USMLE Step 3- Pediatrics

A father and son come to your office because of persistent diarrhea. They relate the presence of watery diarrhea for over 2 weeks. They noted that the diarrhea began after returning from a Boy Scout camping trip in the Rocky Mountains. The diarrhea has waxed and waned for 2 weeks. It is nonbloody and foul smelling. They have had increased flatulence and mild abdominal cramping. What is the most likely etiology of their diarrhea?

You are working in the emergency department and are called to perform a lumbar puncture on a 3-month-old infant who presented with fever and lethargy. The spinal fluid that you obtain is turbid. The laboratory reports that there are 200 WBCs and 5 RBCs per high-power field (HPF). Ninety-five percent of the WBCs in the spinal fluid are neutrophils. Which of the following is the most probable
cause of this illness?

A term infant male is born after an uncomplicated vaginal delivery. The mother’s prenatal labs were negative with the exception of being GBS positive at 36 weeks’ gestation. The mother received two doses of ampicillin prior to delivery and did not have a fever. The infant had APGAR scores of 9 at 1 minute and 9 at 5 minutes. The infant was brought to the newborn nursery and appears well. The father tells you that he has hemophilia. His wife neither has hemophilia nor is a carrier. What does this mean for the baby?

A mother brings her 15-year-old son in for a preparticipation sports physical examination. She feels that her son has not yet undergone pubertal changes and that makes her concerned. Which of the following physical examination findings is usually the first sign of the onset of puberty in males?

A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination, you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is high for a certain condition. You presumptively diagnose the child with which of the following?

A father and son come to your office because of persistent diarrhea. They relate the presence of watery diarrhea for over 2 weeks. They noted that the diarrhea began after returning from a Boy Scout camping trip in the Rocky Mountains. The diarrhea has waxed and waned for 2 weeks. It is nonbloody and foul smelling. They have had increased flatulence and mild abdominal cramping. What would be the most appropriate treatment?

You are working in the emergency department and are called to perform a lumbar puncture on a 3-month-old infant who presented with fever and lethargy. The spinal fluid that you obtain is turbid. The laboratory reports that there are 200 WBCs and 5 RBCs per high-power field (HPF). Ninety-five percent of the WBCs in the spinal fluid are neutrophils. If the laboratory result showed that 98% of the
WBCs in the spinal fluid were lymphocytes, what would be the most likely etiology of the infection?

A mother brings her 4-year-old son to your office, relating that he fell earlier that morning while at the playground. She says that the boy tripped over another child and landed on his outstretched hands. On examination, the boy has some mild swelling around his left wrist, and he says that it hurts when you palpate it. What is the most appropriate next step?

A mother brings her 21/2-year-old daughter to your office for evaluation of frequent urination. The mother relates that the daughter seems to be urinating more frequently, up to 8–10 times in a day, over the past week. The girl complains of pain when she urinates, but the urine does not have any different odor to it. The mother says that the girl otherwise seems fine and still loves to take her bubble bath at night. The girl does not have a fever, weight loss, diarrhea, or vomiting. What is the most appropriate next step in evaluating this girl?

A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination, you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is high for a certain condition. Upon further imaging, what associated finding would be expected?

A 5-year-old male is admitted to the hospital following a 3-week history of spiking fevers and fatigue. Your examination reveals pale mucous membranes and skin. You also find splenomegaly. You are concerned about a possible malignancy. What is the most common malignancy of childhood?

You are working in a community clinic on a Native American reservation. A mother brings in her 8-year-old son for an ophthalmic evaluation. On examination, you find bilateral corneal ulceration and decreased visual acuity. What is the most common infectious cause of blindness in the world?

A mother brings her baby girl for a 9-month well-child visit. You have been following her since birth. Her growth chart is shown in Figure. Her vital
signs and examination are otherwise normal.

The growth pattern is most consistent with which of the following?

A mother brings her 21/2-year-old daughter to your office for evaluation of frequent urination. The mother relates that the daughter seems to be urinating more frequently, up to 8–10 times in a day, over the past week. The girl complains of pain when she urinates, but the urine does not have any different odor to it. The mother says that the girl otherwise seems fine and still loves to take her bubble bath at night. The girl does not have a fever, weight loss, diarrhea, or vomiting. What is the most likely diagnosis?

