42872004 Case Based Exam Pediatrics Clerkship Case Based Exam Pediatrics Clerkship * Required 1. You are called to NICU to evaluate a 1 day old term infant who just had a1 point single episode of bilious vomiting. The pregnancy labor and delivery were uncomplicated with an Apgar scores of 9 at 1 and 5 minutes. Physical examination of the infant reveals no abnormalities. The most appropriate initial step in management is to. * © a. Observe for continued vomiting © b. Measure serum electrolyte levels and CBC O © obtain an UGI series © 4. Place an NGT for decompression 2.A 4 year old girl presents to the ER with vomiting and fever of 39C and 1 point right flank pain Labs exam reveals WN+BC 22,000, with 10% bands and &)% segmenters Urine dipstick positive for nitrites and leucocyte esterases and urinalysis showed WBC 100/hpf. The most appropriate therapy is :* O al Ampicillin O b.Weefotaxime O «iN Ciprofloxacin © 4. Oral trimethoprim/sulfamethoxazole hitpssdocs google. comiformsde/1FAlpQLSdxcSslas\-3FpVLzInM9rZLIZBB|JBIGArctQJnowEVMo2AformResponse re342872004 Case Based Exam Pediatrics Clerkship 3.A3 year old child has isolated breast tissue development with no other 1 point signs of prepubertal development such as pubic hair. All growth parameters are at the Soth percentile. The most appropriate management isto:* ‘a, Measure serum gonadotrophin levels b. Obtain a pelvic ultrasonography ¢. Obtain x-ray of the hand and wrist to determine bone age OoO0°0 4d. Reassure the parents that such breast development usually regress spontaneously 4. An 18 month old boy is referred by the DSWD for evaluation of multiple 1 point skin lesionsThe clinical findings that are most likely due to physical abuse are: * © .Blanching purple patches extending over the right buttocks and down the right leg © b. Purpuric lesions of various colors and sizes over the buttocks and genitalia © Coin shaped and linear ecchymosis over the back d. Slate -gray to bluegreen patches scattered over the buttocks and spine htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse42872004 Case Based Exam Pediatrics Clerkship 5. Two hours after new IVF were begun, a 1.9 kg neonate appers gray and pulseless with muffled hear tones , despite a heart 150 beats /min. CPR and intubation make no improvement. The heart rate on ECG is 133 to 150 beats /min., but distinct P waves are not evident. And QRS complexes are widened. The most appropriate initial intervention is: * © a. Administration of IV Lidocaine © b. Administration of IV 10% Calcium gluconate © . Administration of Iv NaHCO3 CO 4.0C electrical cardioversion 6. You are evaluating a 15 year old girl who has had fever, letahry , confusion and unremitting headaches for 3 days. Examination of CSF reveals 130 leucocytes, 420 RBC and negative Gram stain. MRI shows increased signal in the left temporal lobe. EEG documents focal discharges.Yous sucpect encephalitis. The most likely caus e of encephalitis in this patient is: * a. Enteroviruses b. Measles HIV OoO0o0°0 d. HSV type 7 htpssdocs google. comiformsd/e/1FAlpQLSdxcSslas\-3FpVLzInM9rZLIZBB|JBIGArctQJnowEVMo2AformResponse 32342872004 Case Based Exam Pediatrics Clerkship 7.A 2-year-old develops bone marrow suppression after a viral infection. Pure red cell aplasia is found and the child is diagnosed with transient erythroblastopenia of childhood (TEC). The mother is told it will pass. What type of anemia is this? * O a Hypochromie microcytic anemia © b. Hyperchromic microcytic anemia © ©. Hypochromic macrocytic anemia © 4. Normochromic Normocytic anemia 8 Achild is brought to the emergency center after a soccer game. Physical exam reveals significant knee hemarthroses. Further testing reveals an X-linked recessive disorder involving factor VIII deficiency. Which of the following is most likely? * © 2) Sickle cell disease © >) Alpha thalassemia © ¢)Hemophilia A © 4) Hemophilia B htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse traumatic hemorrhages _1 point iz42872004 Case Based Exam Pediatrics Clerkship 9. A child presents with complaints of bleeding gums when she brushes her 1 point teeth and even when she eats. He had history of severe bleeding following tonsillectomy. Testing reveals a deficiency in von Willebrand factor. What is the drug of choice for this patient for bleeding episodes? * O @)Vitamink © >) Clopidogrel © 4 Desmopressin (DDAVP) O 4) Cryoprecipitate 10. A 2 year old boy with newly developed ALL presents with fever, 1 point petechiae and ecchymosis. He has thrombocytopenia ,prolonged PT, prolonged aPTT and prolonged platelet function assay. The most likely diagnosis is: * © a) Vitamin k deficiency CO ») Disseminated