What percentage of pregnancies end in spontaneous abortion?

30%

Which process is characterized by cell and tissue movements that result in the formation of the three germ layers, endoderm, ectoderm, and mesoderm?

Gastrulation

The skeleton is derived from

Mesoderm

A problem late in pregnancy such as hypertension, or placental insufficiency would be most likely to cause

Asymmetric small for gestational age

A newborn at one minute has some flexion on assessment of muscle tone, a heart rate of 120 BPM, a grimace when the nasopharynx is stimulated, acral cyanosis, and a good strong cry. What is the Apgar score?

A newborn is observed to consistently become cyanotic in appearance while breast feeding. The cyanosis disappears when the neonate cries and becomes fussy. The BEST explanation for this finding is:

Choanal atresia

During the newborn exam a neonate is noted to have head swelling ( a lump) which you determine crosses the skull's suture lines. This MOST likely indicates:

Caput succedaneum

Which of the following is a finding associated with a diaphragmatic hernia?

Asymmetric chest exam

A meconium plug in a neonate is associated with:

Cystic fibrosis

Which of the following is TRUE regarding gestational diabetes?

 It is associated with LGA and fetal hypoglycemia

Which of the following is considered a "normal" reflex in term infants?

Extended toes with traditional Babinski reflex stimulation

Thin upper lip, short up turned nose, and flattened mid-face are facial  characteristics suggestive of :

Fetal alcohol syndrome

 Metformin is useful in the treatment of which one of the following?

Polycystic ovarian syndrome

 A 30 day-old infant weighs 3.2 Kg (7 lb.) Assuming normal growth and development, what would you expect the approximate weight of the infant to be in 90 days age?

5.0 kg

An anxious mother phones you  to ask advice regarding fever ( 38.5 ^oC rectal) management for her child. After careful questioning you are convinced that the child has a viral infection and appears, by clinical history, to be stable. Which of the following is the MOST appropriate recommendation regarding maximum antipyretic dosage and frequency in 44 lb 3 ½ year-old?

300mg APAP q 4 hours prn

Which of the following immunizations should be delayed until 12 months of age?

Varicella

Supporting the head of an infant and allowing it to drop suddenly 1-2 cm will initially produce arm abduction at the shoulders and extension at the elbows. This reflex finding should be regarded as:

Normal, and will usually disappear after 3-4 months

Which of the following represents a normal sequence of developmental milestones achievements during the first 15 months of life?

Raises head slightly, looks after fallen object, sits without support, speaks at least 3 words, walks without support

An infant is expected to triple their weight by ___ months of age.

12

Which of the following, assuming normal development and full compliance with scheduled immunizations recommendations, would represent an infant of the oldest chronological age?

Earliest age at which may receive 2^nd MMR vaccine

What is the caloric content of breast milk and term infant formula?

20 kcal per oz

Breast milk contains antibodies, may decrease the incidence of eczema and asthma, and improves neurodevelopmental outcomes

True

Calculate the daily basal caloric requirement for a 2 year-old toddler who weighs 33 lbs.

1250 calories/ day

Which of the following is TRUE regarding hypoallergenic infant formulas?

It is the recommended formula to use in protein intolerant infants

 A 1 week old infant will commonly weigh less than his/her birth weight.

It is recommended that breast-fed infants be given some form of supplemental iron beginning at age 12 weeks of age.

False

The fat in breast milk and infant formula are the most energy dense nutrients and therefore the primary dietary energy source for young infants

True

The majority of total body water is found in which space?

The intracellular space

What is the daily maintenance fluid requirement for a 20 kilogram child?

1500 ml

A 15 kilogram child is 10% dehydrated.  What amount of intravenous fluid will need to be given to replace his fluid deficit?

900 ml

What is the leading cause of death in adolescence?

Unintentional injury

Differentiate primary amenorrhea from secondary amenorrhea:

Primary amenorrhea is no menses in the presence of secondary sex characteristics by 15 years old

Which of the following is TRUE of the actions of FSH and LH during puberty?

