Board Review Week of July th GROWTH AND DEVELOPMENT

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Board Review Week of July th GROWTH AND DEVELOPMENT Powered By Docstoc
					Board Review Week of May 17, 2010
CARDIOVASCULAR DISORDERS
1. Question 103
During a health supervision visit for a 16 year old boy, you learn that he has experienced chest pain
twice with intense exercise during practice for his high school varsity soccer team. Each time the
pain felt like pressure, radiated to his left shoulder, and was associated with lightheadedness. He
did not seek medical attention after either episode. His father, who is age 49 years, has
hypertension and uses lipid-lowering medication. Results of the boy’s physical examination are
normal, including his blood pressure and cardiovascular examination.

Of the following, the BEST management plan is

    a)   cardiology referral, with only light exercise pending evaluation
    b)   cardiology referral, with restriction of all exercise pending evaluation
    c)   echocardiography, with clearance for exercise if results are normal
    d)   electrocardiography, with clearance for exercise if results are normal
    e)   trial of bronchodilator therapy for exercise-induced asthma

2. Question 184
You are evaluating a 16 year old girl whom your practice has followed for many years. She tells you
that she has fainted twice during varsity soccer practice at her high school. She reports that she
felt fine before each incident and denies using any drugs.

Of the following, the MOST useful information that could be provided by this patient is a(n)

    a)   allergy history
    b)   family history
    c)   past surgical history
    d)   social history
    e)   travel history

3. Question 101
A 4-week-old infant who was born at term without any complications ate well and gained weight for
the first 3 weeks after birth. Over the last week, however, his mother reports that he appears
hungry but fatigues with feeding and now takes twice as long to complete his feeding as he did 1
week ago. He also breathes fast during his feedings and stops frequently to "catch his breath."

Of the following, the MOST likely explanation for the symptoms in this infant is

    a)   aspiration syndrome
    b)   congestive heart failure
    c)   gastroesophageal reflux disease
    d)   inborn error of metabolism
    e)   pneumonia

4. Question 167
You are seeing a 6 week old infant who was born with trisomy 21 and a large atrioventricular septal
defect. Over the previous week, she has tired with feeding and has not gained weight. Her
respiratory rate is 60 breaths/min and heart rate is 150 beats/min. Auscultation reveals mild
retractions and a 2/6 systolic murmur with a gallop rhythm. The liver is palpable at 2 cm below the
costal margin, and the perfusion is good. You decide to increase the caloric content of the formula
to 24 kcal/oz, and you contact her pediatric cardiologist to discuss referral for surgical repair.

Of the following, the BEST therapeutic option while awaiting surgical repair is

    a)   captopril
    b)   furosemide
    c)   hydralazine
    d)   propranolol
    e)   verapamil
5. Question 21
You are evaluating a newborn 6 hours after his birth. Labor and delivery were uncomplicated, but
amniocentesis performed during the pregnancy revealed trisomy 21. Fetal echocardiography at 20
weeks' gestation showed normal findings. The infant currently is sleeping and is well-perfused, with
a heart rate of 140 beats/min and no audible murmurs. His physical features are consistent with
Down syndrome.

Of the following, the MOST appropriate diagnostic study to perform is

    a)   barium swallow
    b)   cervical spine radiography
    c)   echocardiography
    d)   head ultrasonography
    e)   radiography of the abdomen

6. Question 6
A 2-week-old infant presents to the emergency department with a 1-day history of decreased
feeding, pallor, diaphoresis, and increasing somnolence. He was born at term, and the delivery was
uncomplicated. On physical examination, his heart rate is 190 beats/min, his respiratory rate is 80
breaths/min, his blood pressure is 50/30 mm Hg, and his extremities are cool and pale with poor
pulses. You place the infant on a cardiorespiratory monitor and begin your assessment and
management.

Of the following, the MOST appropriate pair of tests to consider in this child is

    a)   complete blood count and bone scan
    b)   electrocardiography and echocardiography
    c)   electroencephalography and head ultrasonography
    d)   lumbar puncture and head computed tomography scan
    e)   serum electrolytes and chest computed tomography scan

7. Question 54
You care for a 6-month-old boy who was born with pulmonary atresia and ventricular septal defect.
He received a modified Blalock-Taussig (systemic-to pulmonary artery) shunt 5 days after birth. His
oxygen saturations have ranged between 70% and 84% at office visits over the past 2 months.
During a health supervision visit, you record a hematocrit of 57% (0.57).

