SILBERT-FLAGG Questions

Question 1

Management of an infant with suspected heart disease and reported cyanotic spell should include:

Prompt referral to cardiologist

And apnea monitor

Instructed the parent to keep a diary of these episodes

Continuous administration of oxygen

Answer 1

Referral to cardiology

Question 2

A common cause of congestive heart failure in the first year life
Pulmonary stenosis

Ventricular septal defect

Rheumatic fever

Complete heart block

Answer 2

Ventricular septal defect is the most common in children can lead to increase pulmonary bloodflow and overtime can cause congestive heart failure if not medically or surgically managed.
Pulmonary stenosis can cause right heart failure from decrease pulmonary bloodflow.

Question 3

The least likely physical findings in a two month old with congestive heart failure?
Tachypnea, tachycardia, Hepatomegaly or pedal edema

Answer 3

Tachypnea and tachycardia & hepatomeagly are early signs of congestion

Peripheral Edema is rare and children; children may develop edema but there must be a 10 % increase in weight and the Edema is usually initially noted in the eyelids

Question 4

Chest pain and young children is usually_____

Answer 4

Non-cardiac in origin

Question 5

The mother of a four month old infant reports that he turned blue and seem to have fast labored breathing after vigorous crying soon after awakening. He settled down in his color and breathing seem to improve. On physical examination, the mucus membranes of the lips and mouth appear mildly cyanotic. A systolic murmur is heard best at the upper and lower left sternal border. Vital signs are normal with normal peripheral pulses. There is no hepatomegaly. He likely diagnosis is:

Congestive heart failure, apnea, cortication of the aorta, TOF

Answer 5

This is a cyanotic spell related to TOF

Question 6

Which statement is true regarding innocent murmurs?

The murmur is often Holosystolic
Prompt referral to a cardiologist indicated
Precordial thrill is present
The murmur is low in intensity grade 1 to 3

Answer 6

The murmur is low in intensity and grading do not require urgent referral to a cardiologist normally 1 to 3

Question 7

When should anabiotic‘s for bacterial endocarditis prophylaxis for children be given? (dental procedures, surgical repair)

Answer 7

Any child with a residual defect at a repair site

Question 8

Most common cause of myocarditis in North America is:

Answer 8

Viral infection
Enterovirus, adenovirus, parvovirus B19

Diphtheria is common in other countries without immunizations

Drug and toxic reactions can cause Carditis but rare

Question 9

And a healthy eight month old with diarrhea but no dehydration, what would be the most appropriate advice to give the parents?
Encourage strength formula for 12 hours
Give oral rehydration solution for 12 hours
Give only fluids until stools return to normal
Get bananas and cereal as tolerated

Answer 9

Starvation depresses the digestive system and prolongs diarrhea ORT is only given if dehydration is present

Question 10

When evaluating a child with abdominal pain what symptom would lead to a likely organic etiology

Night awakening
Pallor
Sweating
Suprapubic pain

Answer 10

Night awakening with abd pain usually does not occur with functional disorders

Question 11

What is the following appropriate regimen for pinworm medication

Daily x7 days repeat as needed
TID for 10 days repeat as needed
B.i.d. for three days repeat in two weeks
One dose one time repeat in two weeks

Answer 11

Albendazole 400 mg orally as a single dose repeat in two weeks

Question 12

A two month old johns frequent vomiting has Miss Doyle convinced that something is seriously wrong. Which of the following is my suggestive of GER?

He’s gained 5 ounces this month
He had a slight weeds today
He is hungry after vomiting
He drinks 7 to 8 ounces every 3 to 4 hours

Answer 12

John has been overfed which were predispose as an infant to GER
A more appropriate intake for a two month old is 4 to 5 ounces every 3 to 4 hours

Question 13

You see Jack a 20-month-old toddler with normal growth and development. For diarrhea. His mother tells you that he is passing up to three loose stools a day and that he drinks 20 ounces of apple juice a day what is the most likely diagnosis?

