Question of the Week # 475

A 2-week-old infant is brought to the office for a regular postnatal follow-up. She was born after an uneventful term pregnancy to a 29-year-old G2P2 woman. Mother reports that the infant is feeding well and seems active. No evidence of any fever. The parents are worried about the ‘rash’ that appeared over the infant’s left cheek. On examination, a lesion is noted on the infant’s left cheek as shown below. Vital signs are within normal limits. What is the most appropriate next step in management of this finding?

lesion

A Surgical excision of the entire lesion
B Biopsy of the lesion
C Laser removal of the lesion
D Reassurance and observation
E Topical 5-fluoro-uracil

Question of the Week # 442

442 ) A 14 month old toddler is brought to your out-patient clinic by her concerned mother regarding a rash that appeared recently in her ano-genital region. The rash has appeared 3 weeks ago and is persistent. Mother says she tried to use local Zinc Oxide  cream but it did not help. There is no history of fever. No vaginal discharge. She is otherwise healthy and reaching all her milestones appropriately. On examination, she is afebrile. There are several papules seen in the ano-genital area as shown below.

IMAGE 3 KIDS

Which of the following is the most appropriate next step?

A) Screen for Child Sexual Abuse

B) Local steroid application

C) Reassure that the rash will resolve in few months

D) Refrain the child from Day-care to prevent transmission

E) Local antibiotic application

Question of the Week # 441

441) A 3 week old male infant is evaluated for a rash in your clinic . Mother appears concerned and she reports rash has appeared all of a sudden over his cheeks, in the genital areas and on certain areas of trunk. The baby is entirely on formula feeds. No history of fever. The mother is healthy and none of the family members are sick at home. The baby was born by an uncomplicated vaginal delivery. On examination, he is afebrile.  There are numerous white papules on his face around the nose, cheeks and in the genital areas. A picture of the rash is shown below:

IMAGE 2 KIDS

Which of the following is the most likely diagnosis?

A) Miliaria

B) Molluscum Contagiosum

C) Erythema Toxicum

D) Milia

E) Staphylococcal Pyoderma

Question of the Week # 424

424) A 3 day old male infant is evaluated for a rash that developed previous night and has been progressing. The rash first started on his face as flat red patches but now it has become bumpy and some of them have pus in it. The baby is breast feeding and there is no history of fever. The mother is healthy and none of the family members are sick at home. The baby was born by an uncomplicated vaginal delivery. On examination, he is afebrile. There are numerous small flat red patches along with yellowish-white papules and numerous pustules all over his trunk and extremities. The lesions on his face seem to be resolving. Palms and soles are not involved. A Wright-stained smear of pustular fluid shows numerous eosinophils and occasional neutrophils. A picture of the rash is shown below:

 

Which of the following is the most likely diagnosis?

A) Miliaria

B) Eosinophilic Pustular Folliculitis

C) Erythema Toxicum

D) Milia

E) Staphylococcal Pyoderma

Question of the Week # 423

423) A 14 month old male baby is brought to your office by his concerned mother for recurrent diarrhea over the past 2 months. He also developed a scaly rash around his mouth, on the cheeks and on buttocks. He has been exclusively breast-fed for about 8 months and has been started on gradual weaning process over the last four months. He is otherwise, a healthy child. There is no family history of eczema. On examination, he is afebrile and vitals are stable. Physical examination shows lesions around the ano-genital area as shown below :

Similar lesions are seen over his cheeks and around the mouth. Which of the following is indicated in this patient at this time?

A) Exclusive Breastfeeding

B) Serum Lead level

C) Serum Zinc level

D) Glucoagon level

E) Sweat Chloride Level

Question of the Week # 255

A 16 year old woman is brought to your office by her mother for medical evaluation. Her mother has been out of country on a long business trip for 8 months and upon her return, she was shocked to notice that her daughter looked much skinnier than she was 8 months ago. The patient has lost about 30 lbs weight in the past 8 months and reports irregular menstruation. She is fearful of gaining weight and has been exercising excessively.  Physical examination reveals a very thin woman with a Body Mass Index (BMI) of 16. She has fine, downy dark hair all over her body. Which of the following findings are frequently seen in association with this condition?

A)     Diarrhea

B)     Tachycardia

C)      Hyperkalemia

D)     Decreased Bone mineral density

E)     Metabolic Acidosis

Question of the Week # 244

244 )  A 10-year-old Caucasian boy presents with right scrotal pain of 7 hours duration. The pain is acute in onset, constant and does not change with position. The patient denies any fever, chills, dysuria, nausea or vomiting. He denies any recent history of trauma. On physical examination, the patient is afebrile and is in moderate distress secondary to pain. There is no urethral discharge. Cremasteric reflex is present bilaterally. There is bluish discoloration and localized tenderness in the upper part of the testes. Labs reveal a normal Complete Blood Count and Urinalysis. What is the most likely clinical diagnosis in this patient?

A)     Testicular torsion

B)      Strangulated Hernia

C)      Congenital Hydrocele

D)     Torsion of Testicular appendix

E)      Acute Epidydimitis

 

 

 

 

Question of the Week # 227

227 )  A 32 year old man is evaluated in the clinic for intensely itchy rash . The rash appeared suddenly on his trunk 24 hours ago  and has spread to his extremities. He denies any fever or  using any recent medications. His travel history is significant for a trip to Colarado 3 days ago where he stayed with his friend in a hotel room. He enjoyed camping in the mountains and spent his evenings in the hotel building’s swimming pool. On examination, there  are multiple red papules all over his body and extremities but not on the head and the neck. Some of the papules are tender. Which of the following is the most appropriate next step in management?

