Prepared by Ibrahim Sammour And Hashim Ayyad Case

Prepared by Ibrahim Sammour And Hashim Ayyad

Case 1 You are called to the newborn nursery to evaluate a 1 -dayold baby who is irritable, tremulous, and has been feeding poorly. On physical examination you note that the term baby weighs 2, 200 g (<5 th percentile), and her head circumference is 31 cm (<5 th percentile). She is hirsute, has fifth finger clinodactyly, and has hypoplastic nails on her hands and feet. Her facial features are swollen, and her eyelids are edematous due to face presentation at delivery. Ø Of the following, the baby’s features are MOST likely due to prenatal exposure to Ø a) b) c) d) e) Alcohol Lithium Retinoic acid Tobacco Valproic acid

Case 2 You see a 13 -year-old African-American boy every 3 weeks in the office because he has severe asthma symptoms. During this visit, he reports that his symptoms have been worsening over the last few months. He is taking his controller medication, as verified by his prescription refills, and the refill record also shows that he uses one beta agonist metered dose inhaler every 3 weeks. Ø Of the following, the MOST likely cause of his worsening symptoms is Ø a) b) c) d) e) Excessive use of the beta agonist inhaler Ineffective controller medication Poor metered dose inhaler technique Recurrent viral infections Underutilization of nebulized beta agonist therapy

Case 3 A 16 -year-old boy sustained a pelvic fracture and bilateral femoral fractures in a motor vehicle accident. He has been in traction for 10 days. His vital signs were normal until 2 days ago, when his blood pressure began rising , ultimately reaching a level of 155/95 mm Hg. The remainder of findings on his physical examination is normal. Lab tests reveal: Na, 140 m. Eq/L; K 4 m. Eq/L; BUN, 12 mg/dl; Creatinine, 1 mg/dl. Urinanalysis reveals a urine specific gravity of 1. 035; no blood, WBCs, nitrites or protein. Ø Of the following, the MOST likely cause of this boy’s elevated blood pressure is Ø a) b) c) d) e) Essential hypertension Immobilization Pyelonephritis Renal failure SIADH

Case 4 You have just begun caring for a 15 -year-old boy who has contracted hepatitis C at birth. He has had a persistent elevated alanine aminotransferase concentration (ALT) since childhood. You refer him to a gastroenterologist, who performs a liver biopsy that demonstrates chronic hepatitis consistent with hep. C infection. He proposes treatment of the patient with alpha-interferon Ø Of the following, a TRUE statement regarding IFN therapy of hepatitis C is that Ø a) b) c) d) e) HCV genotype 1 is the most likely type to be eradicated by IFN therapy eradicates HCV in more than 75% of patients treated IFN therapy may worsen symptoms of major depressive illness Patients who have advanced cirrhosis are the most likely to benefit from treatment with alpha IFN Pretreatment with 14 day of prednisone improves the efficacy of IFN therapy

Case 5 A 4 -month-old boy presents to the emergency department with a fever of 2 days’ duration. He has at least four wet diapers per day, but has frequent vomiting and occasional diarrhea. He is able to take a bottle in the emergency department, but 30 minutes later he vomits most of his feeding. He has a temperature of 39. 6 C. There are no other abnormal findings on physical examination. You obtain a CBC, blood culture, and a catheterized specimen for urinanalysis and urine culture. The urinanalysis reveals 25 -50 WBCs per HPF, positive nitrites and positive leukocyte esterase. Ø Of the following the BEST management course is Ø Admission Antibiotics Renal US VCUG (once repeat culture negative) A No Oral Yes In 1 week B No Oral Yes In 6 weeks C Yes IV Yes In 1 week D No Oral No In 6 weeks E Yes IV No In 6 weeks

Case 6 A 5 -year-old girl presents with rhinitis, congestion, and sneezing of several moths’ duration. Antihistamine therapy has been somewhat helpful, but the girl still has symptoms. You have recommended removing the stuffed animals from her bed and closing the bedroom windows. There are no animals in the home, but some relatives have pets. Ø Of the following, the BEST next step is to Ø a) b) c) d) e) add an intranasal steroid to her regimen Begin antileukotriene therapy Change the type of antihistamine Not allow the child to visit her relatives Order immediate-type skin testing

