ChadGBT Questions Flashcards
1
Q
A 6-year-old girl presents with a 2-year history of pruritic, erythematous, scaly patches on her antecubital fossae, which worsen in the winter. Her mother reports no known allergies and no family history of asthma or hay fever. On examination, you note lichenified plaques on both antecubital fossae.
- A. Acute urticaria
- B. Psoriasis
- C. Atopic dermatitis
- D. Contact dermatitis
A
C. Atopic dermatitis
The chronic nature of the symptoms, location on antecubital fossae, and the absence of a family history of allergic diseases suggest atopic dermatitis. Atopic dermatitis often presents as pruritic, erythematous, and scaly patches in flexural areas and can be exacerbated by dry conditions.
2
Q
A 9-year-old boy with a history of eczema presents with recurrent episodes of wheezing, cough, and difficulty breathing, especially at night. These symptoms seem to exacerbate during the spring season. His physical examination reveals expiratory wheezes and decreased air movement.
- A. Bronchiolitis
- B. Asthma
- C. Cystic fibrosis
- D. Acute bronchitis
A
B. Asthma
The patient’s history of eczema, seasonal exacerbation of symptoms, and clinical findings of wheezing and difficulty breathing are characteristic of asthma. Asthma often has a link with atopic conditions such as eczema and presents with episodic, reversible airway obstruction.
3
Q
A 12-year-old boy presents with 24-hour history of abdominal pain, initially periumbilical, now localized to the right lower quadrant. He has a low-grade fever, nausea, and one episode of vomiting. On examination, he exhibits rebound tenderness and guarding in the right lower quadrant.
- A. Gastroenteritis
- B. Intussusception
- C. Appendicitis
- D. Urinary tract infection
A
C. Appendicitis
The classic migration of pain from the periumbilical area to the right lower quadrant, associated with fever, nausea, and localized signs of inflammation (rebound tenderness and guarding), strongly suggests appendicitis.
4
Q
A 3-year-old boy is brought to the clinic with a 5-day history of high fever, red eyes without discharge, a red, cracked lip with a strawberry tongue, a rash on his trunk, and swollen hands and feet. His parents report that he has been unusually irritable.
- A. Scarlet fever
- B. Measles
- C. Kawasaki disease
- D. Stevens-Johnson syndrome
A
C. Kawasaki disease
Kawasaki disease is characterized by prolonged fever, conjunctivitis, mucosal changes (strawberry tongue and cracked lips), rash, extremity changes (swelling or redness), and irritability. These symptoms match the patient’s presentation.
5
Q
An 18-month-old girl presents after experiencing a generalized tonic-clonic seizure lasting 2 minutes. She had a rectal temperature of 38.9°C at home. She has no history of neurodevelopmental delay, and her immunizations are up to date. There is no family history of epilepsy.
- A. Meningitis
- B. Febrile seizure
- C. Epilepsy
- D. Encephalitis
A
B. Febrile seizure
Febrile seizures are convulsions triggered by fever in children between 6 months and 5 years old, without an underlying central nervous system infection or other identifiable cause. The brief, generalized nature of the seizure and the presence of fever in this age group support a diagnosis of febrile seizure.
6
Q
A 10-year-old boy is brought in for academic difficulties and inability to stay seated during class. He is easily distracted, interrupts others, and has difficulty waiting his turn. His mother reports these behaviors have been present for the past three years.
- A. Autism spectrum disorder
- B. Generalized anxiety disorder
- C. Attention-deficit/hyperactivity disorder
- D. Oppositional defiant disorder
A
C. Attention-deficit/hyperactivity disorder
The persistent pattern of inattention, hyperactivity, and impulsivity that impairs functioning or development, present for more than six months, suggests ADHD.
7
Q
A 2-year-old girl presents with a 24-hour history of irritability, tugging at her right ear, and fever. Otoscopic examination reveals a bulging, erythematous tympanic membrane on the right side.
- A. Otitis externa
- B. Acute otitis media
- C. Tympanic membrane perforation
- D. Foreign body in the ear
A
B. Acute otitis media
The symptoms of ear pain (evidenced by tugging at the ear), fever, and otoscopic findings of a bulging, erythematous tympanic membrane indicate acute otitis media.
8
Q
A 6-month-old infant presents with failure to thrive and differential blood pressure between the upper and lower extremities (higher in the upper). On physical examination, a systolic murmur is noted, and femoral pulses are weak compared to brachial pulses.
- A. Patent ductus arteriosus
- B. Ventricular septal defect
- C. Tetralogy of Fallot
- D. Coarctation of the aorta
A
D. Coarctation of the aorta
The presence of higher blood pressure in the upper extremities compared to the lower, a systolic murmur, and weak femoral pulses are classic signs of coarctation of the aorta.
9
Q
An 8-year-old girl presents with diarrhea, abdominal distention, and failure to gain weight. She also has a pruritic, vesicular rash on her elbows and knees. Laboratory tests show iron deficiency anemia, and serologic testing is positive for anti-tissue transglutaminase antibodies.
- A. Inflammatory bowel disease
- B. Celiac disease
- C. Lactose intolerance
- D. Acute gastroenteritis
A
B. Celiac disease
Symptoms of diarrhea, abdominal distention, failure to thrive, a characteristic rash (dermatitis herpetiformis), and positive celiac serology are indicative of celiac disease.
10
Q
A 4-year-old boy shows limited eye contact, repetitive behaviors, and delayed speech. He becomes extremely upset with minor changes in routine and has difficulty engaging in play with other children. His parents are concerned about his social interactions and communication skills.
- A. Down syndrome
- B. Intellectual disability
- C. Autism spectrum disorder
- D. Hearing impairment
A
C. Autism spectrum disorder
The presence of social communication deficits, restrictive and repetitive patterns of behavior, and distress over changes in routine suggest ASD.
11
Q
A 5-year-old boy presents with spontaneous bruising, prolonged bleeding after minor injuries, and swelling in his knee joints. His mother mentions that his older brother has a similar condition. Blood tests reveal a prolonged activated partial thromboplastin time (aPTT) with a normal platelet count.
- A. Acute lymphoblastic leukemia
- B. Hemophilia
- C. Idiopathic thrombocytopenic purpura
- D. Von Willebrand disease
A
B. Hemophilia
The clinical presentation of spontaneous bruising, joint bleeding, a family history of a bleeding disorder, and the specific laboratory findings are characteristic of hemophilia.
12
Q
A 3-year-old presents with persistent cough, recurrent chest infections, and failure to thrive. The child’s stools are bulky and foul-smelling. Sweat chloride test results are abnormally high.
- A. Asthma
- B. Chronic bronchitis
- C. Cystic fibrosis
- D. Gastroesophageal reflux disease
A
C. Cystic fibrosis
The combination of respiratory symptoms, gastrointestinal manifestations like steatorrhea, failure to thrive, and a positive sweat chloride test strongly suggests cystic fibrosis.
13
Q
A 6-year-old girl presents with fatigue, constipation, weight gain, and delayed growth. Her physical exam shows dry skin, coarse hair, and a delayed relaxation phase of deep tendon reflexes. Thyroid function tests reveal elevated TSH and low free T4 levels.
- A. Hyperthyroidism
- B. Hypothyroidism
- C. Growth hormone deficiency
- D. Cushing syndrome
A
B. Hypothyroidism
The clinical symptoms of fatigue, constipation, weight gain, and delayed growth, along with the characteristic lab findings of elevated TSH and low T4, are indicative of hypothyroidism.
14
Q
A 7-year-old boy presents with dark-colored urine, facial puffiness, and hypertension two weeks after a streptococcal throat infection. Urinalysis reveals red blood cell casts and proteinuria.
- A. Nephrotic syndrome
- B. Acute poststreptococcal glomerulonephritis
- C. Urinary tract infection
- D. Henoch-Schönlein purpura
A
B. Acute poststreptococcal glomerulonephritis
The timing of symptoms after a streptococcal infection, along with the clinical and laboratory findings of hematuria, proteinuria, and hypertension, suggest acute poststreptococcal glomerulonephritis.
15
Q
A 4-year-old unvaccinated boy presents with a pruritic rash, fever, and malaise. The rash started on his trunk and spread to his face and extremities, with lesions at different stages of development, including macules, papules, vesicles, and crusts.
