ABP review

Question 1

Routine evaluation of a 12-month-old child reveals normal growth parameters and developmental skills, but the child has no primary teeth.

Which of the following is the most appropriate next step?

Answer 1

Reassurance

Question 2

An 8-month-old infant no longer babbles or turns her head when called.

Which of the following methods is most appropriate in the assessment of suspected hearing loss in this infant?

Answer 2

Visual reinforcement audiometry

Tympanometry is NOT a hearing test..

Question 3

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?

Answer 3

Unequal refractive error

Question 4

Hematologic abnormalities in Lupus

Answer 4

Hemoglobin Leukocyte Count Platelet Count

Decreased Decreased Decreased

Direct Antiglobulin (Coombs) Test: Positive

Question 5

Delayed puberty in males

Answer 5

No pubertal development by age 14

Question 6

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?

Answer 6

Pneumocystis jirovecii

Question 7

13-year-old boy is brought by his parents for evaluation after he was suspended from school for bullying another student. Over the last 3 months the boy has instigated a number of physical altercations, his grades have worsened, and he is in danger of being expelled. His parents are perplexed by his behavior because the boy himself was a victim of bullying in elementary school. He refuses to talk to them and spends most of his time playing video games alone in his bedroom.

Which of the following is the most appropriate next step?

Answer 7

Assess for clinical depression

Question 8

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?

Answer 8

Hypoplastic left colon syndrome

Question 9

A 2-year-old girl has a tracheostomy because of severe tracheomalacia and bronchomalacia. She is dependent on mechanical ventilation. She is brought to the emergency department because of agitation and diminished breath sounds bilaterally.

Results of venous blood gas analysis after oxygen supplementation in this situation are likely to be most consistent with which of the following?

Answer 9

Respiratory acidosis

Question 10

A 15-year-old boy was rescued from the bottom of a pond, where he had been lying for an unknown period of time. He was successfully resuscitated and regained spontaneous circulation at the scene.

One week after the incident, he was able to breathe spontaneously and had a normal pulse rate and blood pressure. He had sleep-wake cycles, but his gag reflex was absent and he was unresponsive to his environment, including pain and vocal commands. His condition was diagnosed as “persistent vegetative state.”

Three months later, his diagnosis is changed to “permanent vegetative state.” After lengthy discussions regarding their son’s prognosis, the parents request a “do not resuscitate” order but also want artificial nutrition and hydration (ANH) to be continued.

Which of the following is the strongest ethical argument with regard to the continuation of ANH in this situation?

Answer 10

ANH should be continued until the parents decide it is not consistent with their son’s best interests

Question 11

Which of the following clinical manifestations would be expected in a 20-kg child who ingested 6000 mg of acetaminophen 5 hours ago?

Answer 11

Vomiting

Question 12

Which of the following is the most influential factor contributing to presentation of Bipolar disorder?

Answer 12

Family Hx

Question 13

A 16-year-old female long-distance runner is training for a marathon. She has had heat cramps in the past, but no injuries have occurred during her training. Weight is 60 kg. Findings on physical examination are normal. She inquires about fluid intake during the marathon.

Which of the following is the best recommendation?

Answer 13

Fluid intake should be unrestricted

Question 14

A 6-month-old boy has a head circumference at the 90th percentile. His head circumference was at the 50th percentile at birth. The mother states that the boy’s brother and father have large heads.

Evaluation of the boy shows that he rolls over from front to back but not from back to front and that he needs trunk support to sit. He reaches for and grasps a rattle briefly but does not transfer it.

Which of the following is the most appropriate next step?

Answer 14

Computed tomography of the head

Question 15

An otherwise normal 3-year-old child has a 1-hour history of fever, dysphagia, sore throat, and worsening dyspnea. Cyanosis, drooling, and marked respiratory distress with audible stridor are present on physical examination.

Which of the following is the most likely diagnosis?

Answer 15

Epiglottitis

Question 16

A 5-year-old boy is undergoing evaluation prior to entering kindergarten. He lives with his aunt because his mother died 2 years ago, reportedly from a seizure. His development has always been delayed. He had difficulties with coordination last year during preschool. Most recently, he has difficulty with his attention span.

On physical examination, he has a large head and subcutaneous nodules. Sexual maturity rating is stage 2. The remainder of the physical findings are normal.

Which of the following is the most likely diagnosis?

Answer 16

Neurofibromatosis

Look up that and tuberous sclerosis

Question 17

A 4-month-old girl is brought for a well-child evaluation. Findings at her 2-month evaluation were normal except for mild truncal hypotonia. Physical examination today shows an alert infant with a frog-legged posture. She has poor head control when pulled to a sitting position. Deep tendon reflexes are difficult to elicit.