Crohn’s disease
Giardia Lamblia
Celiac disease
Non-specific toddler diarrhea

Answer 13

Toddler diarrhea is caused by carbohydrate mouth certain rules all the juices removed from the diet. Crohn’s disease is not common in children less than two years. Celiac disease may cause failure to thrive. Giardia causes intermittent diarrhea

Question 14

Baby Sally has 7% dehydration what would you expect to see on her examination?
Normal Refill
normal Fontanel
cool/mottled  skin
Dry mucous membranes

Answer 14

Dry mucous membranes, increase heart rate, capillary refill is prolonged

Question 15

In evaluating Billy a child with bloody diarrhea which of the following would not be an appropriate first action? 
Check the growth chart
Hemoccult test for stools
Stool culture
Upper G.I.

Answer 15

An upper G.I. would not be appropriate it looks like anatomy abnormalities. And a child with bloody diarrhea still cultures should be obtained to look for an infectious agent. Hemoccult can be done to prove the presence of blood. Sub optimal growth may point to an inflammatory bowel disease

Question 16

Lillys family eats at fast food restaurants 4-5 times each week. If you suspect the diarrhea is infectious in nature what is likely the causative organism?
Adenovirus
E. coli
S.aureus
Giardia lambila

Answer 16

E. coli is found in undercooked ground beef and leafy greens causing bloody diarrhea

S.aureus Causes vomiting and diarrhea but no bleeding.
Giardia is generally contracted from contaminated water.
Adenovirus is found on the hard surfaces and usually affects children less than three years in daycare

Question 17

Which of the following conditions would most likely occur in a four-year-old boy?

Pyloric stenosis
Recurrent abdominal pain
Intussusception
Giardia infection

Answer 17

Giardia in children 1 to 9 years of age. Pyloric stenosis affects infants in the first few months of life three weeks to four months. Intussusception mostly in the first two years of life. Functional abdominal pain is uncommon in children younger than four mostly but hers between ages 8 and 15.

Question 18

Which of the following may occur with suspected appendicitis

Pain not relieved with ambulation
Young children appear very ill in the early phase
Fever of 102°F
Leukopenia with left shift

Answer 18

Children with appendicitis have difficulty ambulating. Young children may NOT APPEAR very ill in the early phases. Fever is absent or low. There may be leukocytosis with left shift

Question 19

Which of the following serological findings indicates chronic HBV infection.

HBsAG negative 6 months
Anti HBc Positive and HBsAG positive
IGM anti-HBC positive
Anti-HBs positive

Answer 19

HBsAG
Hepatitis B surface antigen is the earliest marker for acute infection and persistence for greater than six months indicates chronic infection. Total anti-HBc (total hepatitis B core antibody) appears in acute infection and persist for life. Positive IgM anti-HBC indicates acute infection. Positive anti-HPS indicates positive immune status after vaccination

Question 20

Children and child care facilities are at greatest risk for it being exposed to which of the following hepatitis infections
HAV, HBV, HCV, HDV

Answer 20

Hepatitis is the most common form of viral hepatitis and children it is transmitted by the fecal oral route but contaminated shellfish and water

Question 21

A two day old baby is in the hospital nursery and still has not passed meconium this is a red flag for what condition

Interception, HUS,Hirschsprung’s disease, pyloric stenosis

Answer 21

Hirschsprung’s disease

Question 22

A 10-year-old boy comes to your clinic for evaluation of a suspected urinary tract infection which of the following signs would lead you to include diagnosis other than a UTI in the differential?

Answer 22

Penile discharge

UTI signs include in recess, frequency, dysuria, urgency, fever, and pain. Discharge may indicate balanitis or a sexual transmitted disease

Question 23

Jay is a nine-year-old boy who has no significant health problems, but his mother is very concerned because he is wetting himself. As you begin your history and physical, you keep in mind that the most common type of enuresis in school-age children is?

Primary nocturnal enuresis
Occasional daytime enuresis
Secondary nocturnal enuresis
Primary diurnal enuresis

Answer 23

Primary diurnal enuresis

Question 24

Which of the following statements is not true with regard to primary nocturnal enuresis?