What is the most sensitive indicator of pneumonia in a child?

A 5-year-old male is admitted to the hospital following a 3-week history of spiking fevers and fatigue. Your examination reveals pale mucous membranes and skin. You also find splenomegaly. This child has an extensive evaluation by the
Hematology-Oncology consultants. Their evaluation excludes the presence of a malignancy. The extensive evaluation did reveal that the child has a WBC count of 22,000 with 41% monocytes and 12% “atypical” lymphocytes. His hematocrit is 28% and erythrocyte sedimentation rate (ESR) is 5. This child likely has which of the following diseases?

A 4-year-old girl is brought in to the office by her mother. She developed chicken pox about 6 days ago. She appeared to be recovering well but mother became concerned because she was persistently scratching at several of the lesions and they were not healing. On examination, the child is afebrile and generally well appearing. On examination of her skin you see the following image (see Figure).

What is the most likely current diagnosis?

A mother brings her baby girl for a 9-month well-child visit. You have been following her since birth. Her growth chart is shown in Figure. Her vital
signs and examination are otherwise normal.

What would be the best next step for management of this infant?

A mother relates seeing worms in her 3-year-old’s stool. She describes them as 1-cm long white threads that seemed to be moving. What is the most likely infectious etiology for this finding?

A 12-month-old male child is brought to your office for a well-child examination and immunizations. You have been following the child since delivery and are aware that he has acquired immune deficiency syndrome (AIDS) and a markedly reduced T-cell count. Which of the following vaccinations should he not receive?

A 5-year-old male is admitted to the hospital following a 3-week history of spiking fevers and fatigue. Your examination reveals pale mucous membranes and skin. You also find splenomegaly. The best course of care for this young man would be which of the following?

A 4-year-old girl is brought in to the office by her mother. She developed chicken pox about 6 days ago. She appeared to be recovering well but mother became concerned because she was persistently scratching at several of the lesions and they were not healing. On examination, the child is afebrile and generally well appearing. On examination of her skin you see the following image (see Figure).

What is the most likely responsible agent?

You see a 3¹/₂-year-old child in the emergency department who has had fever for the past week. The parents relate that their son has some swollen glands, fever, and now seems to be getting a rash on his arms. On examination, you find an uncomfortable appearing young boy whose vital signs are normal with the exception of a temperature of 104°F. You note that he has a red posterior oropharynx with dry, cracked lips. His TMs are normal. He has mild conjunctival injection bilaterally without any discharge. His chest is clear, and his heart sounds are normal. He does not have any hepatosplenomegaly. His has a lacy, confluent macular rash on his chest and upper arms, with mild peeling of the tips of his fingers. What is the most likely diagnosis?

Deficiency of which of the following is the most common nutritional cause of anemia?

While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall. You obtain the following x-ray (see Figure).

What is your interpretation of the x-ray?

While in the emergency department you see a 3-week-old infant. The mother says that the child felt warm earlier in the day and has not been eating very well. The infant has a temperature of 100.9°F and has mildly decreased tone. What is the most appropriate initial management?

A 4-year-old girl is brought in to the office by her mother. She developed chicken pox about 6 days ago. She appeared to be recovering well but mother became concerned because she was persistently scratching at several of the lesions and they were not healing. On examination, the child is afebrile and generally well appearing. On examination of her skin you see the following image (see Figure).

What would be the most appropriate treatment?

You see a 3¹/₂-year-old child in the emergency department who has had fever for the past week. The parents relate that their son has some swollen glands, fever, and now seems to be getting a rash on his arms. On examination, you find an uncomfortable appearing young boy whose vital signs are normal with the exception of a temperature of 104°F. You note that he has a red posterior oropharynx with dry, cracked lips. His TMs are normal. He has mild conjunctival injection bilaterally without any discharge. His chest is clear, and his heart sounds are normal. He does not have any hepatosplenomegaly. His has a lacy, confluent macular rash on his chest and upper arms, with mild peeling of the tips of his fingers. Which laboratory result would be most consistent with the diagnosis?

A 9-month-old male infant is brought to your office for evaluation of new skin lesions. The mother tells you that she recently had to return to work, and the child is now in day care. He has since developed new erythematous facial plaques (see Figure). She also reports that the child has been irritable with chronic diarrhea. On examination, the child has dry scaly plaques symmetrically distributed in the perianal and perioral areas. Which deficiency does this child likely have?