- A. Measles
- B. Varicella infection
- C. Impetigo
- D. Allergic reaction
A
B. Varicella infection
Varicella (chickenpox) presents with a pruritic, vesicular rash in different stages of development, accompanied by fever and malaise, commonly affecting unvaccinated children.
16
Q
A 7-year-old girl presents with polyuria, polydipsia, recent weight loss, and fatigue. Her parents mention she seems more irritable lately. On examination, her breath smells fruity, and she has dry mucous membranes.
- A. Urinary tract infection
- B. Type 2 diabetes mellitus
- C. Type 1 diabetes mellitus
- D. Acute gastroenteritis
A
C. Type 1 diabetes mellitus
The classic symptoms of polyuria, polydipsia, weight loss, and the fruity odor of ketosis are indicative of Type 1 diabetes mellitus, especially in a child.
17
Q
A 6-year-old girl presents with persistent fever, rash, and swelling in her knees and wrists for several weeks. She is lethargic and reports morning stiffness. Her mother notes that the child appears more irritable and fatigued than usual.
- A. Osteomyelitis
- B. Leukemia
- C. Juvenile rheumatoid arthritis
- D. Acute rheumatic fever
A
C. Juvenile rheumatoid arthritis
JRA presents with joint swelling, fever, rash, and morning stiffness. Chronic symptoms and systemic involvement suggest an inflammatory condition like JRA.
18
Q
A 2-year-old boy presents with a 2-day history of fever, vomiting, irritability, and a stiff neck. His mother reports he has been crying more than usual and doesn’t want to be held. On examination, he is lethargic and shows signs of neck stiffness.
- A. Meningitis
- B. Encephalitis
- C. Intracranial hemorrhage
- D. Febrile seizure
A
A. Meningitis
The presence of fever, neck stiffness, irritability, and lethargy in a child is highly suggestive of meningitis, which is an inflammation of the meninges of the brain and spinal cord.
19
Q
A 3-year-old girl presents with pallor, fatigue, and irritability. Her diet consists mainly of cow’s milk, with a poor intake of solid foods. Laboratory tests reveal a low hemoglobin level and microcytic, hypochromic red blood cells.
- A. Thalassemia
- B. Lead poisoning
- C. Acute lymphoblastic leukemia
- D. Iron deficiency anemia
A
D. Iron deficiency anemia
Iron deficiency anemia is common in toddlers and can be caused by a diet high in cow’s milk and low in iron-rich foods, presenting with pallor, fatigue, and irritability, along with microcytic, hypochromic anemia.
20
Q
A 5-year-old girl has a history of recurrent urinary tract infections. She presents with fever, flank pain, and dysuria. A voiding cystourethrogram (VCUG) confirms the diagnosis of vesicoureteral reflux.
- A. Acute pyelonephritis
- B. Bladder exstrophy
- C. Ureterocele
- D. Vesicoureteral reflux
A
D. Vesicoureteral reflux
Recurrent urinary tract infections and the symptomatic presentation, along with a diagnostic VCUG, indicate vesicoureteral reflux, where urine flows backward from the bladder to the kidneys.
21
Q
An 8-year-old boy is brought in due to concerns about his inability to concentrate in school, frequent daydreaming, and failure to complete tasks. He is often forgetful and loses his school supplies. He does not exhibit disruptive behavior or hyperactivity.
- A. Autism spectrum disorder
- B. Generalized anxiety disorder
- C. Attention-deficit/hyperactivity disorder
- D. Major depressive disorder
A
C. Attention-deficit/hyperactivity disorder
ADHD, particularly the inattentive subtype, is characterized by poor attention, forgetfulness, and disorganization, without the hyperactivity often associated with the disorder.
22
Q
A 6-week-old infant presents with projectile vomiting after feeding, constant hunger, and dehydration. On examination, an olive-sized mass is palpable in the right upper quadrant of the abdomen.
- A. Gastroenteritis
- B. Pyloric stenosis
- C. Intussusception
- D. Gastroesophageal reflux
A
B. Pyloric stenosis
Pyloric stenosis typically presents in young infants with projectile vomiting, palpable abdominal mass (“olive”), and signs of dehydration.
23
Q
A 15-year-old boy presents with hypertension noted during a routine physical examination. He reports frequent headaches and leg cramps during exercise. On examination, there is a discrepancy in blood pressure between the upper and lower extremities, with weaker femoral pulses.
- A. Coarctation of the aorta
- B. Patent ductus arteriosus
- C. Atrial septal defect
- D. Ventricular septal defect
A
A. Coarctation of the aorta
Coarctation of the aorta often presents with hypertension, differential blood pressure between the upper and lower limbs, and diminished femoral pulses.
24
Q
A 3-year-old child presents with honey-colored, crusted lesions around the mouth and nose. The child attends daycare, and a few other children have developed similar symptoms. The lesions started as small vesicles that ruptured and became crusted.
- A. Herpes simplex
- B. Atopic dermatitis
- C. Impetigo
- D. Varicella infection
A
C. Impetigo
Impetigo is a common bacterial skin infection in children, characterized by honey-colored, crusted lesions, often following minor skin trauma. Its spread in close communities like daycare centers is common.
25
A 12-year-old obese boy presents with a limp and complains of hip pain, referring to the knee. He has limited internal rotation of the affected hip. The pain has progressively worsened over the past three months.
- A. Legg-Calvé-Perthes disease
- B. Osteomyelitis
- C. Juvenile idiopathic arthritis
- D. Slipped capital femoral epiphysis
D. Slipped capital femoral epiphysis
## Footnote
SCFE typically presents in obese adolescents with hip pain that may refer to the knee, associated with a limp and limited hip internal rotation. The chronic nature of the symptoms and specific demographic factors align with SCFE.
26
A 5-year-old child presents with honey-colored crusting lesions around the mouth and nose, which began as small vesicles that ruptured. The child has no systemic symptoms.
- A. Herpes simplex
- B. Atopic dermatitis
- C. Impetigo
- D. Acne vulgaris
C. Impetigo
## Footnote
Impetigo is characterized by honey-colored crusting lesions, often starting as small vesicles that rupture, typically around the mouth and nose, without systemic symptoms.
27
A 2-year-old boy presents with sudden onset of colicky abdominal pain, drawing his knees to his chest during episodes of pain. He has vomited twice and passed a stool that looks like “red currant jelly.”
- A. Gastroenteritis
- B. Appendicitis
- C. Intussusception
- D. Hirschsprung disease
C. Intussusception
## Footnote
The classic triad of colicky abdominal pain, vomiting, and “red currant jelly” stool (indicating blood and mucus) is highly suggestive of intussusception in a young child.
28
A 16-year-old girl presents with persistent sadness, loss of interest in activities, significant weight change, sleep disturbance, and feelings of worthlessness over the past few months. She has trouble concentrating in school and expresses recurrent thoughts of death.
- A. Bipolar disorder
- B. Generalized anxiety disorder
- C. Major depressive disorder
- D. Adjustment disorder
C. Major depressive disorder
## Footnote
The presence of persistent sadness, anhedonia, significant weight change, sleep disturbance, feelings of worthlessness, difficulty concentrating, and thoughts of death are consistent with major depressive disorder.
29
A 3-year-old boy suddenly starts coughing and wheezing after playing with small toys. He appears in distress with a unilateral wheeze noted on examination. Chest radiograph shows hyperinflation of the right lung.
- A. Asthma
- B. Bronchiolitis
- C. Pneumonia
- D. Foreign body aspiration
D. Foreign body aspiration
## Footnote
Sudden onset of respiratory distress, coughing, wheezing, especially unilateral, following playing with small objects, and radiographic finding of unilateral hyperinflation suggest foreign body aspiration.
30
A 4-month-old infant presents with cyanotic episodes, particularly during feeding and crying. On examination, a systolic murmur is heard over the left upper sternal border, and oxygen saturation decreases with crying.
- A. Ventricular septal defect
- B. Tetralogy of Fallot
- C. Atrial septal defect
- D. Transposition of the great arteries
B. Tetralogy of Fallot
## Footnote
The presentation of cyanotic episodes (cyanotic "Tet" spells), systolic murmur at the left upper sternal border, and hypoxia that worsens with crying are characteristic of Tetralogy of Fallot.