Which of the following is the most appropriate next step?

Answer 17

Genetic studies for spinal muscular atrophy

Question 18

Since the death of her father, an 8-year-old girl has begun to complain of frequent abdominal pain and to express concern about the possible death of her mother, who is currently in good health. The mother reports that school officials are concerned about the girl’s frequent school absences.

This scenario is most consistent with which of the following?

Answer 18

Separation Anxiety

Question 19

An abnormal maternal serum α-fetoprotein concentration may be indicative of each of the following EXCEPT

Answer 19

Wilms Tumor

Question 20

A 3-year-old boy with a history of methylmalonic acidemia has a 2-day history of fever, cough, and nasal congestion. He has had poor oral intake and vomited three times in the last 12 hours. He currently receives oral carnitine therapy and a multivitamin daily.

Physical examination reveals a febrile boy with mildly dry mucous membranes and a capillary refilling time of 3 seconds. Results of influenza A testing are positive.

Which of the following is the most important next step in management?

Answer 20

IV fluids with glucose

Question 21

A child can build a tower of six to seven cubes, turn single pages of a book, and imitate a horizontal crayon stroke.

This child’s developmental age most closely approximates

Answer 21

24 months

Question 22

A 4-year-old boy is brought to the emergency department because of a 6-day history of cough and rhinitis. His symptoms have progressively worsened over the last few days, and he now has high fever and wet cough.

Physical examination reveals tachypnea, retractions, and inspiratory stridor. He has no drooling. Oxygen saturation is 97% (room air).

Administration of which of the following is the most appropriate management for this patient?

Answer 22

Vanc and Ceftriaxone IV

Question 23

An 18-month-old child who had a ventriculoatrial shunt 3 weeks ago for hydrocephalus is now febrile and irritable. The skin over the shunt is erythematous.

Which of the following organisms is the most likely cause of the infection?

Answer 23

S. epidermis

Question 24

A 15-year-old girl has not yet experienced menarche. Thelarche occurred at 10 1/2 years of age. Height and weight are at the 50th percentiles. Her sexual maturity rating is stage 5 for breast development and stage 4 for pubic hair. The external genitalia appear normal.

Which of the following is the most appropriate next step?

Answer 24

Pelvic Ultrasound

Question 25

A 1.2-kg girl is born at 29 weeks’ gestation via cesarean delivery because of fetal distress. Apgar scores are 2 and 8 at 1 and 5 minutes, respectively. The infant is intubated and transferred to the neonatal intensive care unit.

An intermittent murmur is heard on the third day after birth. Echocardiography shows a large patent ductus arteriosus with continuous left-to-right flow, normal ventricular function, and no other intracardiac defects. A complete blood count, platelet count, and blood urea nitrogen, serum creatinine, and serum electrolyte concentrations are normal.

Which of the following is the most appropriate next step?

Answer 25

Begin Indomethacin therapy

Question 26

There is clear evidence to support the use of subcutaneous allergen immunotherapy for which of the following?

Answer 26

Life threatening reaction to insect sting

Question 27

Post Strep GN - fluid management

Answer 27

replacement of insensible loss and urine output

Question 28

A 3-month-old boy has tachypnea, hepatomegaly, a gallop heart rhythm, and tachycardia. No cardiac murmurs are present. There are numerous 3-mm to 12-mm “strawberry” hemangiomata scattered over the trunk.

Which of the following is the most likely diagnosis?

Answer 28

Arteriovenous malformation(s) of the liver

Question 29

A 5-year-old child has received no immunizations.

How many doses of pertussis vaccine does this child need to be immunized?

Answer 29

Four

Question 30

A full-term infant is born to a 26-year-old gravida 1 para 1 woman following a pregnancy complicated by syphilis at 20 weeks’ gestation. The mother was treated adequately at that time and received careful follow-up evaluation. She has been asymptomatic.

At birth, the infant has normal physical findings. Results of a rapid plasma reagin test are 1:2. The mother has not yet decided where the infant will receive pediatric care.

Which of the following is most appropriate for the infant at this time?

Answer 30

Single dose of benzathine penicillin

Question 31

A full-term neonate is born via cesarean delivery because of arrest of labor. The respiratory rate is 68/min, with grunting and mild cyanosis. The infant has a scaphoid abdomen. Breath sounds are decreased on the left.

Which of the following is the most appropriate next step?

Answer 31

Intubate

Question 32

An infant has had several ear infections before her first birthday. The infant was born at 28 weeks’ gestation with a cleft palate and has been treated for reactive airway disease and gastroesophageal reflux. Blood tests have demonstrated high serum IgE concentrations for some foods.

Which of the following is the most likely cause of this infant’s recurrent ear infections?

Answer 32

Cleft palate