Nelson Chapter 41-60

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Which statement is false?

A. Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection

B. Zinc is important in immune function and linear growth

C. Kwashiorkor and marasmus are rare in developed countries

D. The Western diet is associated with increased noncommunicable disease

Components of energy expenditure in children include:

A. Thermal effect of food

B. Basal metabolic rate

C. Energy for physical activity

D. Energy to support growth

E. All of the above

You diagnose a breast-fed 6 wk old infant with cow's milk protein–induced enterocolitis. Which of the following is an appropriate feeding strategy?

A. Change to feedings with a soy-based formula

B. Change to feedings with an extensively hydrolyzed formula

C. Advise milk avoidance in the mother and continuation of breastfeeding

D. A, B, or C

E. B or C

The following statements reflect the AAP's recommendations regarding introduction of complementary foods to infants EXCEPT:

A. Complementary foods may be introduced beginning at 4 mo of age

B. Always introduce rice cereal first

C. Introduce one nutrient ingredient at a time, waiting 3-5 days between new foods

D. Avoid adding salt or sugar to foods

E. Do not offer fruit juice in the 1st 6 mo of life

Which statement about toddler nutrition is NOT true?

A. Birthweight triples in the 1st year of life and quadruples by age 2

B. Juice should be limited to 10-14 oz/day

C. Popcorn, nuts, and grapes are choking hazards

D. Toddlers often favor a certain food only to reject it later

E. Toddlers need to eat 5-7 times per day

The breast-fed infant of a mother who is a strict vegan may experience deficiency of which of the following vitamins if the mother is not receiving supplements of the vitamin?

Which vitamin deficiency does NOT match the clinical manifestation?

A. Iodine—dry skin

B. Iron—anemia

C. Vitamin A—increased child mortality

D. Folate—anemia

E. Zinc—decreased immune function

All of the following are clinical manifestations of kwashiorkor EXCEPT:

Which of the following statements regarding refeeding a child with severe malnutrition is NOT true?

A. Thiamine should be administered before starting feedings

B. Initial rehydration ideally occurs via the oral route

C. Initial feedings should be given every 2 hr, providing 80-100 kcal/kg/day

D. Iron supplementation should be given in the 1st week of refeeding

E. Empirical antibiotics are recommended before refeeding

Clinical features often seen in overweight pediatric patients can include all of the following EXCEPT:

The groups with the highest risk of obesity in the USA are:

The risk of developing obesity in adulthood correlates negatively with:

Which of the following clinical scenarios increases the risk of vitamin A deficiency?

A. Vegetarian diet

B. Chronic intestinal disorders

C. Zinc deficiency

D. B and C

E. All of the above

Which statement about vitamin A toxicity is NOT true?

A. Excess vitamin A in utero can cause congenital malformations

B. It may present as pseudotumor cerebri

C. An infant with a preference for carrots and butternut squash may develop toxicity

D. It may cause fissures at the corners of the mouth, pruritus, and alopecia

E. Symptoms subside rapidly after withdrawing the source of the vitamin

Which of the following patients is at risk for thiamine deficiency?

A. Exclusively breast-fed infant, mother is well-nourished

B. 2 yr old immigrant fed a vegetarian diet

C. 3 yr old refugee whose dietary staple is polished rice

D. 4 yr old American boy who eats only breakfast cereal

E. All of the above

Which statement about vitamin deficiencies is NOT true?

A. A patient with macrocytic anemia should undergo a trial of folate replacement therapy

B. Vegans have a high risk of vitamin B₁₂ deficiency

C. A patient with thiamine deficiency should be treated with supplementation of all the B vitamins

D. Pyridoxine (B₆) deficiency should be considered in an infant with recurrent seizures

E. Pellagra may occur as a complication of anorexia nervosa

A toddler who drinks pasteurized milk and avoids fruit is at risk for what disorder?

A. Rickets

B. Scurvy

C. Beriberi

D. Pellagra

E. Peripheral neuropathy and anemia

Rickets can be caused by:

A. Nutritional vitamin D deficiency

B. Overuse of aluminum antacids

C. Prematurity

D. Distal renal tubular acidosis

E. All of the above

Physical features of vitamin D–deficiency rickets include all of the following EXCEPT:

A. Bitot spots

B. Craniotabes

C. Enlargement of the costochondral junctions

D. Thickening of the ankles and wrists

E. Large anterior fontanel

F. Bowlegs

Which statement about vitamin E is false?