Case 7 You are evaluating a 3 -day-old infant brought to the emergency department for lethargy. The pregnancy, labor, and delivery were uncomplicated, and the bay was discharged from the hospital yesterday. On physical examination, the heart rate is 180 beats/min, the respiratory rate is 80 breaths/min, and the blood pressure is 50/30 mm Hg. The infant is pale and mottled and has cool extremities and weak distal pulses. Ø Of the following, the MOST likely cardiac diagnosis is Ø a) b) c) d) e) Atrio. Ventricular Septal Defect Critical aortic stenosis Large VSD Tetralogy of Fallot Transposition of the great vessels

Case 8 A term infant who was delivered at home is breast-feeding poorly. She is referred to you 7 days after birth by a lactation consultant because of bleeding from the umbilical cord and blood in the stool. Findings on the physical examination are normal. There are no petechiae, and there is no hepatosplenomegally, purpura or neurologic abnormality. Ø Of the following, the MOST likely diagnosis is Ø a) b) c) d) e) Classic vitamin K deficiency Disseminated intravascular coagulation Factor VIII deficiency Neonatal alloimmune thrombocytopenia Von Willebrand disease

Case 9 A 9 -year-old girl comes to your office with a 2 month history of progressive weakness. She has particular difficulty climbing stairs and rising from a chair, and her mother states that she has had a poor appetite, constipation, and lowgrade fever. On physical examination, you note a facial rash that is most prominent on the cheeks and nasal bridge and proximal muscle weakness Ø Of the following, the MOST likely cause of this girl’s weakness is Ø a) b) c) d) e) Dermatomyositis Hypothyroidism Muscular dystrophy Myasthenia gravis Postviral myosits

Case 10 A 3 -year-old girl is brought to the emergency department with a history of blood in her stool. In the past 12 hours, she has had 3 large, mushy bowel motions that the parents say had about 2 tablespoons of blood mixed in with each stool. She has not vomited. She has been afebrile and does not appear uncomfortable when passing the stool. On physical examination, the frightened but active toddler is in no distress. Her abdomen is soft, and rectal examination demonstrates dark red blood. The hematocrit is 25%, platelets 350*103 /mcl, WBC 9*103 /mcl, PT 12. 5 sec, and PTT 25 sec. Ø Of the following, the next MOST appropriate diagnostic procedure is Ø a) b) c) d) e) Abdominal CT Colonoscopy Exploratory laparatomy Nasogastric tube placement 99 m. TC-pertechnetate scan

Case 11 A newborn delivered at 36 weeks’ gestation has excessive oral secretion and choking spells. The maternal history is notable for polyhydramnios. The infant’s abdomen is somewhat distended and tympanitic. Ø Of the following, the BEST procedure to evaluate this infant’s symptoms is Ø a) b) c) d) e) Attempt to pass a catheter through the posterior nose Attempt to pass a nasogastric tube into the stomach Barium swallow Fiberoptic endoscopy Transillumination of the chest

Case 12 A 2 -month-old preterm infant who has a history of Coombs-positive hemolytic anemia and jaundice in the newborn period presents with poor feeding. Physical examination reveals mild edema, pallor, a respiratory rate of 60 breaths/min, a heart rate of 166 beats/min, and a soft systolic heart murmur. Weight gain since the 2 -week health supervision visit has only been 250 g. A CBC reveals a Hb of 7 g/dl and normal platelet and WBC counts. RBC indices are normal. Ø Of the following. The BEST management of this infant is administration of Ø a) b) c) d) e) Increased caloric density formula Multivitamin with iron drops Packed RBC transfusion Subcutaneous erythropoietin Supplemental oxygen

Case 13 An otherwise well 4 -year-old boy presents with a low grade fever and a tender, warm erythematous area with a small punctum above the right knee. He exhibits tender right inguinal nodes Ø Of the following, the condition MOST characteristic of these findings is Ø a) b) c) d) e) Cellulitis Cutaneous abscess Ecthyma Impetigo Necrotizing fasciitis

Case 14 A woman presents to your office in the 3 rd trimester of her 1 st pregnancy. She wants to go back to work 6 weeks after delivering her infant and wishes to discuss the benefits of breastfeeding versus formula feeding. Ø Of the following, a TRUE statement about infant feeding is that Ø a) b) c) d) e) Breastfed infants are more likely to develop Vit. D deficiency than formula-fed infants Breastfed infants who develop colic should be placed on a low-iron infant formula Breastfeeding mothers who follow strict vegetarian diets do not need to worry about their infants developing vitamin B 12 deficiency Infants who are fed cow milk formula have a lower incidence of viral gastroenteritis than do breastfed infants The iron in breast milk has a decreased bioavailability compared with the iron in infant formula

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