Aquifer Pediatrics Exam (2024/2025) - Complete Solutions (Answered)

Aquifer Pediatrics Exam (2024/2025) - Complete Solutions (Answered) 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 adequat ...

Aquifer Pediatrics Exam (2024/2025) - Complete Solutions (Answered) 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 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 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 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 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 would be LEAST LIKELY to be the cause of the infant's symptoms? 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? A. Short-acting beta2-agonist (albuterol) B. Inhaled corticosteroid C. Leukotriene modifier D. Combined Long-acting beta2-agonist and inhaled corticosteroid (LABA-ICS) 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. A. On mother’s chest B. On mothers lap C. On the exam table 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 Considering Rebecca's signs, symptoms, and physical exam findings, now select the most appropriate diagnosis. Choose the single best answer. B/L AOM Of the following factors that you discovered while taking Rebecca's medical history, which are considered risk factors for developing acute otitis media? Select all that apply. Daycare attendance, exposure to cigarette smoke, possible allergies Which two of the pathogens below are the most prevalent causes of AOM? Choose the two best answers. H. influenzae, nontypeable and Strep pneumo Of the following, which treatment option would be best for Rebecca? Choose the single best answer. Amox How would you describe and diagnose her right ear? Choose the single best answer. Amber, nonmobile, retracted position, opaque (OME) You find similar findings for Rebecca's left ear, consistent with bilateral OME. You explain to her mother that the fluid in her middle ear has most likely persisted since her episode of bilateral AOM four months before. Assess language development, order hearing assessment An 18-month-old girl presents to the clinic with nasal congestion and fever for three days. She is previously healthy. She is receiving acetaminophen for fever. Temperature is 101.2 F (38.4 C), pulse is 100 beats/minute, respirations are 24 breaths per minute. Oxygen saturations are 98% on room air. She is alert and well perfused with clear mucus coming from both nostrils and no increased work of breathing. Both turbinates show erythema. Her oropharynx is erythematous. No crackles or wheezing are heard. Her immunizations are up to date. Which of the following infectious organisms is most likely cause of this patient's presentation? Rhinovirus A 14-month-old female presents to the clinic with a fever of 39.2 C and irritability. According to mom, the patient was initially sick one week ago with a runny nose and cough, but these symptoms had resolved. She started pulling at her ear and becoming increasingly irritable last night. She has had several prior ear infections and was most recently treated one month ago with amoxicillin. She is up to date on immunizations. Physical examination reveals a red, opaque, bulging tympanic membrane with bubbles and limited mobility of her left ear. The exam of the right ear is normal. Which of the following is the next step in the management of this patient? Amox/Clav An 18-month-old girl is brought to her pediatrician by her mother who notes that she has been fussy for the past three days and has been pulling on her ears. The child is up to date with her vaccines. Her temperature is 39 C (102.2 F). Otoscopic exam of her left ear shows a yellow, opaque, and bulging tympanic membrane. Which of the following organisms is the most likely cause of the child's condition? H influenza An 18-month-old presents with yellow and poorly mobile tympanic membranes. Four months prior he presented then with several days of nasal congestion, cough, decreased eating, and ear tugging. His exam then revealed a red, nonmobile tympanic membrane and he was treated with amoxicillin. Based on the history and physical exam, what is the most likely diagnosis now? Otitis media with effusion An 8-year-old girl comes to the clinic with two weeks of nasal congestion. Three days ago, she developed a fever of 38.7°C, purulent nasal secretions, malodorous breath, and a nocturnal cough. Examination of the nose reveals bilateral purulent nasal drainage and mild facial tenderness. Which of the following is the most likely diagnosis? Sinusitis What pertinent information have you obtained from this quick chart review? Choose the single best answer. Emily has normal growth and development to date Given the key findings from Emily's