There’s often a positive family history of enuresis
It appears to be related to maturational delay
Some nighttime waiters stop wedding without any form of treatment
The incidence is higher in girls than boys

Answer 24

Primary nocturnal enuresis is seen in almost 3 times more boys then girls

Question 25

While examining a four month old boy, you are unable to palpate one of the testes. The next most appropriate step is to: Reassure the parents that this is a normal finding Refer the child to endocrinologist Re-examine the baby in two months Refer to a urologist

Answer 25

Reassure the parents of this is a normal finding Testes don’t decend until 6 months

Question 26

Which of the following is not true with regard to hypospadia’s? Meatus is formed along the dorsum of the penis It is one of the most common penile abnormalities Circumcision should be deferred A referral for an endocrine evaluation may be indicated

Answer 26

The meatus is formed ventrally along penis

Question 27

A 12 year old girl presents to clinic with symptoms of vaginitis, odor, dysuria, frequency, and discomfort. From further history in lab screening the girl is diagnosed with Canadian albicans vaginitis. Appropriate treatment would include: Avoid bubble bath Topical acyclovir Rocephin clotrimazole

Answer 27

Clotrimazole ,micanazole ,ticsnoxole For a yeast infection

Question 28

A label Adhesion extending from the posterior to the clitoris is noted during a routine assessment of a four-year-old girl. There is no history of difficulty voiding, dysuria, discomfort. The most appropriate initial management is to: Prescribed a topical application of estrogen cream Referred to a G.I. specialist Reassure the parents that no specific treatment is needed Recommend mechanical lysis using petroleum onitment

Answer 28

Reassuring the parents and no specific treatment is needed at this time most lambila Hwy shouls resolve spontaneously during hormonal changes like at puberty.