31
31
A 9-year-old girl presents with a two-week history of itchy, red patches on her elbows and knees. She has a history of asthma and allergic rhinitis. The patches are well-demarcated, raised, and covered with silvery scales. The family history includes her father having a similar skin condition. Which of the following is the most likely diagnosis?**
- A. Atopic dermatitis
- B. Psoriasis
- C. Seborrheic dermatitis
- D. Lichen planus**
B. Psoriasis
## Footnote
The description of itchy, red, well-demarcated patches with silvery scales on the elbows and knees, associated with a personal and family history of similar skin conditions and other atopic disorders, strongly suggests psoriasis. Psoriasis is a chronic inflammatory skin disease with a genetic predisposition.
32
A 3-year-old boy is brought to the clinic with a facial rash that has been worsening over the past week. The rash initially appeared as red, weeping patches and has now developed into thick, yellowish crusts. He has a fever and appears to be in discomfort. Which of the following is the most appropriate management?**
- A. Topical antifungal treatment
- B. Systemic corticosteroids
- C. Oral antibiotics
- D. Topical calcineurin inhibitors**
C. Oral antibiotics
## Footnote
The presence of a rapidly worsening facial rash with weeping patches, yellowish crusts, associated fever, and discomfort suggests a bacterial infection, likely impetigo. Oral antibiotics are appropriate to treat the infection and prevent complications.
33
A 12-year-old girl presents with multiple small, flesh-colored papules on her forehead and cheeks. The lesions are smooth, dome-shaped, and have a central umbilication. The child reports that they are painless but have been increasing in number over the past few months. What is the most likely diagnosis?**
- A. Acne vulgaris
- B. Molluscum contagiosum
- C. Basal cell carcinoma
- D. Keratosis pilaris**
B. Molluscum contagiosum
## Footnote
The description of small, flesh-colored, dome-shaped papules with central umbilication that are painless and have been gradually increasing in number is characteristic of molluscum contagiosum, a viral skin infection common in children.
34
A 15-year-old boy presents with severe acne on his face, chest, and back. He has numerous open and closed comedones, papules, pustules, and a few nodules. His acne has persisted despite over-the-counter topical treatments. What is the most appropriate next step in management?**
- A. Topical retinoids
- B. Oral isotretinoin
- C. Oral antibiotics and topical benzoyl peroxide
- D. Phototherapy**
C. Oral antibiotics and topical benzoyl peroxide
## Footnote
Given the severity of the acne and the presence of inflammatory lesions (papules, pustules, nodules) that have not responded to over-the-counter treatments, a combination of oral antibiotics and topical benzoyl peroxide is appropriate to reduce bacterial load and inflammation.
35
A 6-year-old child presents with oval, scaly, erythematous plaques on the trunk and proximal extremities. The mother reports that the child had a "herald patch" on the back that appeared several days before the rash spread. The child is in good health otherwise. What is the most likely diagnosis?**
- A. Pityriasis rosea
- B. Tinea corporis
- C. Nummular eczema
- D. Guttate psoriasis**
A. Pityriasis rosea
## Footnote
Pityriasis rosea often begins with a single, larger "herald patch" followed by a generalized body rash of oval, scaly plaques. It is self-limiting and usually resolves without treatment.
36
An 8-year-old girl presents with painful, red, swollen lesions on her legs. The lesions began as small red bumps that rapidly grew in size and developed a central area of necrosis. She recently had a minor scrape on her knee. Which of the following is the most likely diagnosis?
- A. Erysipelas
- B. Cellulitis
- C. Furunculosis
- D. Necrotizing fasciitis
B. Cellulitis
## Footnote
The presentation of rapidly growing, painful, red, swollen lesions with a central area of necrosis, especially following a break in the skin like a scrape, suggests cellulitis. This bacterial skin infection affects the deeper layers of the skin and requires prompt antibiotic treatment to prevent further complications.
37
A 10-year-old boy with no significant medical history presents with a sudden onset of widespread, erythematous, target-like lesions on his body. He reports feeling unwell with a slight fever and malaise. There is no known recent medication use or illness. What is the most likely diagnosis?
- A. Erythema multiforme
- B. Urticaria
- C. Stevens-Johnson syndrome
- D. Kawasaki disease
A. Erythema multiforme
## Footnote
Erythema multiforme is characterized by the sudden appearance of target-like lesions, often associated with symptoms like fever and malaise. It can be triggered by infections or other factors, but does not necessarily relate to medication use or severe illnesses like Stevens-Johnson syndrome.
38
A 7-year-old girl presents with a patchy, scaly scalp and associated hair loss. She complains of mild itching. On examination, black dots are noted where the hair has broken off at the scalp surface. What is the most likely diagnosis?
- A. Alopecia areata
- B. Trichotillomania
- C. Tinea capitis
- D. Seborrheic dermatitis
C. Tinea capitis
## Footnote
Tinea capitis, a fungal infection of the scalp, presents with patchy hair loss, scaling, and broken hair at the scalp (black dot appearance). It is common in children and can cause itching and scalp inflammation.
39
An 11-year-old girl presents with large, round, erythematous plaques on her cheeks that worsen with sun exposure. She reports feeling increasingly fatigued and has developed a low-grade fever. Her mother mentions that she has been unusually sensitive to sunlight recently. What is the most likely diagnosis?
- A. Lupus erythematosus
- B. Rosacea
- C. Dermatomyositis
- D. Sunburn
A. Lupus erythematosus
## Footnote
The combination of round, erythematous facial plaques, systemic symptoms like fatigue and fever, and photosensitivity suggests lupus erythematosus, a chronic autoimmune condition that can affect the skin and other organs.
40
A 4-year-old boy is brought to the clinic with rough, bumpy skin on the back of his upper arms and front of his thighs. His mother states that these bumps have been present for several months and are sometimes itchy. There is no redness or scaling. What is the most likely diagnosis?
- A. Keratosis pilaris
- B. Acne vulgaris
- C. Atopic dermatitis
- D. Ichthyosis vulgaris
A. Keratosis pilaris
## Footnote
Keratosis pilaris presents as rough, bumpy skin on areas like the upper arms and thighs. It is caused by the buildup of keratin in the hair follicles and is common in children, often associated with a dry skin condition but not typically red or inflamed.
41
A 13-year-old girl presents with recurrent, painful nodules in her armpits and groin area that drain pus and blood. She has a history of similar episodes over the past year. The lesions heal with scarring. What is the most likely diagnosis?
- A. Hidradenitis suppurativa
- B. Folliculitis
- C. Cystic acne
- D. Furunculosis
A. Hidradenitis suppurativa
## Footnote
Hidradenitis suppurativa is a chronic condition characterized by the occurrence of painful, inflamed nodules and abscesses in areas like the armpits and groin, often leading to scarring. It requires long-term management strategies to control symptoms and prevent new lesions.
42
A 6-year-old girl presents with a 3-day history of an itchy, blistering rash on her wrists and between her fingers. Her mother mentions that she recently attended a sleepover where another child had similar symptoms. On examination, there are small vesicles and pustules with excoriation marks. Which of the following is the most likely diagnosis?
- A. Atopic dermatitis
- B. Contact dermatitis
- C. Scabies
- D. Impetigo
C. Scabies
## Footnote
The clinical presentation of an itchy rash, particularly with vesicles and pustules localized to the wrists and between fingers, and the history of close contact with an affected individual, are characteristic of scabies. Scabies is caused by the mite Sarcoptes scabiei and is highly contagious, often spreading through direct skin contact.
43
A 4-month-old infant is brought to the clinic with a widespread rash that started on the cheeks and spread to the trunk and limbs. The rash is red, scaly, and the infant appears irritable. The mother reports no new foods or products used on the infant. Which of the following is the most appropriate initial treatment?
- A. Topical corticosteroids
- B. Oral antihistamines
- C. Topical antibiotics
- D. Systemic corticosteroids
A. Topical corticosteroids
## Footnote
The description of a red, scaly rash in an infant, particularly involving the cheeks and spreading to other parts of the body, along with irritability, suggests atopic dermatitis (eczema). Initial management includes the use of topical corticosteroids to reduce inflammation and relieve itching.