history, select the SEVEN most likely or most concerning diagnoses you are considering at this junctur Juvenile idiopathic arthritis, leukemia, lyme arthritis, osteomyelitis, septic arthritis, transient synovitis, trauma Which of the following findings is NOT associated with the etiology listed? Choose the single best answer. Carditis: Transient synovitis 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. Emily is a 4-year-old previously healthy female who presents with acute right leg pain, refusal to walk, low-grade fever in the setting of URI symptoms a couple of days ago, and a recent minor fall. The only musculoskeletal finding on exam is limited internal rotation of the right hip, and she is otherwise well appearing. At this point, based on Emily's history and exam, which of the following is your leading diagnosis? Choose the single best answer Transient synovitis From the following, which labs and imaging tests would you like to order (while also trying to minimize costs)? Select all that apply Blood culture, CBC, CRP, ESR, lyme antibody How would you interpret Emily's lab results? Choose the single best answer. The results do not show a degree of inflammation consistent with septic hip. Emily can be given a diagnosis of transient synovitis. Given that Emily weighed 17 kg today, which of the following would be appropriate dosing instructions for ibuprofen? Choose the single best answer. 8.5 mL q6h A 12-year-old male with obesity comes to the clinic with a chief concern of right knee pain. On exam the right knee is neither swollen nor erythematous but he is noted to have limited ROM of the right hip. In addition, when he lifts his right leg, it externally rotates. The patient did not have a URI or any trauma preceding the onset of pain. The vital signs are normal at the time of the visit and he is well appearing and afebrile. What is/are the best next step(s) in management? AP and lateral x-ray of hip A 6-year-old female comes to the clinic because of worsening right knee pain over the past month. On exam, you note generalized lymphadenopathy and splenomegaly. She coughs intermittently throughout the visit, and her mother explains that she is just getting over a cold. You note absence of tenderness, erythema, effusion or warmth over the hip, knee, and ankle joints. Her vitals are unremarkable except for a low-grade fever (100.8 F). Reviewing her chart, you note that she has lost 5 lbs since her visit 2 months ago. She sits with her right leg externally rotated but appears to be in pain despite trying several different positions, refusing to bear weight on that side. What is the most likely diagnosis? Leukemia A 3-year-old female comes to the clinic with a limp and a slightly externally rotated right hip. Which of the following signs/symptoms would you expect in the history or exam if a diagnosis of transient synovitis were made? History of recent upper respiratory tract infection A 3-year-old female is at the pediatrician's office for continued right knee pain after a ground-level fall six weeks ago. The patient is UTD on all immunizations, has no significant PMH, and no recent illnesses. The patient's mother reports the patient complains of pain mostly in the morning when going to daycare but doesn't seem to be bothered by it while playing outside in the afternoon. On exam, the patient's vitals are all within normal limits. Her physical exam reveals a well-appearing toddler who walks stiffly and avoids bending her right knee. The knee has a mild effusion but no obvious erythema. There is pain with passive flexion and extension of the right knee. During the exam she tells you her left ankle also hurts, which her mother had forgotten about but says started hurting the same time as the right knee. Her CBC is normal, while her ESR and CRP are mildly elevated. Which of the following is the most likely cause of this child's condition? JIA A 4-year-old child is refusing to walk over the course of a week. Her mother recalls that she fell off her bike yesterday. On exam, she is afebrile, but has decreased range of motion of her hip. You review her file and note that she is up-to-date on her immunizations and she was last seen three weeks ago for a self-limited episode of diarrhea that she developed while visiting family in rural Mexico. Aspiration of her affected hip joint reveals slight increase in inflammatory cells but normal chemistries and a negative gram stain. Culture is pending. Which of the following is the most likely diagnosis? Reactive arthritis How would you respond? You thank the sister for offering to translate and explain that you have an interpreter available by tablet 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. Isabella