While working in the emergency room you see a 14-month-old boy brought in with apparent leg pain. His parents tell you that he has recently been learning to walk and that this injury is the result of a fall. You obtain the following x-ray (see Figure).

What is the mechanism that likely resulted in this injury?

You see a 2-month-old infant in the emergency department for vomiting. The mother says that the baby has been spitting up more over the past few days and has become more irritable. She denies any fever, diarrhea, or change in formula. The mother tells you that there is a family history of “heartburn” and that her other children have all spit up. The infant has some emesis in the emergency department that seems to be formula mixed with some bile. The infant is intermittently irritable and sleepy. What is the most concerning diagnosis that this
could be?

A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child’s arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000. What is the most likely cause of this child’s bleeding and bruising?

You see a 3¹/₂-year-old child in the emergency department who has had fever for the past week. The parents relate that their son has some swollen glands, fever, and now seems to be getting a rash on his arms. On examination, you find an uncomfortable appearing young boy whose vital signs are normal with the exception of a temperature of 104°F. You note that he has a red posterior oropharynx with dry, cracked lips. His TMs are normal. He has mild conjunctival injection bilaterally without any discharge. His chest is clear, and his heart sounds are normal. He does not have any hepatosplenomegaly. His has a lacy, confluent macular rash on his chest and upper arms, with mild peeling of the tips of his fingers. What is the most appropriate treatment at this point?

Which of the following is regulated by the parathyroid gland?

A 16-year-old sexually active woman is being seen in the emergency department. She is complaining of vaginal discharge. She has a temperature of 99.5°F, but is otherwise well. On pelvic examination, you see a mucopurulent cervical discharge with scant blood. Samples of the discharge are sent to the laboratory for culture. There are no cervical ulcers noted. She does not have any medical allergies. Which of the following is the most common sexually transmitted infection in adolescents?

You see a 2-month-old infant in the emergency department for vomiting. The mother says that the baby has been spitting up more over the past few days and has become more irritable. She denies any fever, diarrhea, or change in formula. The mother tells you that there is a family history of “heartburn” and that her other children have all spit up. The infant has some emesis in the emergency department that seems to be formula mixed with some bile. The infant is intermittently irritable and sleepy. Which of the following would be the most
appropriate initial test?

A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child’s arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000. After discussing various options with a regional pediatric hematologist and the patient’s parents, your most appropriate initial management would be which of the following?

You see a 3¹/₂-year-old child in the emergency department who has had fever for the past week. The parents relate that their son has some swollen glands, fever, and now seems to be getting a rash on his arms. On examination, you find an uncomfortable appearing young boy whose vital signs are normal with the exception of a temperature of 104°F. You note that he has a red posterior oropharynx with dry, cracked lips. His TMs are normal. He has mild conjunctival injection bilaterally without any discharge. His chest is clear, and his heart sounds are normal. He does not have any hepatosplenomegaly. His has a lacy, confluent macular rash on his chest and upper arms, with mild peeling of the tips of his fingers. What is the most worrisome complication of this disease?

A 6-month-old male infant presents to your clinic because the mother is concerned that he is not eating well and he has been constipated. The mother
tells you that her prenatal course and delivery were uneventful. On physical examination, the infant has a puffy face, large tongue, and persistent nasal drainage. Which of the following conditions is most likely to present with these findings?

A 16-year-old sexually active woman is being seen in the emergency department. She is complaining of vaginal discharge. She has a temperature of 99.5°F, but is otherwise well. On pelvic examination, you see a mucopurulent cervical discharge with scant blood. Samples of the discharge are sent to the laboratory for culture. There are no cervical ulcers noted. She does not have any medical allergies. For this patient, what is the most appropriate regimen for initial therapy?

An 8-year-old male presents to your office complaining of a 1-week history of painful knee and elbow joints. On examination, you find a painful, hot, and swollen knee. He also has multiple erythematous macules with pale centers on his trunk and extremities. The laboratory work you order reveals elevated antistreptococcal antibodies. What is the most likely diagnosis?