A. The most common form of vitamin E is tocopherol

B. Premature infants given formula with a high content of polyunsaturated fatty acids and iron supplementation are protected from deficiency

C. Cholestatic liver disease increases the risk of deficiency

D. Premature infants with vitamin E deficiency develop hemolysis, thrombocytosis, and edema

E. Prolonged vitamin E deficiency causes a severe, progressive neurologic disorder

Vitamin K deficiency should be considered when a prolonged prothrombin time and bleeding occur in which clinical scenario:

A. A 7 day old breast-fed infant whose mother refused vitamin K at birth

B. A 6 wk old breast-fed infant who received an oral dose of vitamin K at birth

C. Adolescent with chronic pancreatitis

D. Adolescent with celiac disease

E. All of the above

Which trace element is incorrectly paired with the manifestation of clinical deficiency?

A. Iodine—neutropenia

B. Selenium—cardiomyopathy

C. Iron—anemia

D. Zinc—impaired immunity

E. Fluoride—dental caries

In diabetic ketoacidosis, a patient may have normal serum potassium levels despite significant depletion of total body potassium. This is because:

A. Intracellular fluid (ICF) volume is much larger than extracellular fluid (ECF) volume

B. Potassium is concentrated in the intracellular fluid by the normal action of the Na⁺, K⁺- ATPase pump

C. Serum potassium measurement is falsely elevated by the presence of ketones

D. Both A and B

E. None of the above

Which statement is false?

A. Normal plasma osmolality is 285-295 mOsm/kg

B. Osmolality calculations utilize serum values of sodium, glucose, and potassium

C. If calculation of osmolality and measured osmolality differ by more than 10 mOsm/kg, unmeasured osmoles are present

D. Unmeasured osmoles include ethanol, mannitol, and lipids

E. None of the above

What statement describes a physiologic response to dehydration?

A. Different osmoreceptors in the hypothalamus govern ADH secretion and thirst

B. An increase in serum osmolality causes osmoreceptors in the hypothalamus to stimulate thirst

C. An increase in serum osmolality causes osmoreceptors in the hypothalamus to secrete ADH

D. A decrease in intravascular volume stimulates ADH secretion regardless of serum osmolality

E. All of the above

Hypernatremia may be induced by all of the following EXCEPT:

A. Hyperglycemia

B. Polydipsia

C. Insufficient breast-feeding

D. Gastroenteritis

E. Nephrogenic diabetes insipidus

Moderate to severe hypernatremic dehydration is best corrected by:

A. Sodium restriction and infusion of D₁₀W

B. Repletion of intravascular volume with normal saline, followed by D₅ ½ normal saline at 1. 25 times maintenance rate

C. Repletion of intravascular volume with D₅ ½ normal saline, followed by same fluid at 1. 25 times maintenance rate

D. Repletion of intravascular volume with lactated Ringer solution, followed by same fluid at 1. 5 times maintenance rate

E. Repletion of intravascular volume with normal saline, followed by D₅ ½ normal saline at 2 times maintenance rate

The highest risk of central pontine myelinosis (CPM) occurs in which scenario?

A. A teenager with nausea, fatigue, and hyperpigmentation with serum Na level of 120 mEq/L who is given 3% NaCl IV

B. A toddler with severe gastroenteritis with serum Na level of 120 mEq/L given 60 mL/kg normal saline IV

C. A newborn infant who was given improperly mixed formula over the past week with serum Na level of 125 mEq/L presenting with clinical seizure; given 3% NaCl

D. Adolescent who completed a marathon after stopping at each water station who collapsed at finish with serum Na level of 125 mEq/L; given 3% NaCl

A well-grown 6 mo old presents with a tonic-clonic seizure lasting 30 min. The child is found to be hypothermic and remains lethargic. The diet history reveals that the mother is a participant in the WIC program. Because it is the end of the month, she has begun to dilute the remaining formula with water because there is not enough to last until she receives her next allotment of formula next week. The most likely diagnosis is:

A. Hypocalcemia

B. Hyponatremia

C. Hypoglycemia

D. Hypernatremia

E. Hypokalemia

Potential causes of hyperkalemia include all of the following EXCEPT:

Manifestations of hyperkalemia include all of the following EXCEPT:

Hyperkalemia may be associated with all of the following EXCEPT:

A. Succinylcholine use

B. Burns

C. Trauma

D. Chemotherapy

E. Metabolic alkalosis

F. Digitalis toxicity

G. Uremia

The best method to reduce the potassium level during hyperkalemia, by reducing the body burden of potassium, is:

A. Sodium bicarbonate infusion

B. Glucose and insulin infusion

C. Calcium infusion

D. Albuterol aerosol

E. Kayexalate enema

Clinical manifestations of hypokalemia include all of the following EXCEPT:

A. ECG changes

B. Paralysis

C. Urinary retention

D. Constipation

E. Muscle cramps

F. Blurry vision

Which statement regarding hypermagnesemia is NOT true?

A. Hypermagnesemia may cause hypertension and hyporeflexia

B. Pediatric hypermagnesemia most commonly occurs in neonates born to mothers with preeclampsia or eclampsia requiring treatment with IV magnesium

C. Excessive laxative use may cause hypermagnesemia

D. Hypermagnesemia may be treated with IV fluids and loop diuretics

E. Infants with hypermagnesemia have a poor suck

Possible consequences of hypophosphatemia include all of the following EXCEPT:

A. Hypocalcemia

B. Hemolysis

C. Rhabdomyolysis

D. Paresthesias

E. Seizures

An increased anion gap occurs in all of the following EXCEPT:

A. Diabetic ketoacidosis

B. Renal tubular acidosis

C. Septic shock

D. Methylmalonicacidemia

E. Ethylene glycol poisoning

A normal anion gap acidosis is most likely to be due to:

A. Diabetes mellitus

B. Diarrhea

C. Nephrotic syndrome

D. Uremia

E. Shock

In which clinical setting is sodium bicarbonate therapy NOT indicated?

A. 6 yr old with diabetic ketoacidosis and pH of 7. 2

B. 17 yr old with salicylate poisoning and metabolic acidosis

C. 2 yr old with methanol poisoning causing acidosis

D. 10 yr old with propionic acidemia and acute acidosis due to gastroenteritis

E. 4 yr old with acute renal failure and metabolic acidosis

From the following list, choose the route(s) by which insensible water loss may occur: 1. Sweat, 2. Fecal loss, 3. Evaporative loss from skin, 4. Respiratory water loss, 5. Obligate water for urinary solute excretion

Which of the following is a goal of maintenance fluids?

A. Diminish protein degradation

B. Prevent dehydration

C. Prevent hunger

D. Prevent electrolyte derangements

E. Prevent ketoacidosis

Which patient has an elevated risk of hyponatremia with standard maintenance fluid therapy (D₅ ½ NS if > 10 kg, D₅ ¼ NS if < 10 kg)?

A. 6 mo old NPO for elective hernia repair

B. 4 month old with bronchiolitis and poor oral intake

C. 13 yr old status post motor vehicle accident with multiple fractures, requiring treatment with narcotics and antiemetics

D. 8 yr old with nephrotic syndrome

E. A and D

F. B, C, and D

In which patient is oral rehydration NOT indicated?

A. 2 yr old with moderate hypernatremic dehydration

B. 6 mo old with mild hyponatremic dehydration

C. 4 mo old with severe dehydration and normal serum sodium

D. 3 yr old with moderate dehydration and normal serum sodium

E. A and C

A 10 mo old infant presents with vomiting and diarrhea, tachycardia, normal blood pressure, dry mucous membranes, a capillary refill time of 2 sec, deep respirations, and irritability. The percent dehydration for this patient is:

A. < 3%

B. 3-5%

C. 6-9%

D. 10-12%

E. > 12%

A 4 yr old with severe vomiting due to suspected partial small bowel obstruction is moderately dehydrated and requires IV hydration. The appropriate bolus fluid is:

A. Lactated Ringer solution

B. Normal saline

C. D₅ ½ normal saline

D. 5% albumin

E. A or B

Serious complications hypernatremic dehydration, including its treatment, include:

A. Cerebral thrombosis

B. Cerebral edema

C. Cerebral hemorrhage

D. A and B

E. All of the above

Which of the following statements about pediatric pharmacokinetics and pharmacogenetics is true?

