Peds NBME

1) A 16-year-old boy is brought to the emergency department 20 minutes after the onset of a generalized tonic-clonic seizure lasting 5 minutes. He has hypertension treated with a calcium-channel blocking agent, but he has not been taking his medication. On arrival, he is unarousable. His blood pressure is 250/154mmHg. Examination shows proliferative retinopathy. Urinalysis shows 1+ protein. Which of the following is the most appropriate intravenous pharmacotherapy.
A. Diazoxide
B. Furosemide
C. Hydralazine
D. Lorazepam
E. Sodium nitroprusside
E! Very high yield question: know the anti-hypertensives used for hypertensive emergency (eg encephalopathy)

2) A 3-year-old boy is brought to the emergency department because of a 1-day history of fever, abdominal pain, and diarrhea containing blood and mucous. He has a history of recurrent ear infections treated with antibiotics. He completed a 10-day course of amoxicillin-clavulanate 1 day ago. He appears moderately ill. His temperature is 38.4C, pulse is 104/min, respirations are 20/min, and blood pressure is 100/62mmHg. Abdominal examination shows moderate left lower quadrant tenderness with no rebound. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. Which of the following is the most likely causal organism?
A. Clostridium difficile
B. Salmonella enteritidis
C. Shigella sonnei
D. Staphylococcus aureus
E. Yersinia enterocolitica
Post-antibiotic diarrhea: C. diff

Interesting to recognize that it can be bloody, mucus, and can occur after amoxicillin

3) A 3-month-old boy is brought to the physician by his mother because of a 1-day history of fever, vomiting, and fussiness. He was born at 39 weeks gestation following an uncomplicated pregnancy and delivery. He is alert and mildly irritable but easily consoled by his mother. His rectal temperature is 39C, pulse is 160/min, and respirations are 38/min. Examination of the skin shows no abnormalities. The tympanic membranes are mildly erythematous with normal landmarks and motility. The lungs are clear to auscultation. The abdomen is soft with no palpable masses. The patient is uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is the most appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
E. Vancomycin
Of these, 3rd gen cephalosporins are the best for empiric therapy. Caution with ceftriaxone (it can cause hyperbilirubinemia – may not be a concern in this kid). Cefotaxime is the best choice

4) A 3-year-old boy is brought for a well-child examination. His mother states that his belly seems big. His vital signs are within normal limits. Examination shows aniridia. There is a palpable mass in the right flank. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic acid concentrations (wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen
WAGR syndrome -> abdominal US to detect Wilms tumor

5) A 5-year-old boy is brought to the physician because of a 4-day history of increasing difficulty breathing. His temperature is 37.5C, pulse is 116/min, respirations are 36/min, and blood pressure is 116/80mmHg. Examination shows jugular venous distention and mild swelling of the face and upper extremities. There are moderate intercostal retractions. Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the chest shows a mass in the superior mediastinum and a large pleural effusion in the right hemithorax. Thoracentesis yields 400mL of reddish brown serosanguineous fluid containing numerous erythrocytes. Which of the following is the most likely cause of the pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion
Serosanguinous pleural effusions are always malignant! This is a very classic presentation for non-Hodgkin’s lymphoma (which is often an anterior mediastinal mass that can cause painless LAD, SVC syndrome, and respiratory distress – per BRS)

a 4-day-old newborn is brought to the physician b/c of a 2-day history of progressive jaundice. He was born at 36 weeks’ gestation to a 27-year-old woman, gravid2, para 2, following an uncomplicated pregnancy and delivery and weighed 2608 g(5lb 12oz). The newborn’s blood group is O, Rh-positive, and the mother’s blood group is B, Rh-positive. He has been breast-fed since birth and receives 1 to 2 ounces of a supplemental soy milk-based formula every day. His mother says that he has had about seven wet diapers daily, and his stools are yellow and seedy. At discharge 2 days ago, his weight as 2495 g; he now weights 2608 g. His temp is 36.9C, pulse 138/min, respirations 32/min, BP 65/40. Exam shows scleral icterus and jaundice from the face to the lower abdomen. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies at 36 hours of age and now show:

at 36hrs of age Now
hct 54% 52%
serum
Bilirubin, total (mg/dL) 8.2 12.5
Direct (mg/dL) 0.1 0.3