In the male LH causes the testes to produce testosterone and FSH stimulates the production of spermatocytes

The proposed causes of gynecomastia include testosterone-estrogen imbalance, decreased serum prolactin levels, and abnormal serum protein binding levels.

False

Which of the following BEST represents Tanner stage 4?

Female- projection of areola and nipple to form a secondary mound above the level of the breast. The hair distribution is adult in type but decreased in total quantity. There is no spread to the thighs.

STD testing is generally NOT recommended or useful in most cases of suspected sexual abuse.

True

Which of the following is a hallmark physical exam finding associated with shaken baby syndrome?

Subdural hematoma

Anatomic dolls intended to allow suspected victims of sexual assault to "reenact the assault" are NOT a very useful means of acquiring information from children because of the poor specificity associated with this interview methodology.

True

The MOST common form of child abuse in the USA is:

Physical neglect

An infant submersed in 72 ^o C bath water will sustain immediate burn injuries. 

False (requires Temp 212 or 100 ^o C)

A 2  year-old male who has a history of 1 previous febrile seizure in the past is more prone to have another such seizure than a child of similar age who has never had a febrile seizure

True

A 12 day-old infant is admitted to the hospital for a "septic work-up." Which of the following organisms is the most likely pathogen to be responsible for sepsis in this infant?

Group B Streptococcus

A 12 month old girl is brought in to the clinic by her mom for a fever. The child's temperature is 39^oC. The physical exam is unremarkable except for the fever. The patient appears well-appearing but febrile. You get blood cultures and they reveal bacteria in the blood stream. You diagnose the child with occult bacteremia.  Which of the following is the most common cause of occult bacteremia?

Strep. pneumoniae

Fevers <39^oC cause brain damage in children 36 months old and older?

False

A 4 year old boy is brought to your office by his mom because he has had a fever and "feels sick".  The child's weighs 44 lb and has a temperature of  38^oC, otherwise normal. After getting the history and physical you diagnose the boy with an acute upper respiratory infection. Which of the following is the most appropriate antipyretic medication and dosage for the patient?

200 mg acetaminophen Q 4-6 hours

A 6 year-old girl comes with her dad to the clinic for a sore throat and pain with swallowing. The patient is allergic to penicillin and  denies any cough. On physical exam you note white exudates on her enlarged tonsils and petichea on her soft palate along with lymphadenopathy. You diagnose the child with acute pharngitis. Which of the following is the most appropriate medication to prescribe for the 6 year-old child?

Zithromax

The mechanism by which a fever induces a febrile seizure is by increasing the seizure threshold.

False

A 2 year old girl is brought to the urgent care by her mother for a fever that has lasted 3 days. Mom notes that the child has had a dry cough, rhinorrhea, and nasal congestion. You note that the child is acutely ill but non-toxic appearing. Based on history and physical exam you are unable to identify the source of the fever. Which of the following is the correct diagnosis?

Fever without source

Which of the following is the most appropriate and reliable method of measuring a temperature in 0-3 month old infant?

Rectal

A 10 week-old boy is brought by his parents to the fast track emergency department for a fever.  Upon further investigation you learn that the child was born full term vaginal birth. You do not note any ear infections, soft tissue or skeletal infections.  Mom reports that the infant has not had any prior illness nor has he had diarrhea or constipation. You order a UA with C & S, there are <5 WBC per hpf, in addition to  a CBC with differential, which is within normal limits. What is the likelihood that the child will have serious bacterial illness or occult bacteremia?

The infant meets all the Rochester criteria and is at <1% risk of  occult bacteremia

Which type of heart defect (shunt) do "blue babies" have?

Right to Left shunt; deoxygenated blood to oxygenated blood

An infant male is brought to your clinic for a check-up. During the physical exam you  note finding of upper extremity systolic hypertension and significant disparity in upper and lower extremity blood pressure is suggestive of:

Coarctation of the Aorta

A very large VSD will likely have a ____systolic murmur ad cause the infant to ____.