A. The concept of personalized medicine has value in pediatrics

B. Differing stages of development may explain the variability of phenotype in children with a particular genotype for drug biotransformation

C. Pharmacokinetics describes what the body does to a drug and includes absorption, distribution, metabolism, and excretion

D. Selection of an appropriate drug dosage for a child requires a knowledge of basic pharmacokinetic properties of the drug as well as knowledge of knowledge of age-related organ function

E. All of the above

Liquid formulations of drugs are often preferred for peroral administration in pediatrics. Which of the following is generally NOT a limitation of liquid medications?

A. Difficult to titrate dose

B. Palatability

C. Dosing error related to poor suspension

D. Contamination

E. Drug stability and/or need for refrigeration

Which statement about pediatric poisoning is NOT true?

A. Most poisonings among young children involve a single substance and are unintentional

B. Poison prevention should be discussed at all well child visits beginning at 6 months

C. Pediatric poisonings occur most frequently in the toddler and adolescent age ranges

D. The toddler age group experiences the majority of poisoning deaths

E. Poison control centers are available via phone, 24-7, toll free

Quantitative levels of certain medications are helpful in the management of acute poisonings. For which of the following medications is this NOT true?

A. Salicylates

B. Acetaminophen

C. Iron

D. Carbon monoxide

E. Marijuana

The 4 principles of management of poisonings are what?

A. Decontamination, enhanced elimination, antidote, supportive care

B. Degradation, hydration, oxygenation, antidote

C. Ipecac, clinical monitoring, dialysis, reversal

D. Alkalinization, oxygenation, elimination, hydration

A 15 yr old boy is admitted to your care after the intentional ingestion of 2 g of his own amitriptyline in a suicide gesture. He received activated charcoal for gastrointestinal decontamination. The patient is placed in the ICU for monitoring and remains stable. He is receiving only 0. 45% normal saline. You observe a change in his cardiac monitor display with a widening of his QRS complex to 0. 12 second and occasional ectopic beats. The most appropriate next step in management is to:

A. Ignore these changes because they are still within normal limits

B. Add sodium bicarbonate to his IV fluids to try to raise his serum pH above 7. 4

C. Repeat a dose of activated charcoal

D. Begin a lidocaine infusion at an appropriate dose

E. Order a chest radiograph

A 2 yr old boy arrives in the emergency department after a seizure. On presentation his vital signs are: temperature 40. 2°C, heart rate 200 beats/min, respiratory rate 52 breaths/min. His laboratory values are: arterial pH 7. 2, serum bicarbonate 6 mmol/L, arterial PCO₂18 mm Hg, sodium 148 mmol/L, potassium 3. 1 mmol/L, WBC count 10, 200/mm³. On the basis of the history obtained and the presentation, you suspect that an accidental ingestion has occurred. The most likely toxin is:

A. A tricyclic antidepressant

B. Acetaminophen

C. Cocaine

D. An organophosphate insecticide

E. A salicylate

A 2 yr old boy is noted to be drinking from a container filled with kerosene. He immediately coughs, becomes tachypneic, and is brought to the hospital. The best approach to his treatment is to:

A. Induce emesis

B. Perform nasogastric tube lavage

C. Instill mineral oil

D. Administer steroids

E. None of the above

A 2 yr old child is found playing with a can of crystalline drain cleaner. The child's mother telephones you for help. There are several crystals in the mouth, which you have the mother wash out. The next step in treatment should be to:

A. Have the mother administer lemon juice or orange juice to neutralize the alkaline crystals and come to your office

B. Have the mother administer water or milk and call you back in 2 hr

C. Have the mother administer water or milk and bring the child in for esophagoscopy

D. Simply observe the child because the crystals are so bitter that the child was trying to spit them out when the mother called, and therefore no problems should occur