is a 7-year-old female with vomiting, diffuse abdominal pain, and dehydration who also has polydipsia and enuresis. On exam she is lethargic, tachypneic, and tachycardic, but normotensive and without peritoneal signs. Based on the information you have so far, choose the most likely diagnosis from the differential listed below. Choose the single best answer. DKA You realize that Isabella is quite sick and needs additional interventions quickly. Given your leading diagnosis, what will you suggest to Dr. Sato that you do next? Select all that apply. Random glucose test, UA, IV access, IV fluid bolus with 0.9% saline, continuous CV monitor, STAT electrolytes, Blood gas Which of the following are common signs and symptoms of cerebral edema? Select all that apply. Headache, recurrence of vomiting, inappropriate slowing of heart rate (bradycardia) rising BP (HTN), irregular respirations, restlessness/ irritability, increased drowsiness (lethargy), CN 6 palsies, abnormal pupillary responses Which of the following would you expect to find on the rest of Isabella's lab results? Select all that apply A. pH on a venous blood gas decreased B. Serum sodium decreased C. Potassium normal D. Bicarbonate decreased E. Creatinine elevated F. Serum glucose elevated G. Serum ketones elevated H. Urine ketones elevated All of above Review the chart at the following link. What would be your clinical estimation of degree of dehydration for Isabella? Choose the single best answer. 10% Isabella weighs 22 kg and is approximately 10% dehydrated. How much fluid will she need over the next 24-48 hours in order to replace her current fluid deficit? 2440 Ml You've calculated the total amount of fluid needed and an hourly rate of administration to replace Isabella's deficit. She also needs maintenance fluids. What should the hourly rate be for her maintenance fluids? Choose the single best answer below 62 mL/hour Aside from teaching Isabella and her mother how to administer insulin, choose the other educational priorities that need to be addressed prior to discharge. Select all that apply. All except long term complications, benefits of insulin pump, differences b/w type 1 and 2 diabetes A 15-year-old female is brought to the ER with a chief concern of abdominal pain for three hours. She rates her pain at 8/10 and describes it as constant and located mainly in the middle of her abdomen. It is worse with coughing and moving. She had two episodes of nonbilious, non-bloody vomiting. She is sexually active with her boyfriend of three months and always uses condoms. Her last menstrual period was two weeks ago. Vital signs are normal. On exam, she exhibits involuntary guarding, mild rebound tenderness, and tenderness to palpation between her right anterior superior iliac spine and umbilicus. On pelvic exam, she reports tenderness when attempting to palpate her right adnexa, but no masses are appreciated and there is no cervical motion tenderness. Laboratory studies reveal normal complete blood count and c reactive protein. Which of the following is the most likely diagnosis in this patient? Appendicitis A 4-year-old female with a history of type 1 diabetes mellitus was admitted to a local hospital for treatment of DKA. A few hours after the treatment, she develops grunting, irregular respirations, and has vomited twice. On exam, when asked to gaze forward, her left eye is pointing downward and out. Her diastolic blood pressure is 90 mmHg. What is a likely diagnosis? Cerebral edema A 9-year-old female is brought to clinic by her mother because of two days of abdominal pain and vomiting. She has vomited six times today and has had decreased appetite, but no diarrhea, fevers, sick contacts, or changes in her diet. Her mom states that she has been otherwise healthy apart from increased thirst and occasional bedwetting over the last few weeks. Of note, the patient's maternal grandmother suffers from celiac disease. On exam, the patient is afebrile, has a heart rate (HR) of 180 bpm, BP 90/60 mmHg, RR 50 bpm, and O2 saturation of 98%. She is lying in bed appearing slightly drowsy, taking rapid, deep breaths, and is slow to respond to questions. Her heart and lung exams are normal apart from being tachycardic, and her abdominal exam reveals mild diffuse tenderness to palpation with no rebound or guarding. Which of the following would be the most appropriate next step in management? Fingerstick blood glucose A 9-year-old male presents to the emergency department in an ambulance after he was found unconscious at a local playground. In the ED he is lethargic and difficult to arouse. He is able to minimally verbalize that his head and stomach hurt. He vomits