44
A 10-year-old boy presents with a circular, scaly rash on his thigh that has been gradually expanding over the past two weeks. He is otherwise healthy and has no significant medical history. On examination, the lesion is annular with a clear center and a raised erythematous border. Which of the following is the most likely diagnosis?
- A. Psoriasis
- B. Tinea corporis
- C. Nummular eczema
- D. Granuloma annulare
B. Tinea corporis
## Footnote
The presence of a circular, scaly, and expanding rash with a clear center and raised erythematous border is indicative of tinea corporis, a fungal infection of the skin commonly known as ringworm. It is not related to worms but is caused by dermatophytes.
45
A 7-year-old girl presents with multiple flat, brown patches on her neck and upper back that have become more pronounced over the summer. Her mother is concerned about the sudden appearance and increase in number of these patches. There is no itching or pain associated with these lesions. What is the most likely diagnosis?
- A. Vitiligo
- B. Pityriasis rosea
- C. Tinea versicolor
- D. Melasma
C. Tinea versicolor
## Footnote
Tinea versicolor is caused by a yeast infection of the skin and often presents as flat, hypopigmented or hyperpigmented patches that can become more noticeable with sun exposure. The neck and upper back are common locations for these lesions, which can increase in number and become more evident during warmer months.
46
An 8-year-old boy with a history of asthma presents with crusted, honey-colored lesions around his nose and mouth. The lesions started as small vesicles that ruptured and then crusted over. He was previously treated with a topical antibiotic with no significant improvement. What is the next best step in management?
- A. Continue topical antibiotics
- B. Start oral antibiotics
- C. Apply topical corticosteroids
- D. Initiate antiviral therapy
B. Start oral antibiotics
## Footnote
The description of crusted, honey-colored lesions around the nose and mouth that began as vesicles suggests impetigo, a common bacterial skin infection. If there is no improvement with topical antibiotics, the next step is to start oral antibiotics to adequately treat the infection.
47
A 13-year-old girl presents with a two-week history of cough, night sweats, and weight loss. She recently emigrated from a country with a high prevalence of tuberculosis (TB). On examination, she has diffuse crackles in the upper lobes of her lungs.
What is the most appropriate initial diagnostic test?
- A. Sputum culture for Mycobacterium tuberculosis
- B. Chest X-ray
- C. Tuberculin skin test (TST)
- D. Interferon-gamma release assay (IGRA)
B. Chest X-ray
## Footnote
Given the patient's symptoms and epidemiological background, tuberculosis is a key consideration. A chest X-ray is the most appropriate initial test to identify pulmonary TB, which can show characteristic upper lobe infiltrates or cavitary lesions.
48
A 4-year-old boy is brought to the clinic with a three-day history of high fever, cough, and difficulty breathing. He has a history of cystic fibrosis. On auscultation, there are decreased breath sounds and crackles in the right lower lobe. What is the most likely pathogen, and what is the initial antibiotic therapy?
- A. Pseudomonas aeruginosa; IV ceftazidime or ciprofloxacin
- B. Staphylococcus aureus; Oral flucloxacillin
- C. Haemophilus influenzae; Amoxicillin-clavulanate
- D. Streptococcus pneumoniae; Oral amoxicillin
A. Pseudomonas aeruginosa; IV ceftazidime or ciprofloxacin
## Footnote
In patients with cystic fibrosis, Pseudomonas aeruginosa is a common and serious respiratory pathogen. Initial antibiotic therapy often involves IV ceftazidime or ciprofloxacin to cover for Pseudomonas.
49
A 16-year-old girl presents with fever, severe headache, and a stiff neck. She has a history of splenectomy following a motor vehicle accident two years ago. Her blood culture grows a gram-positive coccus. What is the most likely organism, and what is the first-line treatment?
- A. Streptococcus pneumoniae; IV penicillin or ceftriaxone
- B. Neisseria meningitidis; IV ceftriaxone or penicillin
- C. Haemophilus influenzae type b; IV ceftriaxone or cefotaxime
- D. Staphylococcus aureus; IV vancomycin or nafcillin
A. Streptococcus pneumoniae; IV penicillin or ceftriaxone
## Footnote
Splenectomy patients are at increased risk for infections with encapsulated organisms, particularly Streptococcus pneumoniae. The presentation of fever, headache, and stiff neck is consistent with meningitis, and the first-line treatment for pneumococcal meningitis is IV penicillin or ceftriaxone.
50
An 11-year-old boy presents with recurrent episodes of fever, abdominal pain, and joint swelling. He has a history of frequent throat infections. His recent blood tests show elevated antistreptolysin O (ASO) titers. What is the most likely diagnosis?
- A. Rheumatic fever
- B. Systemic lupus erythematosus
- C. Juvenile idiopathic arthritis
- D. Henoch-Schönlein purpura
A. Rheumatic fever
## Footnote
The history of frequent throat infections, recurrent fever, abdominal pain, joint swelling, and elevated ASO titers suggest rheumatic fever, a post-streptococcal autoimmune disease affecting the heart, joints, skin, and brain.
51
A 7-year-old girl presents with fever, unilateral facial swelling, and pain in front of her ear. She has dry mouth and difficulty eating. On examination, there is erythema and swelling over the parotid gland. What is the most likely diagnosis, and what is the appropriate management?
- A. Parotitis due to mumps; Supportive care and isolation
- B. Bacterial sialadenitis; Antibiotic therapy
- C. Acute otitis media; Amoxicillin
- D. Dental abscess; Dental referral and antibiotics
A. Parotitis due to mumps; Supportive care and isolation
## Footnote
The clinical presentation of fever, unilateral facial swelling, and pain in front of the ear, along with dry mouth, suggests mumps parotitis. Management includes supportive care and isolation to prevent spread of the virus.
52
An 8-year-old girl presents with fever, sore throat, and difficulty swallowing. On examination, she has a grayish membrane covering her tonsils and pharynx. She has not received her childhood vaccinations. What is the most likely diagnosis, and what is the immediate management?
- A. Diphtheria; Antitoxin and antibiotics
- B. Streptococcal pharyngitis; Penicillin
- C. Infectious mononucleosis; Supportive care
- D. Herpangina; Supportive care
A. Diphtheria; Antitoxin and antibiotics
## Footnote
The presence of a grayish membrane covering the tonsils and pharynx in an unvaccinated child is characteristic of diphtheria. Immediate management includes administration of diphtheria antitoxin and antibiotics.
53
A 9-year-old boy presents with a three-day history of fever, headache, and myalgia, followed by the sudden appearance of a rash on his hands and feet. The rash is maculopapular and spreads to involve his arms and legs. He recently returned from a camping trip. What is the most likely diagnosis?
- A. Rocky Mountain spotted fever
- B. Lyme disease
- C. Hand, foot, and mouth disease
- D. Kawasaki disease
A. Rocky Mountain spotted fever
## Footnote
The sudden onset of a maculopapular rash on the hands and feet, spreading to the arms and legs, in conjunction with a history of camping, fever, headache, and myalgia, is suggestive of Rocky Mountain spotted fever, a tick-borne illness.
54
A 12-year-old girl presents with fever, cough, and left-sided chest pain. She has a dullness to percussion and decreased breath sounds at the left lung base. What is the most likely diagnosis, and what is the primary treatment?
- A. Pneumonia; Antibiotics
- B. Pleural effusion; Thoracentesis and antibiotics
- C. Pneumothorax; Chest tube placement
- D. Asthma exacerbation; Bronchodilators and corticosteroids
B. Pleural effusion; Thoracentesis and antibiotics
## Footnote
The symptoms of fever, cough, unilateral chest pain, dullness to percussion, and decreased breath sounds suggest a pleural effusion, likely secondary to pneumonia. Management includes thoracentesis and antibiotics.
55
A 15-year-old boy presents with fever, right upper quadrant abdominal pain, jaundice, and dark urine. He reports consuming raw shellfish recently. His liver function tests are elevated. What is the most likely diagnosis?
- A. Acute hepatitis A
- B. Acute hepatitis B
- C. Acute hepatitis C
- D. Acute cholecystitis
A. Acute hepatitis A
## Footnote
The consumption of raw shellfish, combined with the presentation of fever, right upper quadrant pain, jaundice, and dark urine, suggests acute hepatitis A, which is often transmitted through contaminated food or water.