A well-appearing 6-year-old presents to your office with a chief complaint of bruising. The parents report that the child had a cold 2 weeks ago but completely recovered. The child is sitting on the examining table, in no distress, discussing her favorite cartoons. On examination, you find mucosal bleeding and bruises on the child’s arms and chest. You order a complete blood count (CBC) that has the following results: WBC 12,000, hemoglobin 11 g/dL, and a platelet count of 45,000. Following your initial evaluation and treatment, you see the child for follow-up in 1 week. She continues to appear well but still has obvious purpura and her platelet count is now 17,000. All other cell lines are normal. Of the
options listed below, what is your most appropriate management at this time?

You see a 3-week-old infant in your office for an acute visit. She was born via spontaneous vaginal delivery following a term, uncomplicated prenatal course. The parents are concerned because they have seen some streaks of blood in her diaper over the past few days. The infant’s stools have been soft and not difficult to pass. The parents relate that she is eating 2 oz every 2 hours of a cow’s milk based formula. What is the carbohydrate source in most infant formula?

A 6-month-old male infant presents to your clinic because the mother is concerned that he is not eating well and he has been constipated. The mother
tells you that her prenatal course and delivery were uneventful. On physical examination, the infant has a puffy face, large tongue, and persistent nasal drainage. The above condition can be caused by a deficiency of which of the following?

An 8-month-old boy is brought to the clinic by his mother because he has been lethargic, fussy, and not feeding well over the past several days. The mother has been working two jobs so the baby has been cared for by her boyfriend for the past month. She is very worried because he has not been smiling and vocalizing as much as he normally does and he has not been able to lift his head. What is the most common cause of injury in the first year of life?

An 8-year-old male presents to your office complaining of a 1-week history of painful knee and elbow joints. On examination, you find a painful, hot, and swollen knee. He also has multiple erythematous macules with pale centers on his trunk and extremities. The laboratory work you order reveals elevated antistreptococcal antibodies. Which of the following information is required to make this diagnosis?

A 4-year-old child is brought to your office because of a sudden onset of irritability, weakness, and pallor. The mother tells you that both of her children have been experiencing episodes of vomiting and diarrhea. Your physical examination reveals a blood pressure of 115/80, dry mucus membranes, petechiae, and diffuse abdominal pain. The following laboratory work is obtained:
Urinalysis: microscopic hematuria and proteinuria
Blood urea nitrogen (BUN)/creatinine (Cr):
20/1.0 mg/dL
Hemoglobin: 7 g/dL
Peripheral blood smear: fragmented RBCs
Prothrombin time (PT), partial thromboplastin time (PTT): normal
Coombs’ test: negative
What is the most likely diagnosis?

You see a 3-week-old infant in your office for an acute visit. She was born via spontaneous vaginal delivery following a term, uncomplicated prenatal course. The parents are concerned because they have seen some streaks of blood in her diaper over the past few days. The infant’s stools have been soft and not difficult to pass. The parents relate that she is eating 2 oz every 2 hours of a cow’s milk based formula. What is the most likely cause of the blood in her stool?

A 4-year-old child is seen in the emergency department after having a seizure at home. This is the first time that this has happened. The mother says that the child was sitting on the couch watching television when she suddenly became limp, started drooling, and having generalized tonic-clonic movements of her arms and legs. The mother relates that the child felt like she was “burning up” and that the tonic-clonic activity stopped after a few minutes. The mother says that the child is otherwise healthy, does not take any medicines, and has never been hospitalized. The child’s immunizations are up-to-date, and she has no known drug allergies. On examination, the vital signs are temperature of 104°F, BP 97/49, HR 112, and RR 26. The child is sitting on the examination table playing with stickers and drawing. She has a mild amount of clear nasal congestion but her examination is otherwise normal. When asked, the child replies that she feels fine. What is the most likely diagnosis?

An 8-month-old boy is brought to the clinic by his mother because he has been lethargic, fussy, and not feeding well over the past several days. The mother has been working two jobs so the baby has been cared for by her boyfriend for the past month. She is very worried because he has not been smiling and vocalizing as much as he normally does and he has not been able to lift his head. Which of the following findings on physical examination is suggestive of child abuse?