Which of the following is the most likely explanation for these findings?

a) ABO isoimmunization
b) biliary obstruction
c) dehydration
d) Erythrocyte enzyme defect
e) physiologic jaundice
F) polycythemia

This is physiologic jaundice! He is eating and pooping well and still within the first week of life.

a 1 month old infant has had a 12×8 cm, red, raised, well-defined lesion that is lobulated and compressible overlying the buttocks since birth. Examination also shows multiple petechiae and bruises. Which of the following is the most likely explanation for these findings.

a) DIC
b) high-output congestive heart failure
c) impaired tissue growth due to altered vascular supply
d) increased tissue growth due to increased vascular supply
e) thrombocytopenia from platelet sequestration

E!

A healthy 16-year-old girl comes to the physician for an examination prior to participation in school sports. She had chickenpox at age 3, but has no history of serious illness. Her immunizations were up-to-date when she began kindergarten; the only immunization she has received since then is a diphtheria-tetanus toxoid at the age of 10 years for a laceration on her leg. She has been sexually active for the past year w/ two male partners who have used condoms consistently. She is 163cm and weights 54kg; BMI 21. Vital signs are w/in normal limits. Examination shows no abnormalities. Administration of which of the following vaccines is most appropriate at this time?

a) hepatitis B, diphtheria-tetanus-toxoid, HPV
B) HPV, meningococcal, TdaP
c) MMR, TdaP, hepatitis B
d) PCV, PCV-7, IPV, hepatitis B
e) PCV 7, IPV, MMR
f) Td, meningococcal, MMR

B!

an 18-month girl is brought to the emergency department 1 hour after the onset of vomiting and drooling. She had been left alone in the bathroom of her home for a few minutes before the onset of the symptoms. The family keeps nasal decongestants, acetaminophen, ibuprofen, diphenhydramine, and drain cleaner, and insecticide spray in the bathroom. During the past 5 days, she has had an upper respiratory traction infection treated w/ a nasal decongestant containing pseudoephedrine and acetaminophen. She is agitated and drooling. Her temperature is 37C, pulse is 120/min, respirations are 26/min, and BP IS 80/60. Examination shows two small superficial ulcers on the lips and tongue. the remainder of the examination shows no abnormalities. the most likely cause of these findings is ingestion of which of the following?

a) acetaminophen
b) diphenhydramine
c) drain cleaner
d) ibuprofen
e) organophosphate
f) pseudoephedrine

C! Drain cleaner – look up!

An 8yo girl is brought to the physician because of a diffuse rash for 24hr. She has had cough, congestion, eye discharge, and fever for 4 days. The rash initially began on her face and chest but has spread to involve her abdomen, back, and lower extremities. Her temprature is 38.9 (102.1F), pulse is 100/min, RR 16/min, and BP is 115/70. Examination shows diffuse red, macular and papular rash involving the face, trunk, and extremities; there are no leasions on the palms or soles. Which of the following is the most likely diagnosis?

a) Ehrlichiosis
b) HSP
c) Id reaction
d) Kawasaki disease
e) Pityriasis rosea
f) RMSF
g) Rubeola
h) scabies
i) Scarlet fever
j) Staph Scaled skin syndrome

Rubeola

A 5yo girl w/ a 1 yr hx of chronic nonproductive cough is brought for a follow-up examination. The cough occurs during the day and night and is not exacerbated by exercise. She has not had chills, diarrhea, or weight loss. Inhaled beta adrenergic agonists, two courses of oral abx, and 10 day course of orapred have not relieved her symptoms. She is at the 50th percentile for height and weight. She appears well. Her temp is 37.5C, pulse 96/min, RR 18/min, and BP 82/60. Examination shows no abnormalities. An x-ray of the chest shows no abnormalities except for linear consolidation in the right middle lobe. Which of the following is the most likely diagnosis?

