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Pediatric Questions With Answers

Pediatric Questions With Answers

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Published by: clinicalskills on Sep 28, 2008
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Assessment Exam forUSMLE
*
Step 2:Pediatrics
Answers and Explanations 
*USMLE is a joint program ofthe Federation ofState Medical Boards ofthe United States,Inc.and the National Board of Medical Examiners.
 
©2003 Kaplan,Inc.All rights reserved.No part ofthis book may be reproduced in any form,by photostat,microfilm,xerography or any other means,or incorporatedinto any informationretrieval system,electronic or mechanical,without the written permission ofKaplan,Inc.Not for resale.
 
Pediatrics Assessment Exam
1
1.During an annual visit,a 5-year-old boy is noted to havea heart murmur.The murmur is soft systolic,grade II inintensity,best heard along the left lower sternal border,and does not radiate.The murmur decreases in intensity in the sitting position.The first and second heart soundsare normal and no gallop is heard.The patient is anactive child with no symptoms oftiredness or breathless-ness,and he has a good appetite.He was hospitalized asan infant for bronchiolitis.There is no other history of lung infections.His weight and height parameters are atthe fiftieth percentile.Lung examination reveals goodbreath sounds and no rales.There is no hepatomegaly orperipheral edema.The parents are concerned when they are told about the murmur.Which ofthe following is themost appropriate next step in management?(A)Obtain a chest x-ra(B)Obtain a hematocrit(C)Perform an electrocardiogram(D)Reassure the parents that the child is healthy (E)Send the child for an echocardiogram2.A 7-year-old boy is brought to the physician because of a new-onset rash on the trunk that appeared after arecent family camping trip in central Pennsylvania.Themother remembers that her son had a short-lived “flu”for several days on returning from camping thatresolved with over-the-counter cold medication.Approximately 2 weeks later they noticed a red spotdevelop on his flank that has since been enlarging.They tried applying cortisone cream to it with no result.Theboy is in good overall health and has no past history of serious medical problems.When the physician inquiresabout possible insect bites during the trip,the motherreports that she had removed several ticks from her sonduring their trip.No other family member has had sim-ilar symptoms and the family history is unremarkable.On physical examination the patient is in no acute dis-tress.His vital signs are within normal limits.Inspectionofthe skin reveals a large,annular,erythematous plaquewith central clearing present on the right flank.Thelargest diameter ofthe skin lesion is approximately 12cm.Axillary and inguinal lymph nodes are not palpable.Potassium hydroxide preparation ofskin scrapings fromthe edge ofthe lesion is negative.Which ofthe followingis the most appropriate treatment for this patient?(A)Intramuscular triamcinolone(B)Oral amoxicillin(C)Oral doxycycline(D)Topical hydrocortisone(E)Topical ketoconazole

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