E. Administer ipecac at home and bring the child in to see you

A 16 yr old, 165-lb patient reports consuming 20-40 325-mg capsules containing acetaminophen 1 hr ago. The most appropriate approach to treatment is to:

A. Measure the plasma level and determine potential toxicity from the level on the nomogram

B. Wait until 4 hr after ingestion to measure the plasma level and do nothing else

C. Administer activated charcoal immediately and measure the plasma level of acetaminophen 4 hr after ingestion

D. Send the patient home because an ingestion of this magnitude is not toxic

E. Administer N-acetylcysteine at a dose of 140 mg/kg

A 2 yr old child presents in the emergency department after the reported ingestion of a mouthful of lamp oil. The child reportedly vomited once at home. The child has a heart rate of 160 beats/min, a respiratory rate of 48 breaths/min, and a temperature of 37. 2°C. A chest film is read as normal. The most appropriate therapy for this child is to:

A. Administer syrup of ipecac

B. Administer activated charcoal

C. Remove any ingested lamp oil by gastric lavage

D. Admit the child for observation and supportive care

E. Discharge the child home with a follow-up office visit in the morning

A teenage girl presents in the emergency department with the story that she got upset with her boyfriend and swallowed a " handful of aspirin" about 4 hr previously. One hour afterward, after she began vomiting, she confessed to her mother what she had done. On examination the patient has normal vital signs and is asymptomatic except for the complaint of nausea. A serum salicylate level is ordered, but the laboratory reports no salicylates in her blood. The most appropriate next step in management is to:

A. Discharge the patient home

B. Order an acetaminophen level

C. Request a psychiatric consultation

D. Send a second sample for salicylate determination

E. Order an abdominal radiograph to look for pills in the stomach

Which of the following statements about integrative medicine is NOT true?

A. Dietary supplements undergo the same evidence-based evaluation as medicines by the FDA

B. Massage is generally safe

C. Acupuncture may be effective for chronic pain

D. Less than half of patients using dietary supplements report them to their physician

E. Probiotics may cause sepsis in a critically ill premature infant

Which clinical scenario is of most concern?

A. A 3 yr old has a fever of 104°F, irritability, and mottling of the hands. After antipyretic administration, she is talkative and playful.

B. A 6 mo old was just given acetaminophen for fever. In your office, he is afebrile and somnolent. He has not eaten in 8 hr.

C. A 6 yr old has fever to 101°F, vomiting, and diarrhea. After a dose of ondansetron he tolerates a popsicle.

D. A teenager has sore throat, cough, and fever to 101°F. She complains of feeling tired and has not been able to participate in cheerleading.

E. A 9 mo old has a maculopapular rash and fever. He smiles at the examiner and readily accepts a bottle to drink.

Which diagnosis should be strongly considered in an infant with lethargy and poor feeding?

A. Sepsis

B. Nonaccidental trauma

C. Inborn error of metabolism

D. Meningitis

E. All of the above

Risk factors for neonatal sepsis include all of the following EXCEPT:

A. Maternal GBS colonization

B. Prematurity

C. Peripartum maternal fever

D. Prolonged rupture of membranes

E. Mother received treatment for UTI during pregnancy

A 2 yr old partially immunized child has high fever, poor oral intake, and stridor. Differential diagnosis should include:

A. Bacterial tracheitis

B. Viral croup

C. Group A streptococcal pharyngitis

D. Retropharyngeal abscess

E. Epiglottitis

A 7 day old term infant presents to your office with a small amount of blood mixed with stool in the diaper. The abdomen seems tender on examination. Vital signs are normal for age. The next appropriate step in evaluation is which of the following?

A. Stool culture

B. Abdominal CT scan

C. Abdominal radiograph (KUB)

D. Change the formula and see the infant again in 1 wk

E. Air-contrast enema

Physical examination of an infant should ideally proceed in what order?