a) alpha-1 antitrypsin deficiency
b) asthma
c) bronchiectasis
d) congenital emphysema
e) CF

C! Bronchiectasis

A 9mo old boy has pneumonia for the fourth time. He was born at 28wks with a grade 4 intraventricular hemorrhage and generalized neurologic devastation. Barium swallow shows a grade 4 GERD. Which of the following operative procedures is most likely to decreased the frequency of recurrent pneumonia?

a) Esophagostomy
b) Fundoplication
c) Gastrostomy
d) pyloromyotomy
e) vagotomy and pyloroplasty

Fundoplication for GERD

5)A previously healthy 4-year-old boy is brought to the physician because of a 2-week history of mild itching of his head and scattered areas of hair loss on his scalp. Examination shows several small oval areas of alopecia over the posterior scalp with numerous hairs broken off close to the scalp. Several small, occipital, nontender lymph nodes are palpated. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal organism?

A)Candida albicans
B)Epidermophyton floccosum
C)Malassezia furfur
D)Microsporum audouinii
E)Trichophyton tonsurans

E! Trichophyton > Microsporum as most common
Microsporum could also be yellow-green fluorescent on Wood’s lamp

A 9-year-old girl with type 1 diabetes mellitus is brought to the emergency department because of lethargy, labored breathing, and seven episodes of vomiting over the past 6 hours. Her skin is flushed and warm and she appears severely dehydrated. There is a fruity odor to her breath. She is at the 75th percentile for height and 25th percentile for weight. Her temperature is 37.2°C (99°F), pulse is 110/min, respirations are 24/min, and blood pressure is 100/60 mm Hg. Capillary refill time is 4 seconds, and capillary blood glucose concentration is greater than 500 mg/dL. Which of the following is the most appropriate initial step in management?

A)Intravenous administration of 20 mL/kg of 5% dextrose in water

B) Intravenous administration of 20 mL/kg of 0.9% saline

C) Intravenous administration of 20 mL/kg of lactated Ringer solution with 40 mEq/L of potassium chloride

D) Intravenous administration of 0.1 U/h of regular insulin

E)Continuous intravenous administration of 0.1 U/h of regular insulin

B! Give fluids as first step for DKA

C- too premature to give K

A 4-year-old girl is admitted to the hospital because of a 6-hour history of fever, decreased alertness, and a rash over her chest, arms, and legs. On admission, the patient is obtunded. Her temperature is 38°C (100.4°F), pulse is 120/min, respirations are 30/min and shallow, and blood pressure is 70/30 mm Hg. Examination shows a purple macular rash over the trunk and extremities. The face and extremities are edematous. Fluid is administered by intravenous bolus, and intravenous administration of ceftriaxone and vancomycin is started. Fifteen minutes after admission, the patient becomes apneic. She is intubated, and mechanical ventilation is started. Serum studies show:
Na+ 135 mEq/L
K+ 4 mEq/L
HCO3- 15 mEq/L
Urea nitrogen 35 mg/dL
Creatinine 0.8 mg/dL

Her urine output is 1.5 mL/kg/h. Arterial blood gas analysis on 40% oxygen shows:
pH 7.2
Pco2 35 mm Hg
Pao2 100 mm Hg

One hour later, her urine output decreases to less than 0.5 mL/kg/h. A chest x-ray shows hazy lung fields bilaterally and cardiomegaly. Which of the following is the most appropriate next step in management?

A)Intravenous administration of an isotonic fluid bolus

B)Intravenous administration of dopamine

C)Intravenous administration of furosemide

D)Intravenous administration of nitroprusside

E)Increased inhaled oxygen concentration

B! IV dopamine

A 2-month-old boy is brought to the physician because of coughing spells that have progressively worsened over the past 10 days and are frequently followed by vomiting. On examination, he is afebrile and appears healthy until he spontaneously has a coughing spell. Coughing continues for 20 seconds, at which time he appears cyanotic for 10 seconds. No crackles are heard on auscultation of the chest. Which of the following is the most likely diagnosis?