56
A 4-year-old boy presents with fever, irritability, and a bulging tympanic membrane on the right side. He is pulling at his right ear and crying. What is the most likely diagnosis, and what is the first-line treatment?
- A. Acute otitis media; Amoxicillin
- B. Otitis externa; Topical ear drops with antibiotics and steroids
- C. Otitis media with effusion; Nasal steroids and observation
- D. Acute mastoiditis; IV antibiotics and possible surgical intervention
A. Acute otitis media; Amoxicillin
## Footnote
The child's symptoms of fever, irritability, and a bulging tympanic membrane, along with ear tugging and crying, indicate acute otitis media. The first-line treatment is amoxicillin.
57
A 9-year-old girl presents with fever, bilateral conjunctival injection, cracked lips, a strawberry tongue, and a polymorphous rash. She also has swollen, tender cervical lymph nodes. What is the most likely diagnosis, and what is the mainstay of treatment?
- A. Kawasaki disease; High-dose aspirin and intravenous immunoglobulin (IVIG)
- B. Scarlet fever; Penicillin
- C. Stevens-Johnson syndrome; Corticosteroids
- D. Measles; Supportive care
A. Kawasaki disease; High-dose aspirin and intravenous immunoglobulin (IVIG)
## Footnote
The child's clinical presentation is characteristic of Kawasaki disease, which includes fever, conjunctival injection, mucosal changes (cracked lips, strawberry tongue), polymorphous rash, and lymphadenopathy. The mainstay of treatment is high-dose aspirin and IVIG to reduce the risk of coronary artery aneurysms.
58
A 6-year-old boy presents with abrupt onset of high fever, chills, headache, and leg pain. On examination, he has a petechial rash on his lower extremities. His CBC shows thrombocytopenia. What is the most likely diagnosis, and what is the best initial management?
- A. Idiopathic thrombocytopenic purpura; Corticosteroids
- B. Meningococcemia; Broad-spectrum antibiotics
- C. Henoch-Schönlein purpura; Supportive care
- D. Rocky Mountain spotted fever; Doxycycline
B. Meningococcemia; Broad-spectrum antibiotics
## Footnote
The sudden onset of high fever, chills, headache, and a petechial rash, along with thrombocytopenia, is suggestive of meningococcemia. Immediate empirical treatment with broad-spectrum antibiotics is critical to prevent rapid progression to sepsis and shock.
59
An 18-month-old boy presents with a 2-day history of high fever, drooling, and difficulty breathing. He appears anxious, has a muffled voice, and prefers sitting upright. What is the most appropriate next step in management?
- A. Oral antibiotics and outpatient follow-up
- B. Immediate intubation in the emergency department
- C. Direct laryngoscopy in the operating room
- D. Corticosteroids and nebulized epinephrine
C. Direct laryngoscopy in the operating room
## Footnote
The child's presentation is consistent with epiglottitis, characterized by high fever, drooling, stridor, and a preference for sitting upright (tripod position). This condition is a medical emergency requiring airway management, preferably through direct laryngoscopy in a controlled setting like the operating room.
60
A 4-year-old girl presents with intermittent abdominal pain, nonbloody diarrhea, and a low-grade fever lasting one week. She recently returned from a family vacation in a developing country. What is the most likely pathogen, and what is the appropriate treatment?
- A. Giardia lamblia; Metronidazole
- B. Rotavirus; Supportive care
- C. Salmonella enteritidis; Fluid rehydration and antibiotics
- D. Escherichia coli O157:H7; Supportive care and observation
A. Giardia lamblia; Metronidazole
## Footnote
Given the history of travel to a developing country and the symptoms of intermittent abdominal pain, nonbloody diarrhea, and low-grade fever, Giardia lamblia infection is likely. Treatment with metronidazole is effective.
61
A 10-year-old boy with asthma presents with three days of worsening cough, fever, and wheezing. He is using his rescue inhaler frequently with little relief. What is the most appropriate management to prevent progression to a severe exacerbation?
- A. Start oral corticosteroids and increase inhaled corticosteroid dose
- B. Administer a short course of oral antibiotics
- C. Increase the frequency of rescue inhaler use
- D. Begin a trial of antihistamines and nasal decongestants
A. Start oral corticosteroids and increase inhaled corticosteroid dose
## Footnote
The patient's symptoms suggest an asthma exacerbation, possibly triggered by an underlying respiratory infection. The appropriate management includes starting oral corticosteroids and increasing the dose of inhaled corticosteroids to prevent progression to a severe exacerbation.
62
An 8-year-old girl presents with a sore throat, fever, and anterior cervical lymphadenopathy. Her tonsils are enlarged and erythematous with exudates. Rapid strep test is positive. What is the most appropriate antibiotic therapy?
- A. Amoxicillin
- B. Azithromycin
- C. Cephalexin
- D. All of the above are appropriate
D. All of the above are appropriate
## Footnote
Amoxicillin, azithromycin, and cephalexin are all appropriate antibiotic choices for streptococcal pharyngitis. The selection can be based on patient allergies, local resistance patterns, and patient or parental preference.
63
A 12-year-old girl presents with fever, headache, and confusion. Her parents report a tick bite two weeks ago. She has a stiff neck and photophobia on examination. What is the most likely diagnosis, and what is the appropriate empirical treatment?
- A. Lyme disease; Doxycycline
- B. Meningitis; Broad-spectrum antibiotics and lumbar puncture
- C. Rocky Mountain spotted fever; Doxycycline
- D. Ehrlichiosis; Doxycycline
B. Meningitis; Broad-spectrum antibiotics and lumbar puncture
## Footnote
Although the history of a tick bite raises the suspicion for tick-borne diseases like Lyme disease, the acute presentation with fever, headache, confusion, stiff neck, and photophobia suggests meningitis. Immediate empirical treatment with broad-spectrum antibiotics and diagnostic lumbar puncture is necessary.
64
A 3-year-old boy with no significant medical history presents with three days of high fever, red eyes, cough, coryza, and a spreading rash that started on the face. What is the most likely diagnosis, and what is the standard care?
- A. Measles; Supportive care and vitamin A supplementation
- B. Scarlet fever; Antibiotics
- C. Kawasaki disease; IVIG and aspirin
- D. Rubella; Supportive care
A. Measles; Supportive care and vitamin A supplementation
## Footnote
The clinical features of high fever, cough, coryza (runny nose), conjunctivitis (red eyes), and a rash that starts on the face and spreads downwards are characteristic of measles. Standard care includes supportive treatment and vitamin A supplementation.
65
A 7-year-old girl presents with fever, unilateral neck swelling, and pain, particularly when turning her head. She has a history of a recent upper respiratory tract infection. On examination, there is tenderness and swelling over the mastoid process. What is the most likely diagnosis?
- A. Mastoiditis
- B. Lymphadenitis
- C. Acute otitis media
- D. Parotitis
A. Mastoiditis
## Footnote
The recent history of upper respiratory infection, followed by fever, unilateral neck swelling, pain on head movement, and tenderness over the mastoid process, suggests mastoiditis. This condition requires urgent antibiotic treatment and possibly surgical intervention.
66
A 14-year-old boy presents with fever, sore throat, fatigue, and generalized lymphadenopathy. Blood tests show atypical lymphocytes and elevated liver enzymes. What is the most likely diagnosis, and what is the recommended management?
- A. Infectious mononucleosis; Supportive care and avoidance of contact sports
- B. Acute hepatitis; Antiviral therapy
- C. Acute lymphoblastic leukemia; Chemotherapy
- D. HIV infection; Antiretroviral therapy
A. Infectious mononucleosis; Supportive care and avoidance of contact sports
## Footnote
The constellation of symptoms such as fever, sore throat, fatigue, generalized lymphadenopathy, atypical lymphocytes, and elevated liver enzymes is characteristic of infectious mononucleosis, most commonly caused by Epstein-Barr virus. Management is supportive, with a focus on hydration, rest, and avoiding contact sports to prevent splenic rupture.
67
A 4-year-old girl presents with a 3-day history of high fever, sore throat, and difficulty swallowing. On examination, she has bilateral tender anterior cervical lymphadenopathy, tonsillar exudates without cough, and her voice is muffled. Which of the following is the most appropriate initial management?