Question 29

``` Patients with acute nephrotic syndrome may present with all the following except? Edema Hypertension Dark amber colored urine History of weight loss ```

Answer 29

Patients with nephrotic syndrome can present with Periorbital Adema, hyper or hypotension, tachycardia, weight gain related to fluid overload!

Question 30

It is important to look for evidence of a preceding streptococcal infection ruling out acute nephritis. This is best done by: Throat culture Skin examination ESR ASO titer

Answer 30

ASO titer Anti-streptolysin O Elevate an 80% of patients with proceeding streptococcal infection, peek around 2 to 4 weeks after an episode

Question 31

An adolescent boy presents to the clinic with the painless mass in less side of his scrotum what is the most likely diagnosis? Testicular torsion, epididymitis, incarceration and hernia, hydrocele

Answer 31

Hydrocele, typically manifest as a painless scrotal swelling available size and an inguinal hernia

Question 32

Foul smelling vaginal discharge that it makes a fishy odor when combined with potassium hydroxide is most likely due to : GARDNERELLA vaginalis Candida albicans Chlamydia N. Gonorrhea

Answer 32

Bacterial vaginosis, often causes Gardnerella vaginosis, with a mail order us vaginal discharge, positive whiff/fishy, When the discharge is mixed with potassium hydroxide

Question 33

A 17 year-old sexually active girl with cankers in the general areas noted to have a positive venereal disease research laboratories (VDRL) test. The next step should be to: Treat with Rocephin Perform a specific troponemal antibody test Culture for C.trachomatis Discuss safer sex practices

Answer 33

Treatment is with benzathine penicillin G. If the VDRL test is positive a specific troponemal Tess such as FTAABS should be done to confirm diagnosis of syphilis

Question 34

Most common back to your car is a sexually transmitted infection is?

Answer 34

Chlamydia

Question 35

Which of the following is an absolute contraindication for use of combined hormonal contraception in Adolescent women History of thromboembolism Diabetes Smokes five cigarettes per day Sickle cell disease

Answer 35

Estrogen containing combined hormonal contraceptive increase a Patek production of intrinsic clotting factors and increase the relative risk for thromboembolic events in women with a history of DVT or pulmonary embolism.

Question 36

A 15-year-old girl who began menarche at 13 years of age, complains of monthly menstrual pain on the first day of her periods for one year. She has never been sexually active. Which of the following is not a characteristic of this condition? Increased production of uterine prostaglandins Pain usually starts with an hours of menstrual flow or may proceed flow by up to two days Crampy spasmodic pain in the lower abdominal area, which might radiate to inner thighs Anovulatory cycles

Answer 36

Primary dysmenorrhea usually begins within 1 to 3 years of menarche and is associated with establishment of ovulatory cycles not anovulatory

Question 37

Cara is a 16-year-old adolescent who has been sexually active with a male partner for six months. They have used condoms consistently. She is interested in a hormonal method as well, your advice include all the following except which one? Combine oral contraceptives prevent ovulation Transdermal contraceptive patches must be correctly applied in the site rotated. The vaginal contraceptive ring must be changed weekly Long acting progestins might cause weight gain

Answer 37

The vaginal contraceptive ring is worn for three weeks, removed, and then a new ring is inserted one week later

Question 38

Which of the following is true about LARC‘s (long acting reversible contraceptive)? Nexplanon is radiopaque Vaginal bleeding is predictable Mirena IUD can stay in place for three years Adolescence should avoid using IUDs

Answer 38

Nexplanon The radiopaque

Question 39

Is six month old baby girl diagnosed with her first UTI should be treated with an appropriate anti-microbial agent. Which additional intervention should be ordered for this child? A test of cure VCUG An ultrasound of the kidneys and bladder Prophylactic anabiotic‘s

Answer 39

Ultrasound; six recent studies do not support the use of anti-microbial prophylaxis, Vcug is not recommended routinely after the first UTI

Question 40

True or false radiology testing are rarely indicated with the first UTI infection

Answer 40

False | Initial UTI or one that is febrile should be followed up with an ultrasound

Question 41

What is the definitive diagnostic test for diagnosis in UTI

Answer 41

Urine culture

Question 42

Which is the most likely organism to cause a UTI in pediatric population? Staphylococcus SAPROPHYTICus, Klebsiella, chlamydia, E. coli

Answer 42

E. coli accounts for 80 to 90% of UTIs

Question 43

Suzanne a seven-year-old comes to you for a physical exam prior to participation in soccer. Her mother is concerned that the child still has accidents at night. what is your recommendation to her mother? Avoid a use of criticism or punishment, use a sticker/star chart, treat with medication, purchase and enuresis alarms

Answer 43

Suzanne has primary nocturnal enuresis Avoid use of criticism or punishment

Question 44