A)Aspiration due to gastroesophageal reflux
B)Chlamydial pneumonia
C)Congestive heart failure
D)Pertussis
E)Respiratory syncytial virus bronchiolitis

D! Pertussis

A previously healthy 4-month-old girl is brought to the emergency department in January because of cough and poor feeding for 2 days. She is still urinating and making tears. She initially had a fever of 38.2°C (100.8°F) but has been afebrile for the past day. She appears mildly ill. Her temperature is 37.5°C (99.5°F), pulse is 140/min, and respirations are 56/min. Examination shows pink tympanic membranes with good mobility. There are mild intercostal retractions, and diffuse bilateral crackles and wheezes are heard. Pulse oximetry on room air shows an oxygen saturation of 84%. Which of the following is the most appropriate next step in management?

A)Arterial blood gas analysis
B)Culture of the pharynx for bacteria
C)Viral culture of respiratory secretions
D)X-rays of the chest
E)X-rays of the neck
F)Administration of an inhaled bronchodilator
G)Administration of oxygen
H)Subcutaneous administration of epinephrine

This is bronchiolitis (hypoxemia, cough, bilateral crackles and wheezes in a young infant)

Tx supportively!

1. An otherwise healthy 16yo girl is brought to the physician b/c of 6mo of increasing severe pain with menses. Her mother reports that during this time, her daughter has missed 2 days of school during each menstrual period because of severe pelvic cramps associated w/ vomiting. Menses occurs at regular 28day intervals and lasts 4-5 days. Her last menstrual period was 7 days ago. She currently takes acetaminophen, which provides minimal relief of her symptoms. She has had three lifetime sexual partners, and they use condoms inconsistently. PEx shows no abnormalities. Pelvic examination shows a ternder, normal sized uterus and no masses. Which of the following is the most appropriate next step in management?

a) Pregnancy Test
b) Pelvic US
c) Narcotic therapy
d) NSAIDS
e) SSRI

Likely D but will need to double check to confirm

A 6yo girl is brought to the physician because of a scaly, pruritic rash on the intertriginous areas of her elvows and knees that worsens in the spring and the fall; it often appears in conjunction with episodes of respiratory distress and wheezing. Tx with which of the following is the most effective short term treatment of the rash?

a) Clotrimazole
b) Coal Tar
c) Griseofulvin
d) Lindane
e) Triamcinoline

E! Triamcinolone is a steroid that you can use for atopic dermatitis

3. A 6hr old newborn has had cyanosis of her arms and legs since birth. She was born at 38wk gestation following an uncomplicated pregnancy and c-section for breech presentation. She weighed 2090g at birth. She has been breast feeding well. She is alert and is not in acute distress. Her rectal temprature is 36.2C, puse is 112, RR 36, BP 80/45. Pulse ox 96%. Examination shows cyanosis of the upper and lower extremities but no circumoral cyanosis. Cardiopulmonary examination shows no abnormalities. Cap refill is mildly delayed. Which of the following is the most appropriate step in management?

a) Placement of the newborn under warming lights
b) Blood culture
c) Chest x-ray
d) echo
e) intubation and mechanical ventilation

Possibly place under warming lights – will need to double check

A previously healthy 4yo boy is brought to the physician because of a 1wk hx of intermittent fever. During the past 3 days, he has had decreased activity and joint pain. Yesterday he developed a red rash on his chest. He attends daycare. He appears pale and is not in acute distress. His temperature is 38.4C, pulse 140, RR 24. Examination shows a petechial rash over the chest. The conjunctivae are pale. There is diffuse adenopathy in the cervical chain. A grade 2/6 systolic murmur is heart. The spleen is palpated 1cm below the left costal margin. There is no swelling or redness of the joints. Lab studies show a Hgb of 6.4g/dL, leukocyte count of 50,000/mm3, and platelet count of 10,000/mm3.