- A. Start broad-spectrum antibiotics
- B. Obtain a throat culture and initiate antibiotics based on the culture result
- C. Prescribe symptomatic treatment only (analgesics, hydration)
- D. Immediate referral to an otolaryngologist for possible drainage
B. Obtain a throat culture and initiate antibiotics based on the culture result
## Footnote
The child's presentation is suggestive of bacterial pharyngitis, possibly due to Group A Streptococcus (GAS). The best initial management is to confirm the diagnosis with a throat culture and treat with antibiotics, such as penicillin or amoxicillin, to prevent complications like rheumatic fever and peritonsillar abscess.
68
A 2-year-old boy with no significant past medical history presents with a 2-day history of fever, irritability, and a red rash that started on his face and spread to his trunk and limbs. His mother reports that he had been in contact with another child with a similar rash. On examination, the rash is maculopapular and blanching. What is the most likely diagnosis?
- A. Measles
- B. Rubella
- C. Roseola
- D. Fifth disease
A. Measles
## Footnote
The child's symptoms and the spreading pattern of the rash are characteristic of measles, which is a highly contagious viral illness. The history of contact with another affected child and the progression of the rash from the face to the rest of the body further support this diagnosis.
69
A 6-month-old infant brought to the clinic by his parents who report a 4-day history of fever, cough, and runny nose. The infant appears tachypneic and lethargic. Auscultation reveals diffuse crackles. What is the most appropriate next step in management?
- A. Start oral antibiotics
- B. Perform a chest X-ray
- C. Administer inhaled bronchodilators
- D. Hospitalize for supportive care and observation
D. Hospitalize for supportive care and observation
## Footnote
The infant's symptoms suggest a severe lower respiratory tract infection, possibly bronchiolitis or pneumonia. Given the age, lethargy, and signs of respiratory distress, hospitalization for supportive care, monitoring, and possibly further investigation is warranted.
70
A 3-year-old child with a history of sickle cell disease presents with fever, right upper quadrant pain, and vomiting. On examination, the child is jaundiced and the liver is palpable 2cm below the right costal margin. The most likely diagnosis is:
- A. Acute hepatitis
- B. Acute cholecystitis
- C. Acute chest syndrome
- D. Acute splenic sequestration
B. Acute cholecystitis
## Footnote
Children with sickle cell disease are at increased risk for gallstone formation due to chronic hemolysis, leading to acute cholecystitis. The clinical presentation of right upper quadrant pain, vomiting, and jaundice in a child with sickle cell disease is indicative of cholecystitis.
71
A 15-year-old boy with no significant medical history presents with a 5-day history of cough, fever, and malaise. His mother reports he had a "cold" that has progressively worsened. On examination, he has tachypnea, and chest auscultation reveals crackles in the right lower lobe. What is the most appropriate initial diagnostic test?
- A. Complete blood count (CBC)
- B. Chest X-ray
- C. Sputum culture
- D. Rapid antigen detection test for influenza
B. Chest X-ray
## Footnote
The patient's presentation is suggestive of pneumonia, particularly given the progression from a "cold" to more severe respiratory symptoms and the presence of localized crackles. A chest X-ray is necessary to confirm the presence of an infiltrate, which is indicative of pneumonia.
72
A 7-year-old girl presents with fever, headache, and a rash that began on her wrist and ankles then spread to the trunk, palms, and soles. She recently returned from a camping trip. Examination reveals a petechial rash with some maculopapular lesions. What is the most appropriate treatment?
- A. Oral amoxicillin
- B. Oral acyclovir
- C. Doxycycline
- D. Supportive care only
C. Doxycycline
## Footnote
The presentation is suggestive of Rocky Mountain spotted fever, especially given the history of a camping trip and the characteristic rash including the palms and soles. Doxycycline is the treatment of choice, regardless of age, in suspected cases of Rocky Mountain spotted fever to prevent severe complications.
73
A 10-year-old boy presents with high fever, cough, and right-sided chest pain. He has a history of pneumonia two years ago. A chest X-ray reveals a lobar consolidation. What is the most likely causative agent?
- A. Streptococcus pneumoniae
- B. Mycoplasma pneumoniae
- C. Respiratory syncytial virus (RSV)
- D. Staphylococcus aureus
A. Streptococcus pneumoniae
## Footnote
Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children and can lead to lobar consolidation on chest X-ray. The child's symptoms and radiographic findings are classic for pneumococcal pneumonia.
74
An 8-year-old girl presents with abdominal pain, joint swelling, and a rash on her legs two weeks after a sore throat. Which of the following is the most likely diagnosis?
- A. Henoch-Schönlein purpura (HSP)
- B. Rheumatic fever
- C. Kawasaki disease
- D. Scarlet fever
B. Rheumatic fever
## Footnote
Rheumatic fever can occur following Group A Streptococcus infection, presenting with arthritis, carditis, and other systemic symptoms. The temporal relationship between the sore throat and the onset of symptoms, along with the described manifestations, strongly suggest rheumatic fever.
75
A 16-year-old girl presents with fever, headache, photophobia, and neck stiffness. She has just returned from a high school camping trip. Blood cultures are pending. What is the most appropriate immediate management?
- A. Start empirical antiviral therapy
- B. Begin empirical antibiotic therapy for bacterial meningitis
- C. Perform a CT scan before any intervention
- D. Administer corticosteroids only
B. Begin empirical antibiotic therapy for bacterial meningitis
## Footnote
The clinical presentation is suggestive of meningitis, and immediate empirical antibiotic therapy is critical to cover the most likely bacterial pathogens until culture results are available. Prompt treatment can significantly reduce morbidity and mortality associated with bacterial meningitis.
76
A 5-year-old boy presents with a 3-day history of fever, neck stiffness, and a purpuric rash. His parents report he was recently at a birthday party where another child had a similar illness. What is the primary agent to consider in treatment?
- A. Neisseria meningitidis
- B. Haemophilus influenzae type b
- C. Streptococcus pneumoniae
- D. Enterovirus
A. Neisseria meningitidis
## Footnote
The presentation of fever, neck stiffness, and a purpuric rash is highly suggestive of meningococcal disease caused by Neisseria meningitidis. This is a medical emergency requiring immediate initiation of antibiotic therapy, particularly in the context of a known contact with similar illness.
77
A 14-year-old boy presents with recurrent epistaxis, nasal obstruction, and a mass felt at the back of the nasal cavity. Imaging shows a vascular tumor in the nasopharynx. What is the most likely diagnosis and the best initial management step?
A. Nasopharyngeal carcinoma; start chemotherapy
B. Juvenile nasopharyngeal angiofibroma; surgical referral
C. Adenoidal hypertrophy; corticosteroids
D. Inverted papilloma; radiotherapy
B. Juvenile nasopharyngeal angiofibroma; surgical referral
## Footnote
Juvenile nasopharyngeal angiofibroma is a benign, highly vascular tumor commonly seen in adolescent males, presenting with epistaxis and nasal obstruction. The management includes a surgical referral for excision due to the risk of significant bleeding and potential for growth.
78
A 2-year-old child presents with a barking cough, stridor, and low-grade fever. Symptoms worsen at night and improve with exposure to moist air. Which of the following is the most appropriate treatment?
A. Nebulized epinephrine and oral dexamethasone
B. Broad-spectrum antibiotics
C. Antitussive medications
D. Immediate endotracheal intubation
A. Nebulized epinephrine and oral dexamethasone
## Footnote
The child's clinical presentation is consistent with croup, or acute laryngotracheitis, typically caused by a viral infection. The mainstay of treatment is nebulized epinephrine for airway edema and oral dexamethasone to reduce inflammation.
79
A 5-year-old child is brought to the emergency department immediately after accidentally splashing a household cleaner into his eyes. He presents with red, watery eyes and is in significant distress. What is the first step in management?
A. Immediate referral to an ophthalmologist
B. Prescribe topical antibiotic ointment
C. Copious irrigation of the eyes with saline
D. Perform a fluorescein stain immediately
C. Copious irrigation of the eyes with saline
## Footnote
The initial management of an ocular chemical burn involves immediate and copious irrigation of the eyes with saline or water to remove the offending substance and reduce the extent of the injury, followed by an ophthalmologic evaluation.