A) Doxycycline

B) Lyme Serology

C) Ciprofloxacin

D) Reassurance

E) Amoxicillin-Clavulunate

Question of the Week # 226

226 )  A 2 year old male child is brought by his pregnant mother for evaluation of a rash all over his body. The rash developed 48 hours ago and is associated with fever. She also has a 12 year old daughter at home who is being treated for acute lymphoid leukemia. On examination, the patient has rash in different stages including papules, pustules and vesicles. You suspect chickenpox. The mother denies any history of chickenpox in the past. Which of the following is the most appropriate recommendation?

A)     Varicella vaccine to the male child

B)      Varicella vaccine to the mother

C)      Varicella Zoster immunoglobulin to mother and the daughter

D)     Varicella vaccine to mother and VZIG to the daughter

E)      Varicella vaccine to the mother and the daughter

Question of the Week # 201

201) A 16 year old male athlete is rushed to the Emergency Room after he collapsed during a basket ball match.  In the Emergency Room, he is found to be in cardiac arrest  and cardio-pulmonary resuscitation is begun as per ACLS protocol. A electrocardiogram reveals ventricular fibrillation which is successfully defibrillated with 200 joules. The patient is currently awake but confused. His mother is present at the bed-side and denies any family history of sudden cardiac death. Which of the following is the most common cause of sudden death in young athletes?

A) Aortic dissection

B) Long QT syndrome

C) Blunt trauma to the chest

D) Hypertrophic Obstructive Cardiomyopathy

E) Mitral valve prolapse

Question of the Week # 195

195)  A 3 year old male child is brought to emergency room by his concerned mother because of history of fever for the past 5 days. The patient also has developed a red rash on his extremities.  On physical examination, temperature is 102F. The tongue is very inflamed and has red, enlarged papillae. Posterior pharynx is erythematous without any exudate.  There is a palpable cervical lymph node of 1.8cm on the right side of the neck. There is conjunctival erythema bilaterally. Erythema is noted on palms and soles. and skin appears to be peeling off around the nails. Laboratory investigations reveal a WBC count of 15,000/µl, platelet count of 550000 per μl and an ESR of 50mm/hr. Which of the following therapeutic interventions are most helpful in preventing the complications associated with this condition?

a)      Penicillin

b)      Corticosteroids

c)       Aspirin

d)      Intravenous Immunoglobulin

e)      Clindamycin

Question of the Week # 194

194)  A 3 year old male child is brought to emergency room by his concerned mother because of history of fever for the past 5 days. The patient also has developed a red rash on his extremities.  On physical examination, temperature is 102F. The tongue is very inflamed and has red, enlarged papillae. Posterior pharynx is erythematous without any exudate.  There is a palpable cervical lymph node of 1.8cm on the right side of the neck. There is conjunctival erythema bilaterally. Erythema is noted on palms and soles. and skin appears to be peeling off around the nails. Laboratory investigations reveal a WBC count of 15,000/µl, platelet count of 550000 per μl and an ESR of 50mm/hr. Which of the following is the complication that is most likely to develop if this condition is not treated early in the course?

A) Toxic Shock Syndrome
B) Acute Glomerulonephritis
C) Coronary artery aneurysm
D) Carditis
E) Aortic regurgitation

Question of the Week # 184

Q184)  A 10 year old boy is evaluated in the emergency room after he tripped over and fell during a basketball game. There is no history of loss of consciousness. He denies any injury except  some pain in the occipital area of the skull.  He also reports chronic fatigue. A routine skull x-ray is obtained for evaluation and is shown below:

Which of the following is most likely to be associated with these incidental skull x-ray findings ?

A) Monoclonal gammopathy

B) Pituitary tumor

C) Hemolysis

D) Paget disease

E) Glioma

Question of the Week # 140

140) A 15 year old boy with history of Cystic Fibrosis presents to the Emergency room with complaints of severe right lower quadrant abdominal pain. He also gives a history of nausea and vomiting for the past 8 hours. On examination, his temperature is 102F and he has right lower quadrant tenderness at McBurney’s Point.  CT scan of the abdomen revealed calcified appendicolith within the dilated, fluid-filled appendix and infiltration of the surrounding retroperitoneal fat. The patient is scheduled for Appendicectomy. However, pre-operative labs reveal an abnormal result that would put the patient at an increased risk of bleeding from surgery. The patient is referred for medical clearance. Which of the following is most likely to be abnormal in this patient?

A)     Platelet count

B)      Prothrombin time

C)      Partial Thromboplastin Time

D)     Both Prothrombin time and Partial Thromboplastin time

E)      Bleeding time

Question of the Week # 128

Q128]  Parents of a 2-year-old come in to discuss their child’s recent febrile seizures. The child has experienced four seizures, each associated with fever (usually from an ear infection). Each seizure lasted less than 2 minutes and was generalized tonic-clonic. The child was usually post-ictal for about 60 minutes but then returned to his normal level of mental function. The parents are concerned about the long-term significance of these seizures specifically, about any permanent brain damage and retardation. They wonder if their child should be on medication to prevent the seizures.
Which of the following is the most appropriate statement?

A) Children with a history of febrile seizures usually go on to a more complicated seizure pattern as they age.
B) Children with a history of febrile seizures typically perform less well on standardized school tests.
C) Children with febrile seizures typically are growth retarded.
D) Children with febrile seizures are at greater risk for premature death than the general public.
E) Most children who experience febrile seizures develop normally.

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