Of the following, this child's polycythemia puts him at INCREASED risk for

    a)   acute leukemia
    b)   bacteremia
    c)   cerebrovascular accident
    d)   congestive heart failure
    e)   necrotizing enterocolitis

8. Question 86
A 5-day-old child is brought to the emergency department because he has been difficult to arouse
over the last 6 hours. His parents report that he has not been interested in feeding today and that
he has been breathing rapidly and with a grunting noise. On physical examination, the infant's heart
rate is 185 beats/min, respiratory rate is 80 breaths/min, and blood pressure is 55/40 mm Hg. A
pulse is palpable in the right brachial region, but not in the feet. All of his extremities are cool and
mottled, with a capillary refill of more than 2 seconds.

Of the following, the MOST appropriate next step is to

    a)   arrange for echocardiography at the first appointment in the morning
    b)   initiate a furosemide infusion
    c)   initiate a prostaglandin infusion
    d)   obtain a computed tomography scan of the head
    e)   obtain a lumbar puncture
9. Question 85
You are seeing a 2-week-old girl in your office for a health supervision visit. Her parents report that
she is eating well and has good weight gain. On physical examination, you note a strong right
brachial pulse, but you cannot feel pulses in the right or left femoral region. As you explain the
diagnosis to the parents, they ask you about long-term complications following repair of her
condition.

Of the following, the MOST likely long-term complication for this child is

    a)   frequent pulmonary infections
    b)   hypertension
    c)   neurodevelopmental delay
    d)   poor exercise performance
    e)   renal dysfunction

10. Question 117
You are evaluating a 14-year-old girl in the clinic. She has had a fever for nearly 2 weeks, which she
has attributed to a "cold," although she has not had cough or upper respiratory tract symptoms.
She is concerned about some "spots" that she has noticed on her palms and soles. On physical
examination, you note splenomegaly and erythematous, nontender macules on her fingers, palms
(Item Q117), and soles of her feet. Additionally, she has lost 8 lb since her visit 6 months ago.




Of the following, the MOST appropriate next study for evaluation of this patient is

    a)   antinuclear antibody
    b)   echocardiography
    c)   Lyme titers
    d)   ophthalmologic examination
    e)   tuberculin skin test

11. Question 149
A 15-year-old patient is brought to your office with a complaint of chest pain. She had been healthy
until 3 days ago, when she developed a fever. The pain is precordial, referred to the epigastrium,
and exacerbated by deep breathing and coughing. She refuses to lie down and prefers to sit leaning
forward.

Of the following, the MOST likely expected finding on electrocardiography is

    a)   elevation of the S-T segments
    b)   first-degree heart block
    c)   pre-excitation with a delta wave
    d)   tall peaked T waves
    e)   T-wave flattening
12. Question 181
You are evaluating a 2-year-old girl for fever and fatigue. Her parents report that she has had a
fever for 3 days, a progressive degree of fatigue, loss of appetite, and irritability. On examination,
she has a temperature of 102.3°F (39.1°C), a heart rate of 160 beats/min, a respiratory rate of 40
breaths/min, and a blood pressure of 90/60 mm Hg. She has dry mucous membranes, mild
intercostal retractions, and a 3/6 holosystolic murmur at the cardiac apex. Her liver is palpable 3 cm
below the costal margin. Her pulses are weak but palpable in all extremities.

Of the following, the MOST likely cause of this patient's clinical presentation is

    a)   dehydration from viral illness
    b)   Kawasaki disease
    c)   meningitis
    d)   myocarditis
    e)   rheumatic fever

13. Question 53
A 7-month-old female has undergone the second stage of surgical palliation (Glenn operation) for
hypoplastic left heart syndrome. She was discharged from the hospital 1 week ago, and her mother
brings her to the office because of irritability that began this morning. On physical examination, the
infant is awake and irritable, with a heart rate of 150 beats/min and a respiratory rate of 50
breaths/min. She has cyanosis of the face and mucosal surfaces and swelling of the arms and head.

Of the following, the BEST explanation for this patient's clinical presentation is

    a)   polycythemia
    b)   postpericardiotomy syndrome
    c)   protein-losing enteropathy
    d)   superior vena cava syndrome
    e)   thoracic duct injury

				
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