Soft:  have increased pulmonary flow

Which one of the following is used in premature infants to close a patent ductus arteriosus?

Indocin

Which of the following is the most common congenital heart defect?

Ventricular septal defect

While performing a routine physical exam on a neonate you note a palpable thrill in the upper right sternal boarder. Which of the following would be most consistent with the above description?

Aortic Stenosis

All of the following are components of the Tetralogy of Fallot except which one?

Coarctation of the aorta

A low blood pressure (hypotension) in an infant is a reliable sign of early cardiac decompensation

 Failure of the PDA to close shortly after (3-5 days) after birth will do all of the following except:

Decrease pulmonary blood flow

A 10 year old boy presents to you with an acute exacerbation of his asthma which began about 6 hours ago. He lost his "rescue inhaler" and subsequently has had no medical intervention prior to presenting to your ED. Vitals: T 37.5C  P 130  RR40  BP122/66

What is the drug of choice and its mechanism of action best suited for a child experiencing an acute asthmatic attack?

An inhaled beta-agonists because of its bronchodilator action

A 1 year old child presents to your office in the middle of winter with symptoms of an upper respiratory tract infection, including a "barky" cough noted by the parents. The infant is observed to demonstrate inspiratory stridor and appears in moderate respiratory distress. Given these clinical findings which of the following would be the MOST likely diagnosis to explain this presentation?

Acute Laryngotracheobronchitis

A previously healthy 2 year old presents to the urgent care, after having eaten some Halloween candy, with sudden onset of cough and stridor. There are no signs of fever and the boy is non- toxic appearing. You order a chest X-ray and note hyperinflation of the right lung on CXR and worsening respiratory distress. Which of the following would be the most likely diagnosis?

Acute foreign body aspiration

The Cardinal sign of upper airway obstruction in an infant is:

Stridor

Prior to the advent of HIB what had been the most common cause of acute Epiglottitis?

H. influenza

You are evaluating a child for chronic cough.  While you are in the room, the child coughs about 15 times in a row and ends the paroxysm of coughing with a loud inspiratory whoop.  What is the most likely diagnosis?

Pertussis

A three month old Amish girl presents to your office with fever, tachypnea, rhinorrhea, nasal flaring, and diffuse wheezing.   You order a chest x-ray and you note hyperinflation, peribronchiolar thickening, and patchy infiltrates. You diagnose the girl with bronchiolitis. Given the diagnosis, what is the most likely etiology?

RSV

A "steeple" sign on PA and lateral soft tissue of the neck X-rays is consistent with a diagnosis of which one of the following?

Croup

Which of the following is NOT a target organ/system  affected by cystic fibrosis?

Cardiovascular

A 3 year old female presents to the ER hyperpyrexia, dysphagia, and drooling. The child's vaccines are not up to date.  On x- ray of the neck you note the "thumb print "sign. Which of the following is the most likely diagnosis?

Epiglottitis

S. pneumonia

M. cattaharis

H. flu

1. MC cause of abdominal pain in children

constipation

1. MC of gastroenteritis

viral

1. Low protein diet in PKU will allow normal development

True

1. Absence of ganglionic cells in colon describes

Hirschsprungs Dz

 Which of the following Salter-Harris fractures is easily missed on x -ray, but has the best prognosis (regarding healing)?

Salter-Harris I

An audible "clunk" sound associated with the joint reduction elicited during the ___ physical exam maneuver is suggestive of ___:

Ortolani:  developmental dysplasia of the hip

A 6 year old boy falls off a ladder and lands on his arm. He is in a lot of pain, so his parents take him to the urgent care center where you examine hime and notice some abrasions and swelling in his arm. An x-ray reveals an incomplete break in the boy's forearm. What type of fracture is most likely

Greenstick

Osgood-Schlatter's disease is :

Self-limited disease process that is treated symptomatically

A 12 year old male is brought to the ER by his mother following a fall from a skateboard o his left outstretched hand ( non-dominant) 30 minutes ago. He screamed on the fall and continues to hold his left forearm near his wrist with his right hand. He holds the left arm against his body for support. There is a "dinner fork" deformity, with edema and ecchymosis at the wrist. He is neurovascularly intact, and the skin is closed. With this type of deformity, which of the following fractures is the one most likely  in the case?