a) ALL
b) Anemia of Chronic Disease
c) Autoimmune hemolytic anemia
d) G6PD deficiency
e) HUS
f) Hereditary spherocytosis
g) Lead poisoning
h) Red blood cell aplasia
i) Sickle cell disease
j) thalassemia
k) uremia of chronic renal failure

A! ALL

A 4yo boy is hospitalized because of fever, shallow breathing, and unresponsiveness for 3hrs. His temprature is 40C, pulse 160, RR 60 and BP is 60/35. Examination shows purpura over the loewr extremities. He is intubated and mechanically ventilated. Blood cultures grow Neisseria meningitidis. Two days later, an x-ray of the chest shows bilateral patchy infiltrates. Which of the following is the most likely mechanism of these findings?

a) Cholinergic hyperactivity
b) enzymatic deficiency
c) Increased vascular permeability
d) Mucosal inflammation
e) Oxygen toxicity
f) Surfactant deficiency

C – Damage to endothelial cells of the pulmonary vasculature in sepsis leads to increased vascular permeability and thus pulmonary edema

A previously healthy 8yo boy brought to the emergency department of difficulty breathing 10mins after being stung by a bee. His temp is 36.5C, pulse 130, RR 28 and BP 65/50. Examination shows wheezing, audible stridor, and a generalized urticarial rash. Epi and methlprednisolone are administered. Administration of which of the following is the most appropriate next step?

a) Cromolyn sodium
b) Dopamine
c) Fluid
d) Lidocaine
e) NE

Give fluids – he is in anaphylactic shock

3*-year-*old boy is brought to the physician for a follow*up examination 2 weeks after being treated for an ear infection. He has had recurrent ear infections, sinusitis, and two episodes of bacterial pneumonia since birth. Over the past year, he has undergone placement of two sets of tympanostomy tubes for otitis media. His mother is HIV negative. He currently takes no medications. He is at the 25th percentile for height and weight. Examination shows no abnormalities except for small anterior cervical lymph nodes. Which of the following is the most likely mechanism of disease?

A) Antibody deficiency
B) Impaired chemotaxis
C) Impaired respiratory burst
D) Splenic dysfunction
E) T-*lymphocyte dysfunction

Recurrent sinopulmonary and bacterial infections = humoral deficiency

A 5-*year-*old boy is brought to the physician for a well*-child examination. He is active and has been healthy except for an episode of otitis media 3 weeks ago treated with amoxicillin. His parents emigrated from Vietnam. His diet consists mainly of fruits and vegetables; he occasionally eats fish and chicken but no red meat. Examination shows no abnormalities. Laboratory studies show:
Hemoglobin 10 g/dL
Mean corpuscular volume 64 μm3
Leukocyte count 6100/mm3
Platelet count 225,000/mm3
Red cell distribution width 10% (N=13%-15%)

A blood smear is shown (http://imgur.com/a/tES3u). It has target cells. Which of the following is the most likely explanation for this patient’s anemia?
A) Antibiotic*induced autoimmune hemolysis
B) Decreased synthesis of globin chains
C) Iron deficiency
D) Transient postinfectious bone marrow suppression
E) Vitamin B12 (cobalamin) deficiency

B! South East Asian with asymptomatic anemia and target cells on smear. Microcytic anemia with target cells and normal RDW.

A 10-*day*-old male newborn is admitted to the hospital for treatment of indirect hyperbilirubinemia due to isoimmune hemolysis. He is placed in a room with a 2*-month*-old female infant with dehydration secondary to rotavirus gastroenteritis. Two days later, he develops vomiting and diarrhea, and a stool specimen is positive for rotavirus antigen. This nosocomial infection is most likely caused by failure of caregivers to do which of the following?

