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Old 06-09-2016
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Default Need help! Pediatric NBME 4 self assessment

I'm taking my peds shelf soon. Would really appreciate help on these questions!!!


1. An otherwise healthy 16yo girl is brought to the physician b/c of 6mo of increasing severe pain with menses. Her mother reports that during this time, her daughter has missed 2 days of school during each menstrual period because of severe pelvic cramps associated w/ vomiting. Menses occurs at regular 28day intervals and lasts 4-5 days. Her last menstrual period was 7 days ago. She currently takes acetaminophen, which provides minimal relief of her symptoms. She has had three lifetime sexual partners, and they use condoms inconsistently. PEx shows no abnormalities. Pelvic examination shows a ternder, normal sized uterus and no masses. Which of the following is the most appropriate next step in management?

a) Pregnancy Test
b) Pelvic US (incorrect)
c) Narcotic therapy
d) NSAIDS
e) SSRI


2. A 6yo girl is brought to the physician because of a scaly, pruritic rash on the intertriginous areas of her elvows and knees that worsens in the spring and the fall; it often appears in conjunction with episodes of respiratory distress and wheezing. Tx with which of the following is the most effective short term treatment of the rash?

a) Clotrimazole
b) Coal Tar (incorrect)
c) Griseofulvin
d) Lindane
e) Triamcinoline


3. A 6hr old newborn has had cyanosis of her arms and legs since birth. She was born at 38wk gestation following an uncomplicated pregnancy and c-section for breech presentation. She weighed 2090g at birth. She has been breast feeding well. She is alert and is not in acute distress. Her rectal temprature is 36.2C, puse is 112, RR 36, BP 80/45. Pulse ox 96%. Examination shows cyanosis of the upper and lower extremities but no circumoral cyanosis. Cardiopulmonary examination shows no abnormalities. Cap refill is mildly delayed. Which of the following is the most appropriate step in management?

a) Placement of the newborn under warming lights
b) Blood culture
c) Chest x-ray (incorrect)
d) echo
e) intubation and mechanical ventilation


4. A previously healthy 4yo boy is brought to the physician because of a 1wk hx of intermittent fever. During the past 3 days, he has had decreased activity and joint pain. Yesterday he developed a red rash on his chest. He attends daycare. He appears pale and is not in acute distress. His temperature is 38.4C, pulse 140, RR 24. Examination shows a petechial rash over the chest. The conjunctivae are pale. There is diffuse adenopathy in the cervical chain. A grade 2/6 systolic murmur is heart. The spleen is palpated 1cm below the left costal margin. There is no swelling or redness of the joints. Lab studies show a Hgb of 6.4g/dL, leukocyte count of 50,000/mm3, and platelet count of 10,000/mm3.

a) ALL
b) Anemia of Chronic Disease
c) Autoimmune hemolytic anemia
d) G6PD deficiency
e) HUS (incorrect)
f) Hereditary spherocytosis
g) Lead poisoning
h) Red blood cell aplasia
i) Sickle cell disease
j) thalassemia
k) uremia of chronic renal failure


5. A 4yo boy is hospitalized because of fever, shallow breathing, and unresponsiveness for 3hrs. His temprature is 40C, pulse 160, RR 60 and BP is 60/35. Examination shows purpura over the loewr extremities. He is intubated and mechanically ventilated. Blood cultures grow Neisseria meningitidis. Two days later, an x-ray of the chest shows bilateral patchy infiltrates. Which of the following is the most likely mechanism of these findings?

a) Cholinergic hyperactivity
b) enzymatic deficiency
c) Increased vascular permeability
d) Mucosal inflammation (incorrect)
e) Oxygen toxicity
f) Surfactant deficiency


6. A previously healthy 8yo boy brought to the emergency department of difficulty breathing 10mins after being stung by a bee. His temp is 36.5C, pulse 130, RR 28 and BP 65/50. Examination shows wheezing, audible stridor, and a generalized urticarial rash. Epi and methlprednisolone are administered. Administration of which of the following is the most appropriate next step?

a) Cromolyn sodium (incorrect)
b) Dopamine
c) Fluid
d) Lidocaine
e) NE
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  #2  
Old 06-22-2016
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Default

Quote:
Originally Posted by smile8888 View Post
I'm taking my peds shelf soon. Would really appreciate help on these questions!!!