A. General appearance, auscultation of chest, examination of abdomen and GU tract and then head, including ears and throat

B. General appearance, examination of head, including ears and throat, ausculation of chest, then examination of abdomen and GU tract

C. Examination of head, including ears and throat, ausculation of chest, examination of abdomen and GU tract, then general appearance

D. Examination of head, including ears and throat, general appearance, ausculation of chest, then examination of abdomen and GU tract

An acutely ill child should be assessed with particular attention to the assessment of the ABCs. After evaluation of the airway and respirations, which of the following addresses C?

A. Heart rate

B. Blood pressure

C. Capillary refill

D. Presence of absence of a murmur

E. A, B, and C

F. All of the above

A 6 yr old girl with a history of asthma presents to your clinic with status asthmaticus. You give her 3 separate albuterol treatments and IM dexamethasone. She has improved aeration, expiratory wheezes, and a respiratory rate of 40 breaths/min. You advise admission to the hospital, which is 30 miles away. The mother would like to drive the girl. The most appropriate response would be:

A. Tell the mother to drive the girl directly to the hospital's emergency department

B. Give the girl an albuterol inhaler and tell the mother to drive her directly to the hospital

C. Arrange for an ambulance to transport the patient after arranging the admission

D. Send the child via fixed-wing transport to the hospital

Chapters 61-80

You are walking in a park and come across a child lying on the ground. You gently poke the child and ask " Are you OK? " There is no response. A crowd is gathering. Your next action should be:

A. Start chest compressions

B. Shout to another person to call 911

C. Assess the pulse

D. Assess the airway.

E. Provide 2 rescue breaths

In the setting of a pediatric emergency, an assessment of disability follows assessment of airway, breathing, and circulation. In this context, disabilityrefers to:

A. Contusions

B. Broken limbs

C. Level of consciousness

D. Lacerations

E. All of the above

In a pediatric emergency, a focused history and physical examination occurs in which assessment?

A. Primary assessment

B. Secondary assessment

C. Tertiary assessment

D. Quaternary assessment

Potentially treatable causes of cardiac arrest include:

A. Acidosis

B. Hyperkalemia

C. Hypertension

D. Hypoxia

E. Hypothermia

A toddler arrives at the emergency department via EMS after being found in a creek. CPR has been proceeding for 10 minutes with no return of pulse. The child's father has now arrived and wants to see the child. The best response is:

A. Allow the father to enter the resuscitation room with a social worker

B. Tell the father that family members are not allowed into the resuscitation room

C. Tell the father that once CPR is concluded he may see the child

D. Tell the father he must wait until the chaplain is available to escort him into the room

Brain perfusion pressure generally equals:

A. Mean arterial pressure minus intracranial pressure

B. Diastolic blood pressure minus intracranial pressure

C. Intracranial blood pressure minus systolic blood pressure

D. Systolic blood pressure minus diastolic blood pressure

Severe traumatic brain injury is characterized by a Glasgow Coma Score (GCS) of:

A. 0

B. 1-3

C. 3-8

D. 9-12

14. Correct performance of an apnea test requires:

A. Preoxygenation with 100% O₂ for several minutes

B. Significant elevation of the CO₂ level in the blood without resultant respiratory efforts

C. Maintenance of acceptable O₂ arterial saturation throughout the test (usually 2-4 min)

D. All of the above

E. None of the above

15. Which statement regarding shock is false?

A. Shock is an acute syndrome characterized by inadequate oxygen delivery to meet the metabolic demands of vital organs and tissues

B. Shock is an acute syndrome characterized by systemic hypotension

C. Untreated shock progresses invariably to death

D. The body's response to shock may cause the patient to worsen

E. Shock may be caused by a variety of factors, both infectious and noninfectious

18. A 5 yr old boy presents with petechiae, fresh bruises, low-grade fever, dizziness, and lethargy. You admit him to the hospital and start an IV. The most appropriate next step in management would be:

A. Administration of high-dose Solu-Medrol or Decadron

B. CT scan of the head to rule out meningococcal meningitis

C. Collection of blood for a culture, CBC, and platelet count

D. Administration of 20 mL/kg of normal saline

E. Administration of 1-2 mg/kg of furosemide (Lasix)

19. A 2 mo old infant presents to the emergency department with nasal flaring, wheezing, and respiratory rate (RR) of 70. RSV testing is positive. He is admitted to the floor and given IVF and nasal suctioning. This morning, he sleeps through your examination. RR is 45. He has not awakened to feed in 5 hr. The next step in management is:

A. Discharge the patient as he has improved

B. Advise the nurse to try and feed the patient so that he may be discharged

C. Instruct the team that the patient requires hospitalization for another 24 hs

D. Obtain a stat capillary blood gas measurement

E. Obtain a chest radiograph

Which site of respiratory disease is NOT matched with the common clinical presentation?