Colles fracture

 A "sunrise" x-ray of the knee is commonly ordered to aid in diagnosis of:

Patellar-femoral syndrome

Slipped Capital Femoral Epiphysis is primarily a problem among adolescent boys, and is often initially associated with a "painless limp".

False

An 8 year old afebrile boy presents to the orthopedic clinic because he has significant right hip and knee pain. The boy is noted to walk with a limp as he enters the office, and the boy's mom denies any history of trauma. On physical exam, you note atrophy of the right quadriceps muscles and decreased range of motion of the right hip, particularly with internal rotation and abduction. Leg length inequality is also observed on the right compared with the left. Frog-leg x-ray of the hip reveal cessation of growth at the capital femoral epiphysis and a smaller femoral head epiphysis with widening of the articular space on the right side. There is also a linear radiolucency with the right femoral head epiphysis. White blood cell counts, CRP and ESR are all within normal limits. Which of the following is the most likely diagnosis?

Legg-Calve Perthes Disease

A 13 year old girl presents to your office for her school physical. Upon examination you notice the posterior curvature of her thoracic spine to be very prominent and bulging backwards. What type of deformity of the spine does the girl have?

Kyphosis

A 5 year old girl is brought to the ER following a traumatic event while at the school playground. The teacher says that the child was playing on the swings and decided to jump off, injuring her ankle. An x-ray of the ankle demonstrates a fracture line through the metaphysic  plate of the superior aspect of the distal fibula, ending at the epiphyseal plate. What type of Salter-Harris fracture does the child have?

Salter-Harris type II

3 year old child with flesh colored umbilicated papules (molluscum). Which is true regarding treatment?

treatment is recommended because lesions may lead to scarring

Multiple warts in periungal region, recommended treatment

treat and follow up

NOT associated with impetigo

patho include follicular keritinization leading to disruption of desmosomal adhesion molecules

When discussing acne treatment which is NOT TRUE

you will see significant improvement in 2-3 weeks

Patho of atopic dermatitis includes all EXCEPT

Hormonal variations

3 year old with atopic dermatitis has been treated for 3 months and not responding to treatment, what do you do?

All of the above…consult supervising MD, suspect noncompliance of treatment, consider a taper of oral steroids, and consider an alternate diagnosis

44lb male presents with kerion and you prescribe oral griseofulvin which is only available as 125mg/5cc dose, correct dose and schedule should be

8cc BID for 2 months

Patient treatment for scabies and back for follow-up still complaining of itching

explain that this is due to ongoing allergic reaction to droppings and treat with a mild steroid cream

7 year old female with mouth sores, very painful, exam reveals vesicles on throat. What separates this disease from others?

disease is limited to the mouth and throat

Most common complication of HSV3 (chicken pox)?

secondary bacterial infection

What do Varicella Zosster, Measles, and Rubella all have in common?

all are vaccine preventable

6 year old child with spots in mouth presents for 1 week, crusted patches in corner of left mouth with none in the buccal mucosa found on exam (picure shows grouped vesicles on an erythematous base).

Most likely diagnosis?

Info regarding treatment…

HSV

treatment usually not required and symptoms improve in 3-5 days

3 year old male with rash that started on face and moved downward, on exam morbilliform rash found.

What is the diagnosis?

Mom’s eggo is two months preggo, what should you tell her?

Classic enanthum associated with this rash is?

Measles

birth defects are uncommon but follow up with OB-GYN just in case

Kopliks Spots

14 year old girl presents with a sore throat and rash (picture shown)

What is the diagnosis?

What is the causative agent?

What do you prescribe to fix her up?

Scarlet Fever

Group A Strep

Penicillin

Child presents with 105 temp and rash but is otherwise fine smiling and taking bottle, what is the most likely diagnosis?