1. An otherwise healthy 16yo girl is brought to the physician b/c of 6mo of increasing severe pain with menses. Her mother reports that during this time, her daughter has missed 2 days of school during each menstrual period because of severe pelvic cramps associated w/ vomiting. Menses occurs at regular 28day intervals and lasts 4-5 days. Her last menstrual period was 7 days ago. She currently takes acetaminophen, which provides minimal relief of her symptoms. She has had three lifetime sexual partners, and they use condoms inconsistently. PEx shows no abnormalities. Pelvic examination shows a ternder, normal sized uterus and no masses. Which of the following is the most appropriate next step in management?

a) Pregnancy Test - also incorrect
b) Pelvic US (incorrect)
c) Narcotic therapy
d) NSAIDS --likely the correct answer, primary dysmenorrhea, failed acetaminophen, according to Up to Date NSAIDs are first line
e) SSRI


2. A 6yo girl is brought to the physician because of a scaly, pruritic rash on the intertriginous areas of her elvows and knees that worsens in the spring and the fall; it often appears in conjunction with episodes of respiratory distress and wheezing. Tx with which of the following is the most effective short term treatment of the rash?

a) Clotrimazole
b) Coal Tar (incorrect)
c) Griseofulvin
d) Lindane
e) Triamcinoline - Correct answer


3. A 6hr old newborn has had cyanosis of her arms and legs since birth. She was born at 38wk gestation following an uncomplicated pregnancy and c-section for breech presentation. She weighed 2090g at birth. She has been breast feeding well. She is alert and is not in acute distress. Her rectal temprature is 36.2C, puse is 112, RR 36, BP 80/45. Pulse ox 96%. Examination shows cyanosis of the upper and lower extremities but no circumoral cyanosis. Cardiopulmonary examination shows no abnormalities. Cap refill is mildly delayed. Which of the following is the most appropriate step in management?

a) Placement of the newborn under warming lights
b) Blood culture
c) Chest x-ray (incorrect)
d) echo - also incorrect
e) intubation and mechanical ventilation

Not sure about this one...may be placement under warming lights.


4. A previously healthy 4yo boy is brought to the physician because of a 1wk hx of intermittent fever. During the past 3 days, he has had decreased activity and joint pain. Yesterday he developed a red rash on his chest. He attends daycare. He appears pale and is not in acute distress. His temperature is 38.4C, pulse 140, RR 24. Examination shows a petechial rash over the chest. The conjunctivae are pale. There is diffuse adenopathy in the cervical chain. A grade 2/6 systolic murmur is heart. The spleen is palpated 1cm below the left costal margin. There is no swelling or redness of the joints. Lab studies show a Hgb of 6.4g/dL, leukocyte count of 50,000/mm3, and platelet count of 10,000/mm3.

a) ALL -- probably correct, thrombocytopenia + anemia + lymphocytosis is most indicative of malignant process
b) Anemia of Chronic Disease
c) Autoimmune hemolytic anemia
d) G6PD deficiency
e) HUS (incorrect)
f) Hereditary spherocytosis
g) Lead poisoning
h) Red blood cell aplasia
i) Sickle cell disease - Also incorrect
j) thalassemia
k) uremia of chronic renal failure




5. A 4yo boy is hospitalized because of fever, shallow breathing, and unresponsiveness for 3hrs. His temprature is 40C, pulse 160, RR 60 and BP is 60/35. Examination shows purpura over the loewr extremities. He is intubated and mechanically ventilated. Blood cultures grow Neisseria meningitidis. Two days later, an x-ray of the chest shows bilateral patchy infiltrates. Which of the following is the most likely mechanism of these findings?

a) Cholinergic hyperactivity
b) enzymatic deficiency
c) Increased vascular permeability - correct
d) Mucosal inflammation (incorrect)
e) Oxygen toxicity
f) Surfactant deficiency


6. A previously healthy 8yo boy brought to the emergency department of difficulty breathing 10mins after being stung by a bee. His temp is 36.5C, pulse 130, RR 28 and BP 65/50. Examination shows wheezing, audible stridor, and a generalized urticarial rash. Epi and methlprednisolone are administered. Administration of which of the following is the most appropriate next step?

a) Cromolyn sodium (incorrect)
b) Dopamine
c) Fluid - correct
d) Lidocaine
e) NE
Hope this helped!!
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