Pediatrics PreTest Self Assessment and Review 12th Edition

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Student Reviewers
Fatima Cody-Stanford, MD, MPH
University of South Carolina
PGY-2
Stacy Cooper
SUNY Upstate Medical University
Class of 2008
Ilana Harwayne-Gidansky
SUNY Downstate College of Medicine
Class of 2009
Erica Katz
Stony Brook University School of Medicine
Class of 2008
Tina A. Nguyen
SUNY Upstate Medical University
Class of 2008
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 Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

General Pediatrics
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

The Newborn Infant

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

The Cardiovascular System

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

The Respiratory System

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

The Gastrointestinal Tract

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

The Urinary Tract

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

The Neuromuscular System

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

vii
viii Contents

Infectious Diseases and Immunology

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

Hematologic and Neoplastic Diseases

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

Endocrine, Metabolic, and Genetic Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338

The Adolescent
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
 Introduction
Pediatrics: PreTest™ Self-Assessment and Review, Twelfth Edition, provides
comprehensive self-assessment and review within the field of pediatrics.
The 500 questions in the book have been designed to be similar in format
and degree of difficulty to the questions in Step 2 of the United States
Medical Licensing Examination (USMLE). They may also be a useful study
tool for Step 3 or clerkship examinations.
For multiple-choice questions, the one best response to each question
should be selected. For matching sets, a group of questions will be pre-
ceded by a list of lettered options. For each question in the matching set,
select one lettered option that is most closely associated with the question.
Each question in this book has a corresponding answer, a reference to a text
that provides background to the answer, and a short discussion of various
issues raised by the question and its answer.
To simulate the time constraints imposed by the qualifying examina-
tions for which this book is intended as a practice guide, the student or
physician should allot about one minute for each question. After answering
all questions in a chapter, as much time as necessary should be spent in
reviewing the explanations for each question at the end of the chapter.
Attention should be given to all explanations, even if the examinee
answered the question correctly. Those seeking more information on a sub-
ject should refer to the reference materials listed in the bibliography or to
other standard texts in medicine.

ix
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 Pediatrics
TM
PreTest Self-Assessment and Review
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 General Pediatrics
Questions

1. Two weeks after a viral syndrome, a 9-year-old boy presents to your clinic
with a complaint of several days of weakness of his mouth. In addition to the
drooping of the left side of his mouth, you note that he is unable to completely
shut his left eye. His smile is asymmetric, but his examination is otherwise
normal. Which of the following is the most likely diagnosis?

(Reproduced with permission from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency
Medicine. 2nd ed. New York, NY: McGraw-Hill;2002.)

a. Guillain-Barré syndrome
b. Botulism
c. Cerebral vascular accident
d. Brainstem tumor
e. Bell palsy

1
2 Pediatrics

2. An infant can regard his parent’s face, follow to the midline, lift his head from
the examining table, smile spontaneously, and respond to a bell. He does not yet
regard his own hand, follow past the midline, nor lift his head to a 45° angle off
the examining table. Which of the following is the most likely age of the infant?
a. 1 month
b. 3 months
c. 6 months
d. 9 months
e. 12 months

3. A child is brought to your clinic for a routine examination. She can put on
a T-shirt but requires a bit of help dressing otherwise. She can copy a circle well
but has difficulty in copying a square. Her speech is understandable and she
knows four colors. She balances proudly on each foot for 2 seconds but is
unable to hold the stance for 5 seconds. Which of the following is the most
likely age of this child?
a. 1 year
b. 2 years
c. 3 years
d. 4 years
e. 5 years

4. A 4-year-old girl is noticed by her grandmother to have a limp and a some-

what swollen left knee. The parents report that the patient occasionally com-
plains of pain in that knee. An ophthalmologic examination reveals findings
as depicted in the photograph. Which of the following conditions is most likely
to be associated with these findings?

a. Juvenile rheumatoid arthritis

b. Slipped capital femoral epiphysis
c. Henoch-Schönlein purpura
d. Legg-Calvé-Perthes disease
e. Osgood-Schlatter disease
 General Pediatrics 3

5. A previously healthy 4-year-old child pictured below presents to the emer-

gency room (ER) with a 2-day history of a brightly erythematous rash and
temperature of 40°C (104°F). The exquisitely tender, generalized rash is
worse in the flexural and perioral areas. The child is admitted and over the
next day develops crusting and fissuring around the eyes, mouth, and nose.
The desquamation of skin shown in the photograph occurs with gentle traction.
Which of the following is the most likely diagnosis?

(Courtesy of Adelaide Hebert, MD.)

a. Epidermolysis bullosa
b. Staphylococcal scalded skin syndrome
c. Erythema multiforme
d. Drug eruption
e. Scarlet fever
4 Pediatrics

6. A mother brings to your office an article from the Internet suggesting

that infants in day care have a statistically higher incidence of upper respiratory
infections (p < 0.05) as compared to children not in day care. You explain to
her that this means which of the following?
a. Infants in day care are 5% more likely to have an upper respiratory tract infection
than infants not in day care.
b. A critical threshold for medical significance has been reached.
c. Infants in day care will have an upper respiratory infection 5% of the time.
d. The odds are less than 1 in 20 that the differences in upper respiratory infection
rates observed were only a chance variation.
e. The study suggests that day cares are not safe for children.

7. A patient comes to your office for a hospital follow-up. You had sent him
to the hospital 3 weeks earlier for persistent fevers but no other symptoms;
he was diagnosed with endocarditis and is currently being treated appro-
priately. Advice to this family should now include which of the following?
a. Restrict the child from all strenuous activities.
b. Give the child a no-salt-added diet.
c. Provide the child with antibiotic prophylaxis for dental procedures.
d. Test all family members in the home with repeated blood cultures.
e. Avoid allowing the child to get upset or agitated.

8. A mother calls you on the telephone and says that your 4-year-old son
bit the hand of her 2-year-old son 48 hours previously. The area around the
injury has become red, indurated, and swollen, and he has a temperature of
39.4°C (103°F). Which of the following is the most appropriate response?
a. Arrange for a plastic surgery consultation at the next available appointment.
b. Admit the child to the hospital immediately for surgical debridement and antibiotic
treatment.
c. Prescribe penicillin over the telephone and have the mother apply warm soaks
for 15 minutes four times a day.
d. Suggest purchase of bacitracin ointment to apply to the lesion three times a day.
e. See the patient in the ER to suture the laceration.

9. The adolescent shown presents with a 14-day history of multiple oval

lesions over her back. The rash began with a single lesion over the lower
abdomen (A); the other lesions developed over the next days (B). These lesions
are slightly pruritic. Which of the following is the most likely diagnosis?
a. Contact dermatitis
b. Pityriasis rosea
c. Seborrheic dermatitis
d. Lichen planus
e. Psoriasis