over 75% of sexual abuse perpetrators are known to the victim

47. 72. A one-month-old presents with a history of vomiting for 1 day. Which of the following suggests pyloric stenosis? a) Poor appetite, irritability, low grade fever, diarrhea and vomiting after each feeding b) Regurgitation with burping, in a well-appearing, formula-fed infant c) Non-bilious, projectile vomiting immediately after feedings in a well-appearing hungry infant d) Blood-tinged emesis and stools in an irritable infant fed on milk- based formula

50. Case Study: (Questions 81-82)A five-month-old infant presents in December with 3 days of diarrhea, cough, congestion, mild fever, and vomiting 3 times. On exam, the infant is mildly irritable, well-hydrated, with rectal temp of 101.6F. Stool guaiac is negative.

51. 81. The most likely diagnosis is: a) Enterovirus infection b) Shigella enteritis c) Intussusception d) Rotavirus infection 82. Management of the patient would include: a) Admission to the hospital for iv fluids b) Start amoxicillin suspension c) Continue breast-feeding or current formula d) Draw blood cultures, a CBC and electrolytes

52. 83. Management of functional  constipation in a two-year- old may include which of the  following? a) Increased fiber, milk of magnesia or mineral oil b) Psychological testing and/or counseling c) Frequent use of rectal stimulation or suppositories d) Fluid restriction

55. 86. A 3 y.o. girl presents with incontinence and poor appetite but no fever. Urinalysis confirms pyuria; culture is positive for E. coli. Management should include: a) Oral amoxicillin for three days b) Oral cephalosporin for 5 days, then IVP c) Hospitalization for IV fluoroquinolone d) Oral antibiotic for 7-14 days

56. 87. A 12 yo boy presents with left knee pain and limp for 6 weeks. No history of trauma, fever or malaise. Exam reveals a normal left knee but restricted left hip motion. You should: a) Discuss school avoidance behavior b) Check x-rays for slipped capital femoral epiphysis c) Check knee x-ray for Osgood- Schlatter disease d) Refer for surgical treatment of transient synovitis of the hip

58. 89. Which vaccine is the most likely to cause a fever and rash 8 days after an immunization? a) DTP b) DTaP c) MMR d) HiB

59. 90. All of the following are common barriers to achieving 100% immunization rates EXCEPT: a) Money b) Lack of vaccines c) Real risk of serious complications d) Missed opportunities

60. 91. Management of a newborn  whose mother is Hepatitis B  positive includes: a) Testing for Hepatitis B b) Immunization with Hepatitis B Immune Globulin and Hepatitis B vaccine within 12 hours of birth c) Immunization with Hepatitis B vaccine only before 2 months of age d) Immunization with Hepatitis B Immune Globulin and Hepatitis B vaccine within 24 hours of birth

61. 92. In patients who haven’t received primary dT series, Td and Tetanus immunoglobulin should be given with: a) Closed humerus fractures b) Frostbite injuries c) Closed head injuries d) Congenital heart defects

62. 93. Learning disabilities are  diagnosed in the following areas: a) Reading, math and written expression b) Behavior and reading c) Vision, hearing and physical mobility d) Adaptive skills

64. 95. Mental retardation is  characterized by: a) I.Q. less then 70 b) Impairment in physical function c) Mutism d) Hyperactivity

67. 103. Conduct disorder is typically: a) A developmental stage b) Suspected in children who have violated major social norms c) Treated with Ritalin d) Treated with an SSRI

68. 104. Oppositional Defiant Disorder is: a) A development stage b) Not responsive to counseling or parent education techniques c) Usually does not co-exist with ADHD d) A pattern of negativistic, defiant, and hostile behaviors

69. 105. Autistic children show  impairments in the following  areas: a) Social interaction b) Math skills c) Hearing or vision d) Physical growth

71. 107. Depression in children: a) Is likely to vary in presentation with the age of the child b) Is the result of poor or inconsistent mothering c) Is developmentally appropriate in adolescence d) May present as deceitfulness or theft

72. 108. The first line of treatment for depression in children is: a) SSRI medication b) TCA medication c) Counseling – individual, family, etc. d) Psychostimulant medication

73. 109. Which is false regarding this picture? a) Seen in healthy term infants b) Requires sepsis evaluation c) Lasts up to 7 days d) Seen on any body surface

74. 110. Which is false regarding this picture? a) Mucocutaneous bleeding common b) Can be normal on head and face c) Always treat with reassurance d) Consider sepsis

78. 121. You are seeing a 5 yr old child for the first time, for a routine pre- kindergarten exam. You note a Grade I-II systolic murmur at the lower left sternal border which disappears while supine. There are no extra sounds or cyanosis. You should suspect: a) Tetralogy of Fallot b) Innocent murmur c) Aortic stenosis d) Atrial septal defect

79. 122. You are called to evaluate a term  newborn in the nursery 8 hours after a precipitous vaginal delivery. Nurse notes poor feeding, respiratory rate of 60 and temperature instability. Which of the following is most suggestive of neonatal sepsis? a) CBC with 15,000 WBC and 10% bands b) Blood glucose of 60 c) Chest x-ray with perihilar fluff d) Absolute neutrophil count (ANC) of 800

80. 123. Which of the following is a true statement regarding perinatal HIV exposure? a) Breastfeeding is not associated with HIV transmission b) 20% of HIV-infected infants are due to blood transfusions c) HIV-infected mothers transmit HIV to their infants 30% of the time without treatment d) Oral thrush in infants is pathognomonic for HIV disease

81. 124. Which of these is NOT a danger signal in language development? a) No intelligible speech by 18 months b) Stuttering at 3 years old c) Abnormal vocal quality at 2 years old d) No babbling at 9 months

82. 125. Most inborn errors of  metabolism are: a) Sex chromosome abnormalities b) Autosomal Recessive c) X-linked d) Autosomal recessive

83. 126. Which motor skills are not  associated with the age listed? a) 6 months--sits alone 30 seconds b) 2 years--walks up stairs one step at a time c) 1 year--walks d) 2 months--rolls front to back

84. 127. Which of the following may be a secondary cause of childhood obesity? a) Prader-Willi syndrome b) Blount’s disease c) Sturge-Weber disease d) Hirschsprung’s disease