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 PRE
TEST ®

Pediatrics
PreTest® Self-Assessment and Review

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 Notice

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broaden our knowledge, changes in treatment and drug therapy are required. The
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 PRE
TEST ®

Pediatrics
PreTest® Self-Assessment and Review
Tenth Edition

Robert J.Yetman, M.D.

Professor of Pediatrics
Director, Division of Community and General Pediatrics
University of Texas—Houston Medical School
Houston, Texas

Mark D. Hormann, M.D.

Assistant Professor of Pediatrics
Director, Pediatric Clerkship
Division of Community and General Pediatrics
University of Texas—Houston Medical School
Houston, Texas

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 Reviewers
John P. Breinholt, M.D.
University of Utah School of Medicine
Salt Lake City, Utah
Class of 2000

Francesann Ford
Eastern Carolina University School of Medicine
Raleigh, North Carolina
Class of 2003

Christopher A. Heck
University of South Alabama
Mobile, Alabama
Class of 2001

Sabari Nandi
Robert Wood Johnson Medical School
Piscataway, New Jersey
Class of 2003

v
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 For more information about this title, click here.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

General Pediatrics
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 35

The Newborn Infant

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 89

The Cardiovascular System

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 121

The Respiratory System

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 143

The Gastrointestinal Tract

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 171

The Urinary Tract

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 197

The Neuromuscular System

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 220

vii

Copyright 2004 by The McGraw-Hill Companies, Inc. Click Here for Terms of Use.
viii Contents

Infectious Diseases and Immunology

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 250

Hematologic and Neoplastic Diseases

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 278

Endocrine, Metabolic, and Genetic Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 306

The Adolescent
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 335

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
 Introduction
Pediatrics: PreTest® Self-Assessment and Review, Tenth Edition, provides
comprehensive self-assessment and review within the field of pediatrics.
The 500 questions contained in the book have been designed to be similar
in format and degree of difficulty to the questions contained in Step 2 of
the United States Medical Licensing Examination (USMLE).
Each question has the correct answer, an explanation, and a specific
reference to a textbook. A bibliography that lists the sources used in the
book follows the last chapter.
Perhaps the most effective way to use this book is to allow yourself one
minute to answer each question in a given chapter in order to approximate
the time limits imposed by the USMLE Step 2. As you proceed, indicate
your answer to each question.
When you have finished answering the questions in a chapter, you
should then spend as much time as you need verifying your answers and
reading the explanations. Although you should pay special attention to the
explanations for the questions you answered incorrectly, you should read
every explanation. The editor has designed the explanations to reinforce
and supplement the information tested by the questions. If, after reading
the explanations, you want more information, you should consult and
study the references indicated.

ix

Copyright 2004 by The McGraw-Hill Companies, Inc. Click Here for Terms of Use.
This page intentionally left blank.
 PRE
TEST ®

Pediatrics
PreTest® Self-Assessment and Review
This page intentionally left blank.
 General Pediatrics
Questions
DIRECTIONS: Each item below contains a question or incomplete
statement followed by suggested responses. Select the one best response to
each question.

1. Two weeks after a viral syndrome, a 9-year-old girl presents to your clinic
with a complaint of several days of drooping of her mouth. In addition to
the drooping of the left side of her mouth, you note that she is unable to
completely shut her left eye. Her smile is asymmetric, but her examination
is otherwise normal. This girl likely has
a. Guillain-Barré syndrome
b. Botulism
c. Cerebral vascular accident
d. Brainstem tumor
e. Bell palsy

2. An infant can move his head from side to side while following a moving
object, can lift his head from a prone position 45° off the examining table,
smiles when encouraged, and makes cooing sounds. He cannot maintain a
seated position. The most likely age of the infant is
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 examine. She can dress
with help, can ride a tricycle, knows her own age, and can speak in short
sentences. She had difficulty in copying a square. The age of this child is
most likely
a. 1 year
b. 2 years
c. 3 years
d. 4 years
e. 5 years

Copyright 2004 by The McGraw-Hill Companies, Inc. Click Here for Terms of Use.
2 Pediatrics

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

somewhat swollen left knee. The parents report that the patient occasionally
complains of pain in that knee. An ophthalmologic examination reveals
findings as depicted in the photograph. The condition most likely to be
associated with these findings is

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. The previously healthy 4-year-old child pictured presents to the emer-

gency room with a 2-day history of a brightly erythematous rash and tem-
perature 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 occurs with gentle traction. This child most
likely has

A (Courtesy Adelaide Hebert, M.D.)

B (Courtesy Adelaide Hebert, M.D.)

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

6. You are counseling an adolescent patient about the long-term manage-

ment of her asthma while she is away at college. She brought an article she
found on the Internet that promotes an herbal supplement purported to be a
“safe, natural” treatment for asthma. You recall a recent study in the medical
literature showing inhaled steroids to be statistically superior to the adver-
tised herbal supplement at preventing asthma exacerbations at the p < 0.05
level. You explain to her that this means that
a. The inhaled steroids are 5% better than herbal treatment
b. A critical threshold for medical significance has been reached
c. Patients will not benefit from the herbal treatment 5% of the time
d. The odds are less than 1 in 20 that the differences observed were only a chance
variation
e. It would be unethical to use herbal treatment

Items 7–8
7. A previously healthy 8-year-old boy has a 3-week history of low-grade
fever of unknown source, fatigue, weight loss, myalgia, and headaches. On
repeated examinations during this time, he is found to have developed a
heart murmur, petechiae, and mild splenomegaly. The most likely diagno-
sis is
a. Rheumatic fever
b. Kawasaki disease
c. Scarlet fever
d. Endocarditis
e. Tuberculosis

8. After you make the diagnosis in the previous case, you explain the find-
ings to the family and instruct the family to
a. Restrict the child from all strenuous activities
b. Give the child a no-salt-added diet
c. Ensure that the patient receives antibiotic prophylaxis for dental procedures
d. Test all family members in the home
e. Avoid allowing the child to get upset
 General Pediatrics 5

9. A 5-year-old boy who was previously healthy has a 1-day history of

low-grade fever, colicky abdominal pain, and a skin rash. He is alert but
irritable; temperature is 38.6°C (101.5°F). A diffuse, erythematous, macu-
lopapular, and petechial rash is present on his buttocks and lower extrem-
ities, as shown in the following figure. There is no localized abdominal
tenderness or rebound; bowel sounds are active. Laboratory data demon-
strate
Urinalysis: 30 red blood cells per high-powered field,
2+ protein
Stool: guaiac positive
Platelet count: 135,000/µL
These findings are most consistent with

(Courtesy Adelaide Hebert, M.D.)

a. Anaphylactoid purpura
b. Meningococcemia
c. Child abuse
d. Leukemia
e. Hemophilia B
6 Pediatrics

10. A 4-month-old baby boy has just arrived in the emergency room. He
is cold and stiff. History from the parents is that the seemingly healthy
infant had been placed in his crib for the night, and when they next saw
him, in the morning, he was dead. Physical examination is uninformative.
Routine whole-body x-rays are shown. The most likely diagnosis is

(Courtesy Susan John, M.D.)

a. Scurvy
b. Congenital syphilis
c. Sudden infant death syndrome (SIDS)
d. Osteogenesis imperfecta
e. Battery
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