A. Subglottic stenosis—rapid shallow respirations, grunting, chest wall retractions

B. Status asthmaticus—wheezing, prolonged expiration

C. Pneumonia—rapid shallow respirations, chest wall retractions, grunting

D. Viral croup—inspiratory stridor, suprasternal retractions, prolonged inspiration

E. Bronchiolitis—wheezing, prolonged expiration, chest wall retractions

22. Which of the following statements about ventilator-associated pneumonia (VAP) is NOT true?

A. VAP is multifactorial and causes include endotracheal tube colonization, aspiration of gastric secretions, and suppression of cough reflexes

B. VAP is largely unpreventable

C. Fever, leukocytosis, and infiltrate on chest radiography support a diagnosis of VAP

D. Empirical treatment of VAP should include nosocomial pathogens

25. Which statement about childhood trauma is NOT true?

A. Injury is the leading cause of death and disability in children worldwide

B. In the USA, motor vehicle accidents are the most common causes of death due to injury

C. In the USA, the most common mechanism of injury requiring an emergency department visit is falls

D. In children, blunt trauma predominates, whereas in adolescents, penetrating trauma predominates

E. It is usually preferable to bypass local hospitals and rapidly transport a seriously injured child directly to a pediatric trauma center

29. A 4 yr old girl sustains a head injury after pulling a television set onto her. The paramedics intubate her at the scene because of inadequate respiratory effort. On arrival in the emergency department, she is being ventilated at a rate of 20 breaths/min, and her chest wall rises adequately. Pulse is 100/min, blood pressure is 100/70 mm Hg, and peripheral perfusion is good. What is the most appropriate next step in patient management?

A. Immediate head CT

B. Hyperventilation to attain a PCO₂ of 25 mm Hg

C. Gentle hyperventilation and an intravenous bolus of mannitol

D. Evaluation of level of alertness and pupil size and reactivity

E. Intravenous bolus of 3% saline

30. A 10 yr old boy is brought to the emergency department after being kicked in the abdomen by a horse. Pulse is 80/min; respiratory rate is 18 breaths/min; and blood pressure is 110/70 mm Hg. His abdomen is diffusely tender. The most appropriate diagnostic study for this patient would be:

A. Abdominal ultrasound study

B. MRI of the abdomen

C. Diagnostic peritoneal lavage

D. Abdominal CT study with intravenous contrast

E. Plain abdominal radiographs

31. A 12 mo old immunized child falls and bumps his head on a playtable and sustains a laceration. He presents to your office 2 hr later. You remove a bandage and see a 2-cm simple laceration over the right forehead. The most appropriate management is:

A. Apply topical anesthetic gel, gently irrigate with normal saline, then close with nonabsorbable suture. Apply bacitracin and a clean bandage.

B. Apply topical anesthetic gel, gently irrigate with normal saline, then apply surgical glue. Apply bacitracin and a clean bandage. Prescribe cephalexin for 7 days for prophylaxis.

C. Inject local anesthetic, perform high-pressure irrigation with normal saline, then close with nonabsorbable suture. Prescribe cephalexin for 7 days for prophylaxis.