Roseola

The transition from the embryonic to the fetal period occurs at the end of which week?

Week 8

The neural tube is derived from which of the following?

Ectoderm

Which of the following is true of the neural crest cells?

They will become the peripheral nervous system

Which process is characterized by cell and tissue movements that result in the formation of the three germ layers, endoderm, ectoderm, and mesoderm?

Gastrulation

When an infant's head is turned to one side, and the arm and leg on that side extend while the other side flexes this is known as

The tonic neck reflex

Esophageal atresia would be most likely to present as

Feeding difficulties and respiratory distress in the first few days of life

Hemorrhagic disease of the newborn is prevented by which of the following?

Vitamin K supplementation

A newborn at one minute has active motion on assessment of muscle tone, a heart rate of 96 BPM, a grimace when the nasopharynx is stimulated, acyanotic, and a good strong cry. What is the Apgar score?

8

A "double bubble sign" on abdominal X-Ray is characteristic of

Duodenal atresia

A newborn male at one minute after being born had an APGAR score of 5. When you reassess his score you note some flexion of limbs, a heart rate of 115BPM, coughs and sneezes when nasopharynx is stimulated, pink body with blue extremities and had weak irregular respirations. Which of the following is the most appropriate APGAR score for the boy at 5minutes after birth?

7

During a routine well child check a child's parents expresses a concern about whether their Teddy's developmental milestones are "on track". The parents ask at what age should Teddy be able to roll from back to front. Which of the following is the most appropriate answer?

4-7 months

Which of the following will occur at the earliest age?

Third  Hepatitis B vaccine

A 15 month old boy is brought to your office by his mother for his 15 month old immunizations. Assuming that the child has gotten all of his vaccines on schedule, which of the following vaccines would the child need at his 15 month old check up?

Third IPV

Calculate the daily basal caloric requirement for a child who weighs 25kg

1600 calories/ 24 hours

Which of the following immunizations should be delayed until 12 months of age?

Varicella

Which one of the following is FALSE concerning breast feeding?

HIV cannot be transmitted by breast milk.

Which of the following is TRUE?

 Vitamin D supplementation is recommended in breast fed but not formula fed infants

While you are examining a 6 month-old child the mom asks you what solid foods she can start to feed the child first. Which of the following represents the food that mom should feed the child first?

Vegetables

The recommended introduction of solid foods begins:

At about 4-6 months of age

Which one of the following individuals would have the highest percentage of total body water?

Preterm neonate

The majority of total body water is found in which space?

The intracellular space

What is the daily maintenance fluid requirement for a 35 kilogram child?

1800 ml

A 15 kilogram boy presents to the Emergency room after an episode of gastroenteritis. The child has been vomiting and has had diarrhea. You determine that he is 15% dehydrated.  What amount of intravenous fluid will need to be given to replace his fluid deficit during the first eight hours? (Use the constant 0.6.)

675 ml

Which of the following represents a dilutional cause of hyponatermia?

SIADH

Which of the following represents the primary etiology of polycystic ovarian syndrome?

The of androstenedione to be converted to progesterone

Which of the following best represents secondary amenorrhea?

A 16 year-old who has missed her period after 3 consecutive regular cycles

 Which of the following is the most common bacterial STD?

Chlamydia trachomatis

In a male patient you are examining and note the pubic hair is considerably darker, coarser, and curlier. The distribution is now spread over the junction of the pubes, and at this point that hair may be recognized easily on black and white photographs. Further growth of the penis has occurred, initially in length, although with some increase in circumference. There also is increased growth of the testes and scrotum. Which of the following Tanner stages is represented by the above description?

Stage 3

Which of the following best explained the difference between Gynecomastia and Pseudogynocomastia?

Gynecomastia is caused by testosterone- estrogen imbalance whereas Pseudogynocomastia is caused by excessive fat tissue’’

A 2-year-old child is brought to the emergency room with skin bruises on the head and signs of a non-depressed skull fracture, which is confirmed by an x-ray. There are bruises on both sides of the head. Physical examination finds no other abnormality. The parents say the child climbed a tree and fell from a height. The child has already had several accidents in the past, but none of them was really serious. Which of the following is of the most concern in the ongoing care of this patient?