Incidence of cryptorchidism at 1 year of age is 1%. The best explanation for this is: A child can usually stand making the palpation of the testes easier Examination of the scrotum begins at this age Surgical repair can know be done in a neonatal period Spontaneous resolution offer occurs within the first six months

Answer 44

Spontaneous resolution often occurs in the first 3-6. months, really do they descend after 9 months

Question 45

When counseling a parent with her child diagnosed with hypospadia‘s the following may be a part of the management: Circumcision, radiography, consult with a pediatric urology, surgical correction it to years of age

Answer 45

Consult with a urologist four surgical intervention timing and outcomes

Question 46

On an uncircumcised male the foreskin is retracted and discolored. There’s swelling of the glans the most likely diagnosis is? Balanitis, UTI, phimosis, paraphimosis

Answer 46

Paraphimosis occurs when the narrow tip of the prepuce is withdrawn behind the glans and constricts the penile shaft. This leads to Adema of the distal penis preventing repositioning of over the glans.

Question 47

Meatal stenosis is seen following: | Orchiopexy, circumcision, epididymitis, hypospadias repair

Answer 47

Meatal stenosis of the nearing of the distal urethra Occurs after circumcision or for a variety of other reasons in an older male.

Question 48

A 14 year old male during a track meet falls to the ground during a pole vaulter and start screaming in pain. He complains of tense, searing pain in his right scrotum. He vomits twice. What is the diagnosis?? Orchitis, hydrocele, testicular torsion, acute epididymitis

Answer 48

Testicular torsion

Question 49

Lady with Asians are relatively common finding among infants and young girls. What’s your following statements about this condition is true? They are usually present at birth but may be missed on examination Most cases resolve without intervention Highest incident is from birth to three years Simple lysis of the adhesion is often recommended

Answer 49

Most cases resolve without intervention. are usually not present at birth because of mothers hormones. In the case for occasions are symptomatic or causing your logic issues estrogen cream is applied b.i.d. Resolved in two months

Question 50

What is the most common form of glomerulonephritis

Answer 50

Poststreptococcal These patients have Adema, hematuria, decreased urine output, dark urine related to poor kidney function

Question 51

Most patients with an uncomplicated UTI can be treated on an outpatient basis. The first anabiotic you would want to consider using is? Trimethoprim sulfamethizole Cephalexin Amoxicillin Amoxicillin- clavulanate

Answer 51

Bactrim is the first line drug of choice

Question 52

Cryptorchidism is more prevalent in: Term infants premature infants babies at one year of age toddlers

Answer 52

Premature

Question 53

The three-year-old boy is in the process of toilet training. The parents come to see you because when the child urinates all the urine goes on the floor. You suspect a certain diagnosis because It is a rare disorder and would indicate more serious problem Normally the urine stream is directed at the metal opening at the tip of a penis, and a straight path The child is circumcised Fusion of the urethral folds occurred

Answer 53

A downward stream of urine originating from the underside of the glans is always suspicious for hypospadias

Question 54

Which of the following is used in the management of a child with phimosis? Ice packs general stretching when bathing circumcision in cases of urinary obstruction good hygiene

Answer 54

Proper hygiene, gentle stretching of the foreskin, and circumcision in cases of urinary obstruction or the main management strategies

Question 55

You’re examining a toddler who is visiting from Mexico. The mother is very concerned about her child and is hoping that you can treat him. He learned that the mother has been taking her son to a healer in Mexico but his condition has not improved. The child is fatigued and irritable. He is constipated and does not have much appetite. His hemoglobin is 12.0 G/DL, and the lead level is 18 MCG/DL. What is your next step? Hospitalize the child Measure the blood levels in one month Order a blood transfusion Refer the child for possible chelation therapy

Answer 55

Measure the blood levels in one month The child’s lead level indicates a class IIB , 15-19; we should be treated by completing an environmental assessment to identify potential sources of lead exposure in monitoring blood levels at recommended intervals. This hemoglobin is normal for the child’s age so blood transfusion is not indicated. Chelation therapy is recommended for children with class VI lead levels greater than 45 MCG/DL. Hospitalization is recommended for class 5lead levels >70 MCG/DL.

Question 56

Basically management of all neonates with ABO incompatibility includes: Phototherapy monitoring of BiliRubin and hemoglobin Exchange transfusion Simple transfusion of PRBC‘s

Answer 56

Monitoring of Billi Rubin hemoglobin levels More severe hyperbilirubinemia or anemia present requires more management

Question 57

Which of the following is not associated with RH incompatibility? Mother’s is Rh negative, baby is Rh positive Mother’s is Rh positive, babies RH negative More severe and subsequent sensitized pregnancies Hemolysis may occur up to 6 weeks or more