D. Apply topical anesthetic gel, gently irrigate with normal saline, then apply surgical glue. Give tetanus vaccination.

40. Which statement regarding cold injuries is NOT true?

A. Frostnip results in firm, cold white areas that may blister in 24-72 hours

B. Trenchfoot may cause long lasting autonomic symptoms

C. Frostbite may reverse to normality with early treatment

D. Recurrent freeze-thaw cycles are associated with better prognosis in frostbite

E. Common symptoms of hypothermia may mimic alcohol intoxication

41. Which statement regarding pediatric sedation is true?

A. Urethral catheter placement for voiding cystourethrogram often requires sedation with IV fentanyl

B. Fracture reduction may be successfully performed with IV midazolam

C. The level of sedation required for a bone marrow aspiration procedure is usually moderate or conscious sedation

D. When providing deep sedation, a provider should be prepared to treat apnea

42. Which statement regarding pain in newborn infants is true?

A. Morphine may not be effective

B. Untreated pain has grave short and long-term effects

C. Oral sucrose may decrease pain responses

D. Infant massage and kangaroo care in NICUs may help alleviate pain

E. All of the above

43. A bright 14 yr old boy has had persistent right leg pain for 6 mo after a minor soccer injury has healed. He describes the pain as sharp, shooting, and burning. Results of all imaging studies are normal. He is able to walk on the leg and is attending school. The type of pain the patient is experiencing is most likely to be:

A. Neuropathic

B. Somatic

C. Visceral

D. Peripheral

44. Which of the following statements regarding predictive genetic testing is true?

A. Predictive testing is genetic testing done in a person who is symptomatic for a genetic disorder

B. Predictive testing in children is ethically acceptable if the parents desire it

C. Federal law prevents companies from denying disability insurance based on a positive genetic test

D. If a person has a positive predictive genetic test for a disease, he/she may not ever develop that disease

E. None of the above

45. Genetic counseling is indicated in which of the following clinical scenarios?

A. Abnormal prenatal quad screen

B. Infant born with hypoplastic left heart disease

C. History of multiple miscarriages

D. Two cousins planning to marry

E. Child diagnosed with cystic fibrosis

F. All of the above

46. Which statement regarding treatment of genetic disorders is NOT true?

A. Physiologic therapy for genetic disease such as PKU is curative if started early

B. Newborn screening is important because early identification of genetic disorders allows early treatment

C. Enzyme replacement is available for Gaucher disease and Pompe disease

D. A bone marrow transplant may potentially cure thalassemia major

E. Gene-transfer vehicles include viruses

50. The risk of an autosomal recessive disease in the offspring of a consanguineous mating between 1st cousins is:

A. 2-4%

B. 6-8%

C. 10-12%

D. 50%

E. Zero

60. Which statement regarding genetic disorders of metabolism is NOT true?

A. In severe disorders, the affected infant may be sick at birth

B. Most genetic metabolic diseases are treatable

C. The majority of genetic metabolic disease have autosomal recessive inheritance

D. Early diagnosis is crucial to good prognosis for most disorders

E. Tandem mass spectrometry may identify a large number of disorders with just a few drops of blood

62. Initial laboratory studies to investigate for metabolic disease in an ill infant should include:

A. Lactate, glucose, bicarbonate

B. Glucose, calcium, pH

C. Sodium, glucose, bicarbonate

D. pH, bicarbonate, ammonia

E. Complete blood cell count, sodium, potassium

63. A blonde, blue-eyed girl was admitted at 2. 5 mo of age with severe emesis to rule out pyloric stenosis. She had poor development, eczema, and a musty odor. The most likely diagnosis is:

A. Wiskott-Aldrich syndrome

B. Galactosemia

C. Cystinosis

D. Phenylketonuria

E. Biotinidase deficiency

64. Which statement regarding phenylketonuria (PKU) is true?

A. Affected infants are normal at birth

B. If untreated, PKU generally leads to profound mental retardation

C. Older untreated children may have autistic behaviors

D. A positive newborn screen should be confirmed with a plasma phenylalanine concentration

E. All children with a diagnosis of PKU should undergo additional testing for biopterin deficiency

F. All of the above

65. Which statement regarding the treatment of phenylketonuria (PKU) is NOT true?

A. The goal of therapy is to reduce phenylalanine levels in the plasma and brain

B. A diet free of phenylalanine should be started as soon as diagnosis is established

C. The current recommendation from the National Institutes of Health is that all patients be kept on a phenylalanine-restricted diet for life

D. Oral administration of tetrahydrobiopterin (BH4) may reduce plasma levels of phenylalanine in some patients

E. Careful dietary control in pregnant women with PKU is essential to avoid birth defects in the fetus

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