Abusive family

You've been asked by the courts, to conduct an investigative interview, with a 3-year-old boy. His parents suspect that he is being sexually abused at his preschool, and it is your job to find evidence as to whether or not these allegations are true. Which one of the following is considered an ethical interviewing technique?

asking the child open-ended questions about his sexual history

Which of the following is MOST likely to be irrefutable evidence of shaken baby syndrome?

Posterior rib fracture

Which of the following is a "key" to distinguish bruises of abuse from those associated with accidental trauma?

Pattern of bruise

A child's father has remarried and reports his child has begun to withdraw from activities, seems distracted most of the time, and constantly has unexplained bruises on his body. As his physician, you suspect:

Child Abuse

Which of the following antibiotics is additionally given to "cover" (adequately treat) this specific bacteria in meningitis suspected in an infant <2 months of age?

Ampicillin is given to cover Listeria

A 3 year-old boy is brought to your office by his dad. The boy has a cough, congestion, and fever for 2 days. His fever max has been 103.2^oF. He weighs 25 kg has a heart rate of 110 and a temperature of 103.6 ^oF. Dad has not given the child any medication for the fever because he was unsure of what to give and how much to give to the child. Which of the following is the most appropriate medication and dose for the above  child.

250mg Ibuprofen Q 6-8 hours

Which of the following best represents an example of a fever of unknown origin?

A patient with Kawasaki  with a fever for 8 days

A 10 year old is known to have a baseline heart rate of 60 bpm, and a core body temperature of 98.6 degrees Fahrenheit. What would you expect his heart rate to be if he has a fever of 104.6 degrees Fahrenheit (assume a normal physiologic response)?

120bpm

 All of the following structures are unique to the fetal circulation except which one?

chordae tendineae

Which of the following represents an example of a left to right shunt?

Ventricular septal defect

During a newborn exam of a preterm infant you note a continuous, rumbling, machine like murmur with a bounding pulse. The murmur is maximal at the second left intercostals space at the left upper sternal border. Which of the following is the most appropriate diagnosis given the above description?

Patent ductus arteriosus

An infant is brought to your family practice clinic for its 2 week check up. A holosystolic murmur is heard when you listen to the listen to the left sternal boarder. The first and second heart sounds are "normal". Which of the following is the most appropriate diagnosis given the above  history and physical?

Ventricular septal defect

You are evaluating a female infant with diminished femoral pulses. The blood pressure in the upper extremities is higher than in the lower extremities. There is a systolic ejection murmur that radiates to the left sided interscapular area with associated apical ejection click in right upper sternal border. Which of the following is the most appropriate diagnosis given the above history and physical?

Coarctation of the aorta

An 8 year-old girl is brought to your office after his mom has noticed that the girl has been suffering from polyuria, polydypsia, and polyphagia. Mom has also noticed that her daughter has "lost some weight" and has had repeated urinary tract infections.  According to Dr. Evans, which of the following would be the most appropriate first lab to order for the girl?

UA dip stick

Short stature is defined as height > 3 standard deviations below the mean for their age. Which of the following is NOT an endocrine induced cause of short stature?

Down's syndrome

When is the hemoglobin and hematocrit the lowest in a pediatric patient?

2 months-old

According to Dr. Evans which of the following is the single most important vital sign in children < 6 months-old?

Head circumference

Which of the following best represent the most common cause of failure to thrive, accounting for 90% of the cases?

Failure to feed

An 8 year-old boy is brought in to your office by his single parent for evaluation because he has been doing poorly in school. The boy has lost weight, has poor intellectual performance, and is listless. Upon, further evaluation you diagnosis the boy with primary hypothyroidism. Which of the following would most accurately describe the TSH and free T4 levels based on the diagnosis?

Increased TSH & decreased free T4