Answer 57

Incompatibilities only occur if mother is Rh negative and baby is RH positive

Question 58

Clinical jaundice of the distal extremities will be noted at a BiliRubin level of: <5 5 10 >15 Mg/dL

Answer 58

Jaundice proceeds in a progressive fashion starting at the head down to the chest abdomen and I extremities when the Billy Rubin level which is >15 mg/dL

Question 59

Diagnostic findings inconsistent with B thalassemia would be Hemoglobin normal Reticulocytes increased Hgb > 3.6 Hypochromia, microcytosis

Answer 59

Hemoglobin is usually decreased in patients with B thalassemia

Question 60

Aspenic children are often increased risk for which of the following? Bacterial infections Viral infections Parasites Fungal infections

Answer 60

Bacterial, particularly those with encapsulated organisms can be life-threatening to asplenic children

Question 61

Expected hemoglobin range for sickle cell anemia is: 6. 5 to 9.5 G/dL 13. 5 to 16.5 G/DL 8. 5 to 12.5 G/DL 9. 5 to 13.5 G/DL

Answer 61

Higher hemoglobin‘s are associated with sickle cell c; 6.5 to 9.5 Those with sickle cell trait have normal hemoglobin

Question 62

Normal hemoglobin for a child

Answer 62

12/13 G/DL ——15/17 G/dL

Question 63

Prophylactic penicillin should be initiated in children with sickle cell anemia by: 3 years of age 12 Years of age 9 months of age 2 to 3 months of age

Answer 63

Penicillin prophylaxis is critical because of the risk of potential life-threatening infection with encapsulated bacteria should be given to sickle cell children at 2-3 months of age

Question 64

Which of the following blood levels is not considered lead poisoning? <5 10-14 >15 >70 ug/dL

Answer 64

<5

Question 65

Which of the following is not considered preventive management for iron deficiency anemia? Iron fortified cereal from 6 to 12 months of age If breast-feeding, supplemental iron drops or iron fortified cereal by 4 to 5 months of age Iron fortified formula until 6months of age No cows milk until 1 year of age

Answer 65

Iron fortified formula should be given until 12 months of age if not breast-feeding

Question 66

A newly circumcised if it is still bleeding an hour after the circumcision. Your differential diagnosis would include all except: Hemophilia Von Willebrand disease Sickle cell anemia WiScott Aldrich syndrome

Answer 66

Von Willebrand’s disease is a disorder where clotting is impaired and would cause bleeding Hemophilia is a bleeding disorder with the absence of the clotting factor VIII WiScott Aldrich syndrome X linked disorder caused by dysfunctional platelets, eczema, and abnormal B/T cell function—bleeding Sickle cell anemia does not usually cause a cute bleeding problems

Question 67

Which medication should be avoided with a child with ITP? Decongestants Acetaminophen Aspirin Sulfa drugs

Answer 67

Aspirin can cause bleeding problems

Question 68

You will see the results of a newborn screening and find out your TSH is done at day two is 82 mIU/L what is your best option? Have a child come to the clinic next week for a reevaluation Rescreen the child in one month Begin thyroid supplementation immediately Reassure the family that this is a normal finding

Answer 68

Congenital thyroid screening is included and every newborn screening done prior to discharge by seven day a life If the free T4 <6.5 and the TSH is >20 If it should be started immediately on thyroid replacement referred to endocrinology; delay can result in mental retardation

Question 69

You’re evaluating a 13-year-old girl for Graves’ disease. Which of the following signs would not support the diagnosis? Elevated TSH Exophthalmos Positive family history Enlarged thyroid

Answer 69

Elevated TSH; hyper thyroid has low TSH elevated T3 T4

Question 70

The routine screening of a newborn your practice indicates that a baby has congenital hypothyroidism and is in need of a referral to endocrinology. The treatment of choice for congenital or acquired hypothyroidism is: Potassium iodine Levothyroxine Radiation therapy methimazole

Answer 70

Levothyroxine

Question 71

A child in your clinic is being a valuated for short stature, findings include delayed bone age, delayed onset of puberty, stature that is normal for the child’s bone age. Mom reports father grew taller in college and wonders if this will happen with their son. The most likely cause of these findings is: Familial short stature Chromosomal abnormality Endocrine abnormality Constitutional delay of growth and puberty

Answer 71

Constitutional delay of growth in puberty, is characterized by bone age that is delayed for chronological age and normal growth velocity for bone age. Familial Short stature is slow growth during the first 2-3 years followed by low normal growth velocity

Question 72

Which chromosomal abnormality is associated with short stature in girls? Down syndrome Turner syndrome Klinefelter syndrome Prader Willi syndrome

Answer 72

Turner syndrome

Question 73

Newborn infant with birth length less than the 50th percentile in micropenis should be suspected of having

Answer 73

Growth hormone deficiency

Question 74

Most common cause of myocarditis viral or bacterial ?

Answer 74

Viral