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					March’09 Quiz 2

1. An afebrile 15-year-old girl presents with bilateral swelling of the parotid glands. She has lost
30 lb (18 kg) in the past 6 months. Her current weight is at the 75th percentile for age. She has
had an endoscopy for recurrent epigastric pain. She admits to inducing vomiting after meals.
Of the following, the clinical feature MOST specific to her diagnosis is
A. a body mass index that is less than 15
B. a distorted perception of body size
C. amenorrhea for more than 3 months
D. binge eating at least twice a week for 3 months
E. hypokalemic hypochloremic metabolic alkalosis

2. A 4-year-old boy has a 2-day history of a rash that appeared on the third day of amoxicillin
therapy for otitis media. Physical examination reveals an afebrile, well-appearing child.
Concentrated on the distal extremities are erythematous macules and papules ranging from 0.5
to 1 cm in diameter. Some lesions have a central vesicle or appear dusky. There are two
erosions on the buccal mucosa.
Of the following, the MOST likely diagnosis is
A. erythema multiforme minor
B. morbilliform amoxicillin eruption
C. Stevens-Johnson syndrome
D. toxic epidermal necrolysis
E. urticaria

3. A 15-year-old girl presents with secondary amenorrhea and a body mass index of 17 (10th
percentile). She denies a history of self-induced vomiting, laxative use, or increased physical
activity. She is in the 9th grade, gets good grades, and is on the swim team. She lives with both
parents, who are employed, and a younger sibling. When questioned about her weight, the teen
responds that she does not believe that she is too thin or think that her recently adopted vegan
diet is a problem.
Of the following, the MOST appropriate initial step in the evaluation of this adolescent is to
obtain a
A. bone densitometry study
B. detailed weight history
C. nutrition consultation
D. serum thyroxine level
E. urine specimen to screen for amphetamine use

4. A 15-year-old girl has a 3-month history of chest pain and a 15-lb (6.75-kg) weight loss. Her
parents recently separated, and she recently stopped making the high school honor roll. On
close questioning, she reveals that for the past 6 months she wakes up choking and coughing
out saliva. She also states that although she wants to eat, as soon as she swallows any solid
food, she involuntarily vomits. Physical examination shows a thin, cooperative teenager who
has mild tachypnea. Rales are auscultated at the base of the right lung. Findings on the
abdominal examination are normal. Laboratory studies demonstrate a hematocrit of 36% (0.36),
erythrocyte sedimentation rate of 18 mm/h, and serum albumin level of 3.6 g/dL (36 g/L).
Of the following, the MOST likely diagnosis is
A. achalasia
B. bulimia nervosa
C. Crohn disease
D. duodenal ulcer
E. gallstones
March’09 Quiz 2

5. Of the following, the factor MOST likely to be associated with a fatal outcome for adolescents
who have anorexia nervosa is
A. peripheral edema
B. prepubertal onset
C. presence of bradycardia
D. prolonged QTc interval
E. purging behaviors

6. You are discussing contact dermatitis due to plants with a group of medical students.
Of the following, the statement that you are MOST likely to include in your discussion is that
A. desensitization is available and effective for patients who have recurrent plant contact
B. it is safe to handle poison ivy plants during the winter months
C. patients who have severe or extensive disease should be treated for 3 days with prednisone
D. the rash of poison ivy may be spread by fluid from within vesicles
E. washing the skin after contact with poison ivy may lessen the severity of the eruption

7. A 14-year-old girl has unexplained weight loss and epigastric pain. Her last visit was 6
months ago for a sports physical examination for track. She runs approximately 5 miles each
morning and "works out" with the school track team daily. She denies intentionally trying to lose
weight, but her mother notes a definite disinterest in food over the past year. The adolescent is
doing well in school, and the mother denies stress in the home. The remainder of her medical
history, review of systems, and physical examination are unremarkable.
Of the following, the MOST likely diagnosis in this adolescent is
A. anorexia nervosa
B. Crohn disease
C. depression
D. hyperthyroidism
E. tuberculosis

8. An 8-year-old boy presents with an acute, pruritic eruption on the arms and legs
characterized by erythematous papules, patches, and vesicles, some of which are in a linear
arrangement. He has experienced similar episodes in the past.
Of the following, the MOST likely diagnosis is
A. atopic dermatitis
B. contact dermatitis
C. impetigo
D. nummular eczema
E. shingles

9. You are evaluating a 1-year-old boy who has a 2-day history of rhinorrhea, pharyngitis, and
low-grade fever. Today he developed a barking cough with inspiratory stridor and a temperature
of 101°F (38.3°C). On physical examination, he has a hoarse voice, coryza, a mildly inflamed
pharynx, and a slightly increased respiratory rate (35 breaths/min).
Of the following, the MOST likely cause of his illness is
A. adenovirus
B. coronavirus
C. enterovirus
D. papillomavirus
E. parainfluenza virus
March’09 Quiz 2

10. A 4-year-old boy who has cystic fibrosis and currently is asymptomatic presents to the clinic.
He did not receive his influenza immunization this year, and his mother recently was diagnosed
with influenza A by rapid antigen testing.
Of the following, the BEST therapeutic action is
A. influenza vaccine alone
B. influenza vaccine plus oseltamivir
C. influenza vaccine plus rimantadine
D. influenza vaccine plus zanamivir
E. observation

11. Over the past week, you and your colleagues have seen a number of previously healthy
children younger than 2 years of age who present with fever, coryza, cough, vomiting, and
diarrhea. Several of the children have required hospitalization for respiratory distress and
pneumonia. You suspect that influenza virus infection is the cause of these illnesses.
Of the following, the MOST rapid test to confirm the diagnosis in these patients is
A. enzyme immunoassay antigen detection
B. immunoglobulin M (IgM) titers on acute sera
C. IgM titers on acute and convalescent sera
D. polymerase chain reaction
E. viral culture

12. You are evaluating a 7-year-old girl who has a 2-day history of a rash without fever or other
symptoms. The only notable findings on physical examination are round, erythematous, thin
plaques, each of which has a central violaceous discoloration or blister. The lesions are
concentrated on the extremities, including the hands and feet, with relative sparing of the trunk.

Of the following, the MOST likely diagnosis is
A. erythema migrans
B. erythema multiforme
C. Stevens-Johnson syndrome
D. toxic epidermal necrolysis
E. urticaria