Board Review November Quiz Quest

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					November Quiz Questions:

Question 1
A 6-year-old boy presents to the clinic with a 2-day history of fever and noisy breathing. His mother is
concerned because she feels that her son is "going to die." His past medical history is unremarkable, but
he has not yet received his fifth diphtheria-tetanus-acellular pertussis (DTaP) or his second measles-
mumps-rubella (MMR) vaccination. On physical examination, the boy appears scared and toxic and has
labored respiration and a very harsh cough. He is not drooling and can lie flat while you examine him. His
temperature is 103.5°F (39.7°C), respiratory rate is 35 breaths/min, heart rate is 168 beats/min, and
blood pressure is 107/68 mm Hg. Although he has tachypnea, his lungs are clear to auscultation, he has
no heart murmur, and findings on his abdominal examination are benign.

Of the following, the MOST likely diagnosis is
    a)   bacterial tracheitis
    b)   bronchitis
    c)   epiglottitis
    d)   foreign body aspiration
    e)   laryngotracheobronchitis

    Question 48
    A 2-year-old girl presents to your office with a 3-week history of a "barky" cough. According to her
    mother, the girl has had no fever or upper respiratory tract infection symptoms, but she has
    complained intermittently of a sore throat for the past 2 weeks. On physical examination, the child
    appears well and playful. Her throat is nonerythematous, and her lungs are clear to auscultation.
    Because of the persistence of her symptoms, you obtain chest radiograph (Item Q48A).

    Of the following, a TRUE statement about this patient's condition is that
    a)   complications include bronchiectasis and pneumonia
    b)   immediate removal is recommended for foreign bodies retained >24 hours
    c)   spontaneous passage of foreign bodies located at the thoracic inlet is likely to occur
    d)   the majority of patients who have retained foreign bodies are asymptomatic
    e)   the most likely location for a foreign body to lodge is at the gastroesophageal junction




    Question 4
    A 16-year-old girl who has moderate persistent asthma presents to the emergency department with
    coughing, wheezing, and increasing dyspnea. She states that she was feeling fine until she was
    exposed to cologne that one of her classmates was wearing. An ambulance was called after her
    symptoms did not improve following administration of two puffs of her beta-2 agonist inhaler. On
    physical examination, the teenager has a respiratory rate of 30 breaths/min, heart rate of 90
    beats/min, and pulse oximetry of 98% on room air. She has difficulty completing a sentence and
    points to her neck, saying it is "hard to get air in." Her lungs are clear to auscultation, and
    rhinolaryngoscopy demonstrates adduction of one of the vocal cords during inspiration with a
    posterior glottic "chink." Pulmonary function testing shows a blunted inspiratory loop (Item Q63A).

    Of the following, the MOST likely cause for this patient's symptoms is
         a)   asthma exacerbation
         b)   subglottic stenosis
         c)   vocal cord dysfunction
         d)   vocal cord nodule
         e)   vocal cord paralysis

Question 79
A 17-year-old boy is applying for entry into military service and requires a complete history and physical
examination. During the interview, he states that he is healthy, although he admits to being treated for
three cases of pneumonia over the past 10 years. A chest radiograph performed during the last infection
showed a left lower lobe pneumonia, and the patient states that the infection is " always on that side."
The only finding of note on the physical examination today is slightly diminished breath sounds over the
left lower lobe.

Of the following, the MOST likely cause for this boy's recurrent pneumonias is
    a)   bronchogenic cyst
    b)   congenital cystic adenomatoid malformation
    c)   congenital lobar emphysema
    d)   extrapulmonary sequestration
    e)   intrapulmonary sequestration

Question 95
A 5-month-old female infant presents with a 4-day history of increasing lethargy, drooling, constipation,
and a weak cry. The parents report that the infant had been very healthy until this past week; she had no
preceding sick contacts, viral symptoms, or fever. The infant is bottle fed and over the past month has
been introduced to various home-pureed fresh fruits and vegetables, although the parents deny giving her
any honey or homemade canned products. They currently have two dogs and a cat and live in the
northwestern United States in a new subdivision that is still under construction. On physical examination,
the infant is afebrile but has symmetrically decreased tone, absent deep tendon reflexes, poor muscle
strength, and a weak cry.

Of the following, the MOST likely diagnosis is
    a)   botulism
    b)   diphtheria
    c)   lead poisoning
    d)   meningitis
    e)   tetanus

Question 99
A 10-day-old infant who was born at 28 weeks' gestation has been weaned off of the ventilator and is
receiving supplemental oxygen at an Fio2 of 0.30. He experiences episodic apnea 10 to 12 times daily and
has corresponding bradycardia and oxygen desaturation, as measured by pulse oximetry (Item Q99A).
Some of the episodes require tactile stimulation and an increase in supplemental oxygen for resolution.
Physical examination reveals no baseline tachypnea, tachycardia, or increased work of breathing. No heart
murmur is appreciated, and he is normotensive. He appears acyanotic and well perfused, with a recent
hematocrit of 35% (0.35). Results of head ultrasonography performed 3 days ago were normal.

Of the following, the BEST treatment for this infant is
    a)   continuous positive airway pressure
    b)   diaphragmatic (phrenic nerve) pacing
    c)   intravenous ampicillin
    d)   intravenous caffeine citrate
    e)   intubation and assisted ventilation

Question 102
A 6-month-old previously healthy girl is brought to your office because she has not been eating well
today. The mother reports that the baby is interested in taking the bottle, but stops feeding within 1
minute and seems to have trouble breathing. She is irritable but consolable in her mother's arms. She is
pale, afebrile, and has a respiratory rate of 70 breaths/min. Her heart rate is too fast to count, she has
palpable pulses in all extremities, and her perfusion is fair, with a capillary refill time of 2 to 3 seconds.