intravascular coagulation © ©)Hemophilia A © 4) Hemophilia B htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse42872004 Case Based Exam Pediatrics Clerkship 11A 3 year old girl is brought to OPD with petechaie and bruising on the face, back ,chest and lower extremities. Which noticed by mother this morning. The mother states that her daughter has been healthy except for viral upper respiratory infection, 2 weeks ago, The most likely diagnosis is: * © @) Acute leukemia © ») Aplastic anemia © ©) Autoimmune haemolytic anemia © 4) Idiopathic thrombocytopenic purpura 12. A2 year old boy with thrombocytopenia and large hemagioma that sequesters and destroys platelets is consistent with diagnosis of : * © a)Kasabach-Merrit syndrome © ») Fanconi anemia © ©) Wiskott-Aldrich syndrome © 4) Bernard -Soulier syndome 13, A11week old male newborn infant is brought to the ER because of vomiting and decreased feeding for 3 days. On exam, he is jaundiced and has hepatomegaly. He is admitted in NICU but he died of E.Coli sepsis. Urine reducing substance is positive. The most likely diagnosis is :* © aturlers disease © Hartnup disease O «.Galactosemia © 4. Gaucher disease htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 1 point 1 point 1 point42872004 Case Based Exam Pediatrics Clerkship 14,6 year old girl presents to the OPD for well-child check up. Her growth was normal until 2 years old when her height started to fall off the growth chart steadily decreasing to Sth percentile, On examination On exam she has webbed neck, a shield chest with widely spaced nipple and a heart systolic murmur was heard at the back. Which of the following is the most likely diagnosis? * O a.down syndrome © b. Turner syndrome O «Patau syndrome © 4. Edward syndrome 15. A 6 year old boy is brought to the OPD for consult regarding the child's developmental delay. He was born full term via normal spontaneous delivery and normal at birth but has not been meeting his developmental milestones. He is hyperactive and urinated in diapers. While examining the boy, you noticed mousy musty smell . Which of the following is the most likely diagnosis? * © @.Homocystinuria © b-Tyrosinemia © ©. Phenylketonuria © 4. Maple syrup urine disease htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 2342872004 Case Based Exam Pediatrics Clerkship 16. During a well child visit at the OPD, the mother of a 10 month old infant note that he is unable to sit alone or roll over and startles very easily to sounds. On eye examination you note a cherry red spot. The most likely diagnosis is * © a Tay-Sachs disease © b. Nieman Pick disease © Hunter syndrome © 4-Hurler disease 17. A15 year old boy with mental retardation has been referred to you. On physical exam, you note that he has large head,|arge ears and large testes. Which of the syndromes is associated with these findings and mental retardation? * © a. Fragile X syndrome O »-Prader wii syndrome © «.Klinefelter syndrome © 4. Wiliam syndrome 18. A1 year old child presents with sinopulmonary infections associated with chronic diarrhea infection with Giargia Lamblia and atopic diseases. What is the most likely immune defi a. Selective IgA deficiency b. Congenital agammaglobulinemia (Bruttor's disease) ¢. Severe combined immune deficiency d. Common variable immune deficiency OoO00°0 htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 1 point 1 point 1 point42872004 Case Based Exam Pediatrics Clerkship 19. A110 month old baby with a history of recurrent pneumonias, frequent 1 point oral thrush, chronic diarrhea, signs of UTI and recurrent skin infections was brought to you due to failure to thrive (FTT). The total serum hemolytic complement (CH50) is normal. What is your likely consideration as to the cause of this FIT? * © a. Agammaglobulinemia © b. Chronic granulomatous disease © ¢. Complement deficiency © 4. Common variable immunodeficiency 20.A 1 year old boy has a history of episodes of otitis media, sinusitis and 1 point pneumonia He has not any fungal, protozoal or mycobacterial infections. You suspect a disorder of humoral immunity disorder. Which of the following is the most appropriate initial screening test to be requested? * © a Total haemolytic complement (CH50) © b. Serum Immunoglobulin levels © « Dihydrothodamine flow cytometry test or NBT © 4. Peripheral blood smear (PBS) htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse42872004 Case Based Exam Pediatrics Clerkship 21. A 6 week old term infant referred for anemia. Hb 7.5, Retic 2%. Mother 1 point (O+, Baby A+ , Direct Coombs +, Cord blood Hb 14.2 g/dL. Jaundice of 15mg/dL. at 48 hours of life, received d photo Rx and discharged