80
A 9-year-old child presents with gradual hearing difficulty and poor academic performance. The audiometry shows significant sensorineural hearing loss. Which of the following is the most likely cause?
A. Chronic otitis media
B. Otosclerosis
C. Noise exposure
D. Meningitis
C. Noise exposure
## Footnote
In children, sensorineural hearing loss can often be attributed to noise exposure, especially in the context of gradual hearing loss without a history of infections or other systemic conditions like meningitis, which can also cause sensorineural hearing loss but typically presents more acutely.
81
A newborn presents with purulent eye discharge starting on the second day of life. The mother had untreated Chlamydia during pregnancy. What is the most appropriate management?
A. Topical erythromycin
B. Systemic azithromycin
C. Warm compresses and eye cleaning
D. Topical corticosteroids
B. Systemic azithromycin
## Footnote
Ophthalmia neonatorum caused by Chlamydia requires systemic treatment with azithromycin to effectively eradicate the infection, in addition to topical eye care.
82
A 10-year-old child presents with sudden onset of unilateral facial weakness, inability to close the eye on the affected side, and drooping of the mouth. There is no history of trauma. What is the most appropriate initial management?
A. Start high-dose corticosteroids
B. Immediate neuroimaging
C. Prescribe antiviral therapy
D. Observe for spontaneous recovery
A. Start high-dose corticosteroids
## Footnote
The child’s presentation is consistent with Bell’s palsy. Early treatment with corticosteroids can improve the likelihood of complete recovery.
83
n infant presents with inspiratory stridor that worsens with crying and improves in the prone position. The physical examination is otherwise unremarkable. What is the most likely diagnosis and management plan?
A. Laryngomalacia; reassurance and observation
B. Vocal cord paralysis; immediate laryngoscopy
C. Foreign body aspiration; bronchoscopy
D. Tracheomalacia; surgical intervention
A. Laryngomalacia; reassurance and observation
## Footnote
Laryngomalacia is the most common cause of stridor in infants, characterized by a collapse of the supraglottic structures during inspiration. It usually resolves spontaneously, and management is supportive unless there are signs of severe airway compromise.
84
A 4-year-old child presents with a right eye that frequently turns inward. The visual acuity test shows decreased vision in the right eye compared to the left. What is the most likely diagnosis and the most appropriate management?
A. Strabismus; surgical correction
B. Amblyopia; patch therapy of the left eye
C. Cataract; surgical removal
D. Retinopathy of prematurity; laser therapy
B. Amblyopia; patch therapy of the left eye
## Footnote
The child has amblyopia, often a result of untreated strabismus, leading to decreased vision in the misaligned eye. Patch therapy of the stronger eye forces the use of the weaker eye, thereby improving vision.
85
A 12-year-old child presents with night blindness and a history of hearing loss. The examination reveals a constricted visual field and bilateral sensorineural hearing loss. What is the most likely diagnosis?
A. Retinitis pigmentosa
B. Usher syndrome
C. Congenital rubella syndrome
D. Acoustic neuroma
B. Usher syndrome
## Footnote
Usher syndrome is characterized by a combination of sensorineural hearing loss and retinitis pigmentosa, leading to night blindness and visual field constriction.
86
An 8-year-old child presents with mouth breathing, snoring, and frequent awakenings during the night. Examination reveals enlarged adenoids obstructing the nasopharyngeal airway. What is the most appropriate management?
A. Nasal corticosteroids
B. Adenoidectomy
C. Continuous positive airway pressure (CPAP) therapy
D. Antibiotic therapy
B. Adenoidectomy
## Footnote
In cases of adenoid hypertrophy leading to significant obstruction and sleep disturbance, adenoidectomy is the treatment of choice to relieve airway obstruction and improve symptoms.
87
A 3-year-old girl is brought in by her parents for concerns about her speech delay and frequent inattention. Physical examination reveals a bilateral amber-colored fluid behind the tympanic membrane, with no signs of acute infection. What is the most likely diagnosis and the best initial management?
A. Acute otitis media; start high-dose amoxicillin
B. Chronic serous otitis media; tympanometry and hearing test
C. Eustachian tube dysfunction; intranasal corticosteroids
D. Cholesteatoma; surgical referral
B. Chronic serous otitis media; tympanometry and hearing test
## Footnote
The child presents with signs of chronic serous otitis media, characterized by fluid accumulation in the middle ear without signs of acute infection, often leading to hearing impairment and speech delays. Tympanometry and hearing tests are essential to assess the extent of hearing loss and guide further management.
88
A 4-year-old boy presents with high fever, drooling, and a muffled voice. He appears anxious and prefers sitting upright. On examination, he has inspiratory stridor and is very irritable when an attempt is made to examine his throat. What is the most appropriate immediate action?
A. Perform a throat examination in the clinic
B. Administer oral corticosteroids and observe
C. Secure the airway in a controlled setting
D. Start broad-spectrum antibiotics orally
C. Secure the airway in a controlled setting
## Footnote
The child’s symptoms are suggestive of epiglottitis, a medical emergency requiring immediate airway management in a controlled setting, such as an operating room or intensive care unit, where intubation can be performed safely.
89
A 2-year-old boy presents with fever, irritability, and pulling at his right ear. Otoscopic examination reveals a bulging, erythematous tympanic membrane with purulent middle ear effusion. What is the most appropriate first-line treatment?
A. Amoxicillin
B. Ibuprofen and watchful waiting
C. Topical antibiotic ear drops
D. Oral decongestants
A. Amoxicillin
## Footnote
The child has acute otitis media, characterized by the rapid onset of symptoms and middle ear effusion. First-line treatment for AOM in children, especially those under 6 years of age or with severe symptoms, is oral amoxicillin.
90
A 6-year-old child presents with red, itchy eyes and yellow discharge, noted especially in the morning. The child has been in close contact with another child with similar symptoms. What is the most likely diagnosis and the appropriate treatment?
A. Allergic conjunctivitis; antihistamine drops
B. Viral conjunctivitis; cool compresses and lubricating eye drops
C. Bacterial conjunctivitis; topical antibiotic eye drops
D. Keratitis; referral to an ophthalmologist
C. Bacterial conjunctivitis; topical antibiotic eye drops
## Footnote
The presence of purulent discharge, especially with a history of close contact with an affected individual, suggests bacterial conjunctivitis. Topical antibiotic eye drops are the treatment of choice.
91
A 5-year-old boy is brought to the clinic by his mother, who reports that he has been experiencing unilateral foul-smelling nasal discharge and frequent nosebleeds for the past week. On examination, you notice a purulent discharge from his right nostril. What is the most likely diagnosis?
A. Acute sinusitis
B. Nasal foreign body
C. Allergic rhinitis
D. Adenoid hypertrophy
B. Nasal foreign body
## Footnote
Unilateral foul-smelling discharge and recurrent epistaxis in a child are highly suggestive of a nasal foreign body. Retrieval and removal of the foreign object is necessary to resolve the symptoms.
92
A 7-year-old child presents with sore throat, fever, and difficulty swallowing for three days. Examination reveals enlarged, erythematous tonsils with white exudates. The child also has tender cervical lymphadenopathy. What is the most appropriate initial step in management?
A. Immediate tonsillectomy
B. Oral antibiotic therapy
C. Throat culture and sensitivity testing
D. Supportive care with analgesics and hydration
C. Throat culture and sensitivity testing
## Footnote
Given the symptoms, a bacterial cause such as streptococcal pharyngitis is possible. A throat culture and sensitivity test is essential to confirm the diagnosis and guide appropriate antibiotic therapy.
93
An 8-year-old child presents with fever, proptosis, restricted eye movement, and eyelid swelling that has worsened over two days. The child has a history of recent sinusitis. What is the most appropriate management?
A. Oral antibiotics and close follow-up
B. Immediate IV antibiotics and hospital admission
C. Topical eye antibiotics
D. Nasal decongestants and cold compresses
B. Immediate IV antibiotics and hospital admission
## Footnote
The child’s symptoms suggest orbital cellulitis, a severe infection that requires immediate treatment with IV antibiotics and hospital admission to prevent complications such as vision loss or intracranial spread.
94
A child with a history of recurrent otitis media presents with postauricular pain, swelling, and erythema, along with protrusion of the auricle. Which of the following is the most appropriate management?