A) Dispose of diapers and other waste items properly
B) Observe gown and glove precautions (WRONG)
C) Observe hand*washing techniques
D) Place the patients in a reverse airflow room
E) Restrict visitors to the room

Observe hand-washing precautions for rotavirus

A 13-*year-*old girl with cystic fibrosis is brought to the physician because of a 6-*month history of progressive difficulty breathing. Her mother says that her daughter’s hands and feet have appeared swollen during this period. Her temperature is 37°C (98.6°F), pulse is 98/min, respirations are 30/min, and blood pressure is 124/84 mm Hg. Examination shows dusky nail beds and clubbing of the fingers and toes. There is nasal flaring and moderate intercostal retractions. Bilateral crackles and rhonchi are heard on auscultation. S2 is loud and split in the second left intercostal space. The liver edge is palpated 5 cm below the right costal margin, and the spleen tip is palpated 1 cm below the left costal margin. There is bilateral pitting edema over the dorsum of the hands and feet. Laboratory studies show:
Serum
Na+126 mEq/L
Cl- 84 mEq/L
K+ 4.1 mEq/L
HCO3-36 mEq/L
Albumin 2.8 g/dL

Urine protein 1+

Pulmonary function tests show a decrease in forced vital capacity from 75% to 30% of predicted value over the past year. An x-*ray of the chest shows marked hyperinflation with coarse nodular infiltrates bilaterally. Which of the following is the most likely explanation for this patient’s edema?

A) Cirrhosis of the liver
B) Cor pulmonale
C) Inferior vena cava obstruction
D) Lymphedema
E) Nephrotic syndrome
F) Protein*losing enteropathy
G) Vitamin E deficiency

Interstitial lung disease + loud P2 (from pulmonary HTN) + e/o of right heart failure = cor pulmonale

A 2-year-old girl is brought for a follow-up examination 2 days after initiating amoxicillin therapy for a right lower lobe pneumonia. She had been healthy prior to onset of
the pneumonia. She continues to have fevers and cough, and she now has right-sided chest pain. Her immunizations are up-to-date. She appears ill and is tachypneic.
Her temperature is 38.5°C (101.3°F), pulse is 140/min, and respirations are 45/min. Repeat x-rays of the chest show a large dense consolidation in the right lower lung
field and a fixed right-sided effusion. Which of the following is the most likely causal organism?
A) Enterobacter cloacae
B) Haemophilus influenzae type b
C) Mycobacterium avium-intracellulare
D) Pseudomonas aeruginosa
E) Staphylococcus aureus
E! Staph aureus

A previously healthy 7-year-old boy is brought to the physician because of progressively worsening headaches and difficulty walking over the past 6 weeks. Examination
shows bilateral papilledema, right abducens palsy, and gait ataxia. Which of the following is the most likely diagnosis?
A) Acoustic neuroma
B) Dandy-Walker syndrome
C) Medulloblastoma
D) Optic nerve glioma
E) Pinealoma
Medulloblastoma

A previously healthy 17-year-old boy comes to the physician because of fever and enlarged lymph nodes for 3 weeks. He has had a 9-kg (20-lb) weight loss over the
past 2 months. He has had six to eight loose stools daily for 4 weeks. His temperature is 39°C (102.2°F), pulse is 80/min, and respirations are 30/min. Examination
shows dry skin. There are bilateral 2-cm lymph nodes in the neck, axillae, and groin. The lungs are clear to auscultation. The liver edge is palpated 1 cm below the right
costal margin; the spleen tip is palpated 7 cm below the left costal margin. Laboratory studies show:

Hemoglobin 10 g/dL
Leukocyte count 2100/mm3
Segmented neutrophils 80%
Lymphocytes 18%
Monocytes 2%
Platelet count 180,000/mm3
Serum
lgA 340 mg/dL
lgG 2300 mg/dL
lgM 390 mg/dL

Which of the following is the most likely diagnosis?
A) Common variable immunodeficiency
B) HIV infection
C) Selective lgA deficiency
D) Severe combined immunodeficiency
E) Thymic-parathyroid dysplasia (DiGeorge syndrome)
F) X-linked agammaglobulinemia

B! This is acute HIV infection. Be on the lookout if they have lots of nonspecific symptoms over a subacute time course.