at 5 days. No complaints, pale, Total Bilirubin 3.5, Direct 0.5. Blood smear shows spherocytes and nucleated RBC. The most likely explanation for his anemia is:* a, G6PD deficiency b. Hereditary spherocytosis c. ABO incompatibility oOo0o°o d. Rh hemolytic disease 22. Which of the following scenarios would make you suspect the 1 point possibility of immunodeficiency? * © a.Anewborn baby with sepsis with maternal history of UTI prior to birth © b.A3 month old baby with pneumonia with history of 2 hospitalizations © °-ASmonth old baby infected with Klebsiella pneumoniae while admitted atthe charity wards © 4.A1 month old baby with infected BCG site that responded to topical antibiotics htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 102342872004 Case Based Exam Pediatrics Clerkship 23. A2 month old boy has a history of recurrent pus formation and cellulitis. 1 point in his flank and back areas. He is currently admitted in the hospital for lung abscess. What is the initial steps in management of this infant? * © a. Administer a narrow spectrum antibiotic specific for staphylococcal infection IV © b. Administer intravenous immunoglobulins immediately © .Prophylatic trimethoprim-sulfamethixzole © 4. Administer 2 synergistically working broad spectrum antibiotics IV 24, An infant boy was noted to have recurrent infections with encapsulated 1 point organisms (S. aureus, S. pneumonia, H influenza) when he turned 7 months old. What findings will you expect if you do a physical exam on this baby? * a. Eczemas b. Telangiectasias c, Underdeveloped tonsils and adenoids OoOO00°0 d. Café-au lait spots 25. A 4 year old boy with a painless growing soft tissue mass within the 1 point orbit with accompanying proptosis and eyelid swelling. The most likely diagnosis: * © a Osteogenic sarcoma CO b Retinoblastoma O c Teratoma © 4. Rhabdomyosarcoma htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 0342872004 Case Based Exam Pediatrics Clerkship 26. You are called to the NICU and evaluate a newborn infant with 1 point ambiguous genitalia. The mother had an amniocentesis showing a fetus with XX genotype. Physical examination showed no palpable gonads, small phallic structure and labial fusion with a urogenital opening. Which of the following is the most likely diagnosis? * © atermaphrodite O b.Hypopituitarism © ©. Congenital adrenal hyperplasia © 4. Partial androgen insensitivity 27. An obese 13 year old girl is suspected of having the diagnosis of Type 2. 1 point Diabetes mellitus. Which of the following statements regarding this suspected diagnosis is correct? * a. She is likely to present with serious DKA during adolescence b. Type 2 DM is more likely to occur in children <10 years of age . She is likely to have had islet cell antibodies before the onset of clinical symptoms d. Type 2 DM has a strong hereditary component OO00°0 htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 122342872004 Case Based Exam Pediatrics Clerkship 28. A 13 year old girl is brought to the ER because of palpitations and tachycardia. Her mother reports that she lost 5 Ibs during the past 2 months. Physical exam showed BP 130/75 and a HR of 115 beats/min, and enlarged thyroid gland . You suspect Grave's disease. Which of the following statements regarding Grave's disease is correct? * © a. Subtotal thyroidectomy is the most appropriate initial management © P:Sitls with Graves disease have an increased likelihood of developing precocious puberty © «This disease is more common in males CO 4. Radioactive iodine treatment is effective 29. You are called to the PICU to evaluate a 4 year old girl with Type DM who is in diabetic ketoacidosis. She was alert and conversant but over the last hour she has become obtunded and listless. Which of the following conditions is most likely cause of her change in mental status? * O a -Hypdergiycemia © b.Cerebral edema O Hyperkalemia © 4. Hypercalcemia htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 192342872004 Case Based Exam Pediatrics Clerkship 30. An 8 year old girl presents to the OPD because of short stature. Her height remained below the 3rd percentile for the past several years. Bone age determination was 3 years younger her chronologic age. Which of the following diagnosis should be considered? * O a Genetic short stature © b. Skeletal dysplasia CO «Growth hormone deficiency © 4. turer syndrome 31. Anewborn with congenital Hypothyroidism is diagnosed and treated adequately by two weeks of age. It can be anticipated that with continued treatment he will have * © @ short stature but normal intelligence © Short stature and slight mental retardation O «Normal growth and development © 