Of the following, the MOST likely additional finding expected in this child is
    a)   crackles over the lungs
    b)   conjunctivitis
    c)   hepatomegaly
    d)   nuchal rigidity
    e)   rash on the extremities

Question 116
The parents of a 6-month-old boy call you in the middle of the night because he is coughing and has nasal
congestion. You had diagnosed a viral upper respiratory tract infection when you saw him earlier today.
The parents are frustrated that the cough is persistent and request medicine for their boy so they can
sleep.

Of the following, the MOST appropriate recommendation is
     a) chlorpheniramine/pseudoephedrine combination
     b) codeine
     c) dextromethorphan
     d) guaifenesin
     e) saline nasal drops

Question 148
An 18-month-old girl is brought to the emergency department by her mother, who reports that the girl
has had a high fever and difficulty breathing for 1 day. She has had a barking cough for the last 3 days
but had been afebrile and breathing comfortably until today. Her immunizations are up to date. Her
temperature is 104°F (40°C), her respiratory rate is 50 breaths/min, she exhibits inspiratory stridor and a
brassy cough, and she appears ill. Lung examination reveals decreased breath sounds bilaterally with
transmitted upper airway sounds. An anterior neck radiograph shows subglottic narrowing and a ragged
tracheal air column.

Of the following, the MOST likely diagnosis is
     a) acute viral laryngotracheitis
     b) angioneurotic edema
     c) bacterial tracheitis
     d) epiglottitis
     e) retropharyngeal abscess

Question 163
An infant who was born at 26 weeks' gestation, weighing 700 g, is nearing 37 weeks corrected age. He is
receiving nasal cannula oxygen (0.2 L/min) and being treated with diuretics for chronic lung disease. He
has no intracranial hemorrhage and is growing well on enteral feedings via a nasogastric tube. Attempts at
oral feeding have been unsuccessful because of frequent oxygen desaturation, bradycardia, and concerns
over the inability to coordinate sucking-swallowing. The mother asks why you are continuing to feed her
son via a feeding tube.

Of the following, the condition that BEST explains why her son has feeding problems is
     a) apnea of prematurity
     b) chronic lung disease
     c) gastroesophageal reflux
     d) necrotizing enterocolitis
     e) tracheoesophageal fistula

Question 164
You are asked to consult on a 9-month-old boy who has been hospitalized five times for wheezing. His
history reveals occasional coughing with feedings, but results of a pH probe performed during his last
admission were normal. His weight and height are at the 50th percentile. Except for scattered wheezes
with good aeration bilaterally, results of his physical examination are normal.

Of the following, the test that is MOST likely to reveal the cause of his recurrent wheezing is
    a)   chest computed tomography scan
    b)   immunoglobulin panel
    c)   inspiratory and expiratory chest radiographs
    d)   pulmonary function testing
    e)   videofluoroscopic swallow stud

Question 56
The mother of a 6-month-old infant calls you because the infant's feeding has been decreasing for the
past 12 hours, and she appears pale and is perspiring. You ask the mother to bring the infant to the
emergency department immediately. On physical examination, the girl is pale and irritable; weighs 7 kg;
and has a respiratory rate of 60 breaths/min, good breath sounds, weak but palpable pulses, and a heart
rate of 250 beats/min with narrow complexes on the monitor. Her oxygen saturation is 100% wearing a
facemask in her mother's arms. She is sucking intermittently on her pacifier.

Of the following, the BEST course of action is
     a) carotid massage
     b) defibrillation with 14 joules
     c) Holter monitoring
     d) intravenous administration of adenosine
     e) oral administration of verapamil


Question 72
A 16-year-old girl returns to your office with complaints of palpitation and tachycardia. You had referred
her to the hospital for an electrocardiogram (ECG) 1 month ago when she presented with similar
symptoms, and results were interpreted as normal. On physical examination today, she is alert, mildly
anxious, but in no distress. Her weight is 3 kg less than it was last month. Her pulses are strong, heart
rate is 126 beats/min, respiratory rate is 20 breaths/min, and blood pressure is 130/72 mm Hg. You note
a soft systolic murmur along the left sternal border. There is no jugular venous distention or
hepatomegaly. You order a repeat ECG (Item Q72A).

Of the following, the BEST assessment of the ECG and the likely diagnosis is




    a)   sinus arrhythmia in a healthy adolescent
    b)   sinus node disease with anorexia nervosa
    c)   sinus rhythm with Wolff-Parkinson-White syndrome
    d)   sinus tachycardia with hyperthyroidism
    e)   supraventricular tachycardia with amphetamine use

Question 88
As the doctor for the high school basketball team, you are asked to evaluate the center, who injured his
right index finger on the rim while dunking the basketball. During your evaluation, you note a hematoma
on the finger, but normal range of motion and no broken skin. He has minimal tenderness. You also note
arachnodactyly (Item Q88A)




and hypermobility of his thumb joints. He wears glasses, has a pectus carinatum (Item Q88B),
and after a detailed measurement, his arm span relative to his height is 1.15. He tells you that he can
play without pain and is looking forward to the state playoffs later in the week. His parents tell you that
basketball offers his best chance of attending college.

Of the following, your BEST advice to the patient and his family is for a(n)
    a)   cardiology referral with echocardiography and no practice or games until the evaluation is
         completed
    b)   chromosomal analysis and practice but no games until test results are available
    c)   electrocardiogram and no practice or games until the test is completed
    d)   exercise stress test and practice but no games until the test is completed
    e)   genetics evaluation when the season is completed and self-limited participation in games

				
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