A. Oral analgesics and observation
B. Immediate IV antibiotics and surgical consultation
C. Topical antibiotics and warm compresses
D. Systemic decongestants and nasal corticosteroids
B. Immediate IV antibiotics and surgical consultation
## Footnote
The symptoms are indicative of mastoiditis, a complication of otitis media. This condition requires urgent treatment with IV antibiotics and possible surgical intervention to prevent further complications.
95
A 3-year-old child presents with fever, irritability, and refusal to eat or drink. Examination shows multiple small ulcers and vesicles on the gums and inside the cheeks. The most likely diagnosis is herpetic gingivostomatitis. What is the best management?
A. Topical anesthetic and oral acyclovir
B. Systemic antibiotics
C. Antifungal medication
D. Immediate surgical referral
A. Topical anesthetic and oral acyclovir
## Footnote
Herpetic gingivostomatitis, caused by HSV, presents with oral ulcers and systemic symptoms. Management includes supportive care with topical anesthetics for pain relief and oral acyclovir to reduce viral shedding and severity.
96
A 2-year-old child is brought in for a routine check-up, and the mother mentions a recent appearance of a white reflex in one of the child’s eyes, noticeable in photographs. What is the most appropriate next step?
A. Reassure and schedule a follow-up in six months
B. Refer to an ophthalmologist for immediate evaluation
C. Prescribe corrective glasses
D. Start topical steroid eye drops
B. Refer to an ophthalmologist for immediate evaluation
## Footnote
A white pupillary reflex, or leukocoria, can be a sign of retinoblastoma, a serious ocular malignancy in children. Immediate referral to an ophthalmologist is necessary for diagnosis and treatment planning.
97
A 4-year-old boy presents with a history of recurrent otitis media. His mother reports that he often turns up the volume on the television and speaks loudly. On examination, you notice a dull, retracted tympanic membrane with limited mobility. There is no fever, ear pain, or otorrhea. Which of the following is the most appropriate next step in management?
A. Start high-dose amoxicillin
B. Immediate tympanostomy tube placement
C. Obtain a pure tone audiometry
D. Prescribe nasal corticosteroids
C. Obtain a pure tone audiometry
## Footnote
This child shows signs of Otitis Media with Effusion (OME), characterized by fluid in the middle ear without signs of acute infection. The key management step is assessing hearing loss, best done through pure tone audiometry. This test helps determine the impact on the child's hearing and guides further intervention, possibly including watchful waiting or tympanostomy tubes if there is significant hearing loss or structural damage.
98
A 7-year-old girl presents with ear pain, especially when pulling the earlobe, and a recent history of swimming. On examination, you observe edema and erythema of the ear canal, with purulent discharge. The tympanic membrane is not well visualized due to the swelling. What is the most appropriate treatment?
A. Oral antibiotics
B. Topical antibiotic-steroid drops
C. Systemic antifungal therapy
D. Tympanostomy tube placement
B. Topical antibiotic-steroid drops
## Footnote
The patient has Acute Otitis Externa (AOE), often called "swimmer's ear," characterized by inflammation of the external auditory canal. The first line of treatment is topical antibiotic-steroid drops, which address the infection and inflammation. Oral antibiotics are reserved for severe cases or if there is spread beyond the ear canal.
99
A 5-year-old boy presents with bilateral itchy, red eyes, and eyelid swelling. His mother notes a stringy, white discharge and mentions that the child has a history of eczema and seasonal allergies. What is the most likely diagnosis?
A. Bacterial conjunctivitis
B. Viral conjunctivitis
C. Allergic conjunctivitis
D. Keratitis
C. Allergic conjunctivitis
## Footnote
The child’s symptoms of bilateral itchy, red eyes with stringy discharge, along with a history of atopic conditions, are indicative of allergic conjunctivitis. This condition often presents with more itching and watery to stringy discharge and is typically bilateral, distinguishing it from bacterial or viral causes, which are often more purulent and unilateral.
100
A 16-year-old patient presents with severe sore throat, fever, muffled voice, and unilateral tonsillar enlargement with deviation of the uvula to the opposite side. Which of the following is the most appropriate management?
A. Oral antibiotics and outpatient follow-up
B. Immediate needle aspiration or incision and drainage
C. Tonsillectomy
D. Corticosteroid therapy
B. Immediate needle aspiration or incision and drainage
## Footnote
The patient shows signs of a peritonsillar abscess, which requires prompt drainage (either by needle aspiration or incision and drainage) to prevent complications. Oral antibiotics are necessary but not sufficient as initial management. Tonsillectomy may be considered later for recurrent cases.
101
A 3-year-old child is brought in for a routine check-up. On examination, you notice intermittent crossing of the eyes, which the mother says has been occurring for several months. What is the most appropriate next step in management?
A. Reassurance and observation
B. Immediate surgical referral
C. Prescribe corrective glasses
D. Refer to an ophthalmologist for further evaluation
D. Refer to an ophthalmologist for further evaluation
## Footnote
Strabismus, or misalignment of the eyes, should be evaluated by an ophthalmologist to determine the underlying cause and appropriate treatment, which may include glasses, patching, exercises, or surgery. Early intervention is crucial to prevent amblyopia ("lazy eye") and ensure proper visual development.
102
A 12-year-old obese boy presents with a limp and pain in his left hip, which he says has been worsening over the past few months. He mentions the pain sometimes radiates to the anterior thigh and knee. On physical examination, internal rotation of the left hip is limited and painful.
A. Legg-Calvé-Perthes disease
B. Juvenile idiopathic arthritis
C. Osteomyelitis
D. Slipped capital femoral epiphysis
D. Slipped capital femoral epiphysis
## Footnote
SCFE typically presents in overweight adolescents with hip pain, referred knee pain, and limited hip movement, especially internal rotation. The chronic nature and specific symptoms guide the diagnosis towards SCFE.
103
A 5-year-old child presents with honey-colored crusting lesions on the face and extremities. The mother reports that the lesions started as small vesicles which ruptured and developed into the current appearance. The child attends preschool and has had a recent history of upper respiratory tract infection.
A. Cellulitis
B. Herpes simplex virus infection
C. Varicella infection
D. Impetigo
D. Impetigo
## Footnote
Impetigo is characterized by honey-colored crusting lesions, often preceded by vesicles. It is common in children, especially those in close contact settings like preschool, and can be secondary to skin trauma or respiratory tract infections.
104
A 5-week-old male infant presents with projectile non-bilious vomiting after feeding, hunger, and subsequent weight loss. On examination, an olive-sized mass is palpable in the epigastric region, and peristaltic waves are visible across the abdomen.
A. Gastroesophageal reflux disease
B. Intussusception
C. Pyloric stenosis
D. Acute gastroenteritis
C. Pyloric stenosis
## Footnote
The classic presentation of projectile non-bilious vomiting, palpable olive-sized mass in the epigastric area, and visible peristalsis in a young infant suggests pyloric stenosis.
105
A 3-year-old unvaccinated child presents with fever, cough, conjunctivitis, coryza, and a maculopapular rash that started on the face and spread downwards. Koplik spots are noted on oral examination.
A. Rubella
B. Roseola
C. Measles
D. Scarlet fever
C. Measles
## Footnote
The presence of fever, cough, conjunctivitis, coryza, and a descending maculopapular rash, along with Koplik spots, are hallmark features of measles.
106
A 4-year-old child presents with episodes of cyanosis, especially during feeding or crying. The mother reports that the child often squats after running. On examination, a systolic murmur is heard at the left upper sternal border.
A. Ventricular septal defect
B. Atrial septal defect
C. Tetralogy of Fallot
D. Coarctation of the aorta
C. Tetralogy of Fallot
## Footnote
The "tet spells" (episodes of cyanosis) and squatting behavior after exertion, along with a characteristic murmur, point towards Tetralogy of Fallot, a congenital heart defect.
107
A 2-year-old child suddenly begins choking and coughing during playtime. The parent reports that the child was playing with small toys. On examination, the child has decreased breath sounds on the right side and is wheezing.
A. Asthma
B. Bronchiolitis
C. Pneumonia
D. Foreign body aspiration
D. Foreign body aspiration
## Footnote
Sudden onset of respiratory distress while playing with small objects, combined with unilateral decreased breath sounds and wheezing, suggests foreign body aspiration.