4. Normal stature but a mild degree of mental retardation 32. A term newborn baby gil is delivered via NSD complicated by prolapsed umbilical cord and meconium stained AF, with poor APGAR score, 6 hours after birth she developed seizures. The most likely cause of seizures in this infant is: * a. Hypoxic- ischemic encephalopathy b. Intracranial hemorthage c. Intaruteriune infection OoO00°0 d. Congenital CNS anomalies htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 1 point 1 point 1 point saz42872004 Case Based Exam Pediatrics Clerkship 33. A.9 month old infant was brought to the hospital because of upward 1 point rolling of eyeballs, stiffening of extremities and circumoral cyanosis. He had moderately high grade fever for 2 days accompanied by rhinorrhea and mild cough. Physical examination was essentially normal except for a mildly congested throat. Neurologic examination was essentially normal. The probable diagnosis is: * a. Breath-holding spells b. Simple febrile seizure «. Idiopathic epilepsy oOo0o°o d. Encephalitis 34. A 5 week old male infant presents to the clinic with jaundice. On 1 point examination his liver is enlarged 4 cm below the right costal margin. Lab evaluation reveals total bilirubin of 12.9 with direct component of 5.9 The most appropriate next step in management is. * © a. Refer the patient for liver btransplant © b. Order an urgent abdominal ultrasound and refer for liver biopsy CO ¢ Start phototherapy to treat the patient's jaundice CO 4. Start oral ursodeoxycholic acid to enhance bile flow htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 192342872004 Case Based Exam Pediatrics Clerkship 35.5 year old girl has a history of nausea, vomiting and loss of appetite ‘On physical examination her conjunctivae are icteric and the right upper quadrant of her abdomen is tender. What is the most likely diagnosis? * © a. Acute hepatitis A O b- Acute chotangitis © «Acute cholecystitis © 4. Acute pancreatitis 36. A 5 year old child has skin test with PPD placed as part of a health supervision visit. When the child returns 48 hours later, the PPD is read as having 8 mm of induration. The child is well, has no known exposure to active TB. The most likely explanation for the induration on PPD testing is : * O a cross-reactivity with nontuberculous bacteria © b. Hypersensitivity reaction to preservative in the PPD O Improper placement of the PPD © 4. Newly acquired tuberculosis htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 162342872004 Case Based Exam Pediatrics Clerkship 37. A6 year old boy presents with tea colored urine. He was diagnosed with 1 point URI2 days ago. His parents report that a similar episode occurred 4 months ago. There is no history of trauma. Findings include BP 105/70, Tempt 38C and absence of rash or joint abnormalities. Serum complement is normal The most likely explanation of these findings is: * © aalport hereditary nephritis © b-Postinfectious AGN © c.lgA nephropathy © aNephrotic syndrome 38. A 13 month old infant presents with a 2 day history of fever, fussiness 1 point and poor feeding. Findings include a pale irritable child, dry mucous membranes , cool extremities,, weak peripheral pulses, CRT 4 sec, HR 180, BP 100/50 and RR 35. The most appropriate initial management of this child is to administer: © @.AnIV bolus of 10 mi/k of DSW © b.An IV bolus of 20 mi/K of DS 0.3% NaCl © .AnIV bolus of 20 mi/Kg 0,9% normal saline © 4.5% Albumin hitpssdocs google. comiformsde/1FAlpQLSdxcSslas\-3FpVLzInM9rZLIZBB|JBIGArctQJnowEVMo2AformResponse ies42872004 Case Based Exam Pediatrics Clerkship 39, Amonth old girl is evaluated episodes of wheezing. She feeds slowly and sweats during feeding. Findings include weight in 5th percentile, Length 50th percentile. Soft systolic ejection murmurs at the left upper sternal border and in the back., liver edge 3 cm below the right costal margin and diffuse respiratory wheezing. The most appropriate initial step is* a, Administration of nebulized salbutamol b. Chest x-ray to rule out foreign body aspiration c. Palpation of pulses and measurement of BP in all extremities oOo0o°o d. Perform 2 D-Echocardiography 40. A 37 weeks gestation baby is born after an uncomplicated pregnancy. At birth, he is lethargic and had a HR of 40. 