On a Monday morning you see a 12-year-old otherwise healthy boy in the emergency department. The parents brought the boy in because they noticed
that he started to have an abnormal gait in the past few days. He seems to be shuffling his feet. The boy complains that his legs feel heavy and are tingling.
He relates that his arms feel fine. His past history is significant for attention deficit/hyperactivity disorder (ADHD) for which he is taking methylphenidate.
He denies trauma or taking any other medicines or drugs. On examination, he is afebrile with normal vital signs. His entire physical examination is normal with the exception of the examination of his lower extremities. He has 3/5 strength throughout both of his lower extremities with a normal muscle mass. His all joints have a full range of motion, without any pain or swelling. His reflexes are absent and he describes some paresthesias of his feet and ankles. What is the most likely diagnosis?

A mildly mentally retarded 9-year-old girl is brought to your office for acne. On examination, she does not actually have acne but has small flesh colored papules along her nasolabial fold. Her past history is significant for having had a first (afebrile) seizure last year. The mother reminds you that she has a faint birthmark on her hip that is pale and becomes more prominent in the summer, when the child’s skin tans. Examination of this area reveals a 5-cm oval patch that is hypopigmented. Which condition would she most likely have?

In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking (“seal” like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F. What is the most likely diagnosis?

A 4-year-old child is seen in the emergency department after having a seizure at home. This is the first time that this has happened. The mother says that the child was sitting on the couch watching television when she suddenly became limp, started drooling, and having generalized tonic-clonic movements of her arms and legs. The mother relates that the child felt like she was “burning up” and that the tonic-clonic activity stopped after a few minutes. The mother says that the child is otherwise healthy, does not take any medicines, and has never been hospitalized. The child’s immunizations are up-to-date, and she has no known drug allergies. On examination, the vital signs are temperature of 104°F, BP 97/49, HR 112, and RR 26. The child is sitting on the examination table playing with stickers and drawing. She has a mild amount of clear nasal congestion but her examination is otherwise normal. When asked, the child replies that she feels fine. Which test(s) should be performed while the child is in the emergency department to evaluate the cause of these seizures?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. Which of the following signs is associated with Down syndrome?

On a Monday morning you see a 12-year-old otherwise healthy boy in the emergency department. The parents brought the boy in because they noticed
that he started to have an abnormal gait in the past few days. He seems to be shuffling his feet. The boy complains that his legs feel heavy and are tingling.
He relates that his arms feel fine. His past history is significant for attention deficit/hyperactivity disorder (ADHD) for which he is taking methylphenidate.
He denies trauma or taking any other medicines or drugs. On examination, he is afebrile with normal vital signs. His entire physical examination is normal with the exception of the examination of his lower extremities. He has 3/5 strength throughout both of his lower extremities with a normal muscle mass. His all joints have a full range of motion, without any pain or swelling. His reflexes are absent and he describes some paresthesias of his feet and ankles. Which of the following is the most appropriate initial management plan?

A mildly mentally retarded 9-year-old girl is brought to your office for acne. On examination, she does not actually have acne but has small flesh colored papules along her nasolabial fold. Her past history is significant for having had a first (afebrile) seizure last year. The mother reminds you that she has a faint birthmark on her hip that is pale and becomes more prominent in the summer, when the child’s skin tans. Examination of this area reveals a 5-cm oval patch that is hypopigmented. In evaluating her first seizure, a head CT was performed. Which finding would be most consistent with her diagnosis?

In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking (“seal” like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F. What is the most common etiology of this illness in children?

A 4-year-old child is seen in the emergency department after having a seizure at home. This is the first time that this has happened. The mother says that the child was sitting on the couch watching television when she suddenly became limp, started drooling, and having generalized tonic-clonic movements of her arms and legs. The mother relates that the child felt like she was “burning up” and that the tonic-clonic activity stopped after a few minutes. The mother says that the child is otherwise healthy, does not take any medicines, and has never been hospitalized. The child’s immunizations are up-to-date, and she has no known drug allergies. On examination, the vital signs are temperature of 104°F, BP 97/49, HR 112, and RR 26. The child is sitting on the examination table playing with stickers and drawing. She has a mild amount of clear nasal congestion but her examination is otherwise normal. When asked, the child replies that she feels fine. Which of the following medications would be most appropriate to be given to the child while in the emergency department?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. After confirming that the child does indeed have Down syndrome, the parents ask you what problems their baby may have in the future. With which of the following is the infant most likely to have problems?

