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1. A previously healthy 6-year-old girl is brought to the physician by her parents because of intermittent right knee pain for 2 months. The pain typically occurs in the morning and after naps. She has not had fever, rash, or symptoms in any other joint. She plays soccer twice weekly but has not had any injuries. Her parents recall that she had a sore throat for 2 days prior to the onset of her knee pain. There is no family history of osteoarthritis. She is at the 25th percentile for height, 70th percentile for weight, and above the 97th percentile for BMI. Her temperature is 37°C (98.6°F). Examination shows slight bowing of the lower extremities. The right knee is larger than the left knee. There is tenderness of the right knee to palpation. Range of motion of the right knee is decreased. Her erythrocyte sedimentation rate is 45 mm/h. X-rays of the knees show no abnormalities. Which of the following is the most likely diagnosis?
A) Acute rheumatic fever
B) Juvenile arthritis
C) Septic arthritis
D) Tear of the anterior cruciate ligament
E) Tibia vara
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2. A 3-month-old girl is brought to the emergency department 30 minutes after the onset of lethargy. There is no history of trauma, and she has not had fever, diarrhea, or vomiting. She was born at 27 weeks' gestation, and required 2 months of ventilatory support and a 2-week course of dexamethasone therapy for respiratory distress syndrome of the newborn and bronchopulmonary dysplasia. She had an umbilical arterial and venous catheter in place during the first 2 weeks of life. Her temperature is 36.7°C (98.1°F), pulse is 140/min, respirations are 20/min, and blood pressure is 110/85 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Doppler ultrasonography shows renal artery thrombosis. Which of the following is the most likely explanation for this patient's hypertension?
A) Chronic obstructive pulmonary disease
B) Idiopathic intracranial hypertension
C) Increased renin production
D) Prematurity
E) Prolonged use of corticosteroids
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@ann17, thx #1- How can you distinguish between Juvenile Arthritis or Tibia Vara (Blount's disease)?
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3. A previously healthy 4-year-old boy is brought to the physician because of a 1week history 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 day care. He appears pale and is not in acute distress. His temperature is 38.4°C (101.1°F), pulse is 140/min, and respirations are 24/min. 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 heard. The spleen is palpated 1 cm below the left costal margin. There is no swelling or redness of the joints. Laboratory studies show a hemoglobin concentration of 6.4 g/dL, leukocyte count of 50,000/mm3 , and platelet count of 10,000/mm3.
A) Acute lymphoblastic leukemia
B) Anemia of chronic disease
C) Autoimmune hemolytic anemia
D) Glucose 6-phosphate dehydrogenase deficiency
E) Hemolytic uremic syndrome
F) Hereditary spherocytosis
G) Lead poisoning
H) Red blood cell aplasia (aquired) WRONG
I) Sickle cell disease
J) Thalassemia
K) Uremia of chronic renal failure
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at the ESR levels..those will be elevated in JIA opposed to blounts!
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3 is ALL. previously healthy kid means this is an acute process. he has leukocytosis, thrombocytopenia (petechial rash over chest), anemia. this tells you the BM is being infiltrated. splenomegaly again due to infiltration. hope this helps.
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4. A healthy 9-month-old girl is brought to the physician by her parents for a well-child examination. Her parents are concerned that she is not gaining enough weight. She is breastfeeding six times daily and taking small amounts of baby food from a spoon. She is at the 5th percentile for weight and 25th percentile for length and head circumference. Review of the growth chart shows that this growth pattern has been consistent since birth. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?
A) Reassurance that this growth pattern is within normal limits
B) Increasing caloric intake by adding more baby food (WRONG)
C) Replacing breastfeeding with soybased formula
D) Supplementing breastfeeding with whole cow milk
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5. A 5-year-old boy is brought to the physician for a well-child examination. He is active and has been healthy except for an episode of otitis media 3 weeks ago treated with amoxicillin. His parents emigrated from Vietnam. His diet consists mainly of fruits and vegetables; he occasionally eats fish and chicken but no red meat. Examination shows no abnormalities. Laboratory studies show:
Hemoglobin 10 g/dL
Mean corpuscular volume 64 μm3
Leukocyte count 6100/mm3
Platelet count 225,000/mm3
Red cell distribution width 10% (N=13%–15%)
A blood smear is shown ( http://imgur.com/a/tES3u). Which of the following is the most likely explanation for this patient's anemia?
A) Antibiotic-induced autoimmune hemolysis
B) Decreased synthesis of globin chains
C) Iron deficiency (WRONG)
D) Transient postinfectious bone marrow suppression
E) Vitamin B12 (cobalamin) deficiency
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6. A 10-day-old male newborn is admitted to the hospital for treatment of indirect hyperbilirubinemia due to isoimmune hemolysis. He is placed in a room with a 2-month-old female infant with dehydration secondary to rotavirus gastroenteritis. Two days later, he develops vomiting and diarrhea, and a stool specimen is positive for rotavirus antigen. This nosocomial infection is most likely caused by failure of caregivers to do which of the following?
A) Dispose of diapers and other waste items properly
B) Observe gown and glove precautions (WRONG)
C) Observe handwashing techniques
D) Place the patients in a reverse airflow room
E) Restrict visitors to the room
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