02 oxygen was administered by bag and mask. And he was intubated. His HR remained at 40 beats per minute. The most appropriate next step in management is: * © a. Administer Epinephrine CO b. Administer HCOS © . Administer Calcium gluconate © 4. Begin chest compression htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 182342872004 Case Based Exam Pediatrics Clerkship 41, A term baby born to a mother with insulin dependent pregestational 1 point diabetes has an HGT of 32 mg/dl at 1 hour of life. He is awake and has normal vital signs. Which of the following is the most appropriate next step in management? * O aPlace anv and administer glucose. © b-Recheck the glucose in 1 hour © Admit to the nursery for observation © 4unstruct the mother to breastfeed him and recheck the glucose in 10 minutes 42. A 30 hour old full term infant has facial and chest jaundice. He is 1 point breastfeeding well and has an otherwise normal examination. His bilirubin level is 15.5 mg/dL. Which of the following is the most appropriate course of action? * © a Stop breastfeeding for 48 hours and supplement with milk formula CO b Start phototherapy CO Start exchange transfusion © 4. Observe, wait for 6 hours and recheck serum bilirubin 43.A 2 year old girl with a history of esophageal atresia and VSD is 1 point hospitalized for pneumocystis carinii pneumonia. Her immunodeficiency is likely to result from which of the following? * © aAgammaglobulinemia © . DiGeorge syndrome © Chronic granulomatous diseases CE 4. Severe combined immunodeficiency syndrome htpssdocs. google. comiformsia/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 1912342872004 Case Based Exam Pediatrics Clerkship 44, A13 month old child is seen in the OPD clinic. His mother reports that she is exclusively breastfeed for the child until he was 6 months of age. He is still breastfeed approximately 4- 5 times daily but the mother reports he also drinks 2-3 oz of water daily, 8-10 2 of juice daily and has been doing well eating table foods. What dosing of vitamin D would be the most appropriate for this child? * © 2.2001 daily © b.400 10 daily O 600 1U daily © 4.80010 daily 45. A 15 month old boy is brought to the ER because of increasing bloody diarrhea over the past 2 days. She reports he was febrile 2 days ago with several episodes of vomiting that had resolved yesterday. In the past 24 hours he has had more than 10 episode of bloody diarrhea with the most recent appearing to consist only blood with no stool mixed with it. On PE he is lethargic Which of the following is NOT part of his immediate management? * a, CBC, PT APTT determination b. A bolus of normal saline ¢, Ultrasound of the abdomen d. Colonoscopy Oo000 hitpssdocs google. comiformsde/1FAlpQLSdxcSslas\-3FpVLzInM9rZLIZBB|JBIGArctQJnowEVMo2AformResponse 1 point 1 point 2012342872004 Case Based Exam Pediatrics Clerkship 46. A mother brings to the OPD clinic her 4 year old son who began complaining of right knee pain 2 weeks ago, is limping slightly , is fatigued and has had fever of 380C. Which of the following laboratory test is most important? * O @Anatinuclear antibodies © b-Rheumatoid factor © ©.CBC and platelets O «esr 47. A1 week old infant presents with a right midquadrant abdominal mass and decreased urinary output. There has been no temperature lability, irritability or abnormal stooling or urine appearance. Which of the following tests would be most helpful in the determining the etiology of this infants’ abdominal mass? * O asarium enema © b.Abdominal ultrasound © «©. Abdominal CT scan © 4. Urinary catecholamines htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 1 point 1 point 2342872004 Case Based Exam Pediatrics Clerkship 48. 47 year old girl has had fever, conjunctivitis, erythema of the oropharynx and generalized maculopapular rash. Her lips, lymph nodes and extremities appear normal. Which of the following laboratory tests would not be used to establish a diagnosis? * O acre b. ESR ©, CBC and Platelets d. Antinuclear antibody e. Urinalysis OoO00°0 49. A 15b year old adolescent girl with primary amenorrhea is noted to be well below the fifth percentile. For height. SDhe has hypertension, a low posterior hair line prominent and low set ears and excessive nuchal skin. What is the most likely diagnosis? * © & xxx syndromes © »b.Klinefelters syndrome © .Turners syndrome CO 4. Fragile X-syndrome htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 2342872004 Case Based Exam Pediatrics Clerkship 50. A year old girl has 1 day of fever of 39.20C, anorexia, 2episodes of 1 point vomiting and abdominal pain . Which of the following would not be part of your examination? * © a. Auscultation of the abdomen © b. Inspection of the oropharynx © Percussion of the abdomen © 4. Digital rectal examination Page 2 of 2 Back Submit Never submit passwords through Google Forms. This content is neither ctzated nor endorsed by Google. Report Abuse - Terms of Seivice - Privacy Folicy, htpssdocs. google. comiformsla/FAlpOLSdixcSslas\-3FpVLzNMSrZLIZBB|JBIGArcTQJnowEVMoaAlformRosponse 2023