You are called to see a 12-hour-old male infant who was born to a 19-year-old G1 woman with no prenatal care. She presented to the emergency room completely dilated and crowning. The baby was born minutes later. On examination, the baby is febrile and tachypneic. A CXR confirms the presence of pneumonia. What is the most likely infectious agent?

Which of the following conditions usually causes hypoglycemia at birth?

In January, you see an 18-month-old boy in the middle of the night in the pediatric emergency department. The father relates that 1 hour ago his son started coughing. The father describes the cough as barking (“seal” like). The child has mild stridor at rest, but otherwise is not in respiratory distress. His RR is 45 breaths per minute. He has a temperature of 103.4°F. What is the most common x-ray finding in this illness?

A 2-week-old infant is brought to the office for a check-up. The father relates that they have no concerns except that the baby seems to have tearing from his left eye. They also point out some swelling at the edge of his left eye. The infant is eating, sleeping, stooling, and voiding well. On examination, you find a ¹/₂ × ¹/₂ cm firm nodule inferior to the medial canthus of the left eye. What does this most likely represent?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. The infant begins to have progressively large amounts of bilious emesis. The infant feeds well and has only a small amount of abdominal distention. What is the most likely diagnosis?

A 4-year-old is brought to your office by his mother for evaluation. She is concerned because the child has been spiking fevers and pulling on his left ear.
Your examination reveals a bulging and erythematous tympanic membrane (TM). Which of the following is most likely to be the cause of his illness?

A 10-month-old infant has a dysplastic right external ear, some preauricular tags, and a small notch (coloboma) in the iris and lower lid. Which condition does he likely have?

Parents bring their 12-year-old son to your clinic for evaluation. The child states that he gets teased a lot in school because of his short stature. His weight and height are below the 10th percentile for his age. His parents are of average height. Following your physical examination, you determine that he has tanner stage 1 development and his bone age is that of a 9-year-old male. His examination is
otherwise normal. What is the most likely diagnosis?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. If you were to perform an abdominal x-ray, what is the most likely finding that would be seen?

A 4-year-old is brought to your office by his mother for evaluation. She is concerned because the child has been spiking fevers and pulling on his left ear.
Your examination reveals a bulging and erythematous tympanic membrane (TM). You determine that the child should receive antibiotics. The initial antibiotic of choice should be?

While working in the emergency department in the winter, you examine a 3-week-old female infant. The baby is accompanied by her mother and father. They report that the baby has been congested for the past 24 hours. The parents have been taking the infant’s temperature rectally and report that it has been normal. The
infant was a born at 35 weeks’ gestation and was delivered by caesarian due to preeclampsia. On examination, you see a well-appearing infant with a respiratory rate (RR) of 46 and a heart rate (HR) of 112. The TMs are normal and the lung fields are clear to auscultation. The mother relates that she has had a “cold” for the past few days. The father reports that he smokes, but only outside. As part of your evaluation you perform a nasopharyngeal swab for RSV antigen, which comes back positive. The best course of action for this infant is which of the following?

Parents bring their 12-year-old son to your clinic for evaluation. The child states that he gets teased a lot in school because of his short stature. His weight and height are below the 10th percentile for his age. His parents are of average height. Following your physical examination, you determine that he has tanner stage 1 development and his bone age is that of a 9-year-old male. His examination is
otherwise normal. Which of the following is a true statement regarding the assessment of a child with short stature?

You are called to see a newborn in the nursery because the nurse is concerned that the baby may have Down syndrome. What is the most common central nervous system (CNS) complication of Down syndrome?

Which of the following has a carrier state that is not considered contagious?

A term infant male is born after an uncomplicated vaginal delivery. The mother’s prenatal labs were negative with the exception of being GBS positive at 36 weeks’ gestation. The mother received two doses of ampicillin prior to delivery and did not have a fever. The infant had APGAR scores of 9 at 1 minute and 9 at 5 minutes. The infant was brought to the newborn nursery and appears well. The most appropriate management of the infant would be which of the following?

A mother brings her 15-year-old son in for a preparticipation sports physical examination. She feels that her son has not yet undergone pubertal changes and that makes her concerned. Which of the following is a true statement regarding puberty delay?