Fever, LAD, weight loss, diarrhea, HSM, significant leukopenia
Other common findings: sore throat, oral ulcerations, myalgias/arthralgias, headache, nausea, vomiting

A 14-year-old girl is brought to the physician because of lower abdominal cramps and intermittent pain in her knees and hips for 6 weeks. The cramps are relieved by
bowel movements. During this period, she has had 6 to 10 urgent, bloody bowel movements daily. Examination shows a swollen, mildly tender left knee joint. Her
hemoglobin concentration is 14.5 g/dl, leukocyte count is 16,000/mm3, and platelet count is 790,000/mm3. Analysis of knee joint aspirate shows straw-colored, slightly
turbid fluid with a leukocyte count of 2000/mm3 (40% segmented neutrophils). Which of the following is the most likely diagnosis?
A) Adenovirus gastroenteritis
B) Chronic nonspecific diarrhea of childhood
C) Giardiasis
D) Henoch-Schonlein purpura
E) Pseudomembranous enterocolitis
F) Ulcerative colitis
F! Ulcerative colitis: bloody stools, leukocytosis, thrombocytosis, abdominal pain, arthralgias, with knee aspiration <10,000 leukocytes

Two weeks after a camping trip in New England, a 5-year-old boy develops a 3-cm, red, circular lesion with a clear center, lymphadenopathy, conjunctivitis, myalgia, and nausea. Antibodies to Proteus vulgaris Ox19 are negative. Which of the following is the most likely causal agent?

A) Bacterium
B) Fungus
C) Rickettsia
D) Spirochete
E) Virus

D! Spirochete

A 9-month-old boy is brought to the physician 2 months after his parents noticed that he seemed to be ignoring them. On questioning, they note that he does not appear to be startled by loud noises. Growth and development have been otherwise normal. He was born at term to a 28-year-old woman, gravida 2, para 1. His mother’s blood group is A. Rh-negative, and his blood group is A. Rh-positive. He had a serum total bilirubin concentration of 25 mg/dL at the age of 2 days and received phototherapy for 2 days. He continued to be mildly jaundiced until the age of 1 month. Serum studies since then have shown no abnormalities. Examination today shows no abnormalities. which of the following is most likely to have prevented this patient’s current condition?
A. Avoidance of breast-feeding
B. Water supplementation
C. Longer course of phototherapy
D. Antibiotic therapy
E. Exchange transfusion
Rh hemolytic disease of the newborn -> do exchange transfusion

17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to hospital, paramedics administered O2 and ECG showed *J-wave*. She is lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls …

what diagnostic modality do you use for patient with gross hematuria after MVA hemodynamically stable –> CT to see the source if unstable do FAST malignant pleural effusion condition in which cancer causes an abnormal amount of fluid to collect …

what is the most prevalent extraintestinal complication of inflammatory bowel disease? Anemia bp is low what kind of ABG wil you see lactic acidosis – PH – 7.2 anion gap etaboic acidosis WE WILL WRITE A CUSTOM ESSAY SAMPLE ON …

– PTH secreting tumor (hypercalcemia) is squamous cell Ca || 67 YO postal worker with a 5 min episode of weakness and numbness in his hand. Ni sequelae and has smoked 1ppd x 45 years. Carotid bruits are heard bilaterally. …

“47 YOW comes in with a BMI of 67 , chafed skin on inner thighs, under breasts, twice requiring admission for abtx for panniculitis. Also has thick curdy vaginal discharge.Best long term management for this pt?”, gastric bypass “37 YOw …

The parents of a 7-month-old girl with a sickle cell crisis ask why the nurses keep giving their daughter pain medication so often. Which response best explains the rationale for the nurses’ action? “We are trying to control her pain …

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