Growth/Development — MCQs

An 8-year old boy is brought to the emergency department because he has been lethargic and has had several episodes of nausea and vomiting for the past day. He has also had increased thirst over the past two months. He has lost 5.4 kg (11.9 lbs) during this time. He is otherwise healthy and has no history of serious illness. His temperature is 37.5 °C (99.5 °F), blood pressure is 95/68 mm Hg, pulse is 110/min, and respirations are 30/min. He is somnolent and slightly confused. His mucous membranes are dry. Laboratory studies show: Hemoglobin 16.2 g/dL Leukocyte count 9,500/mm3 Platelet count 380,000/mm3 Serum Na+ 130 mEq/L K+ 5.5 mEq/L Cl- 99 mEq/L HCO3- 16 mEq/L Creatinine 1.2 mg/dL Glucose 570 mg/dL Ketones positive Blood gases, arterial pH 7.25 pCO2 21 mm Hg Which of the following is the most appropriate next step in management?

An otherwise healthy 14-year-old girl is brought to the emergency room by her father because of excessive thirst, excessive urination, and weight loss. Her symptoms started acutely 5 days ago. Vital signs reveal a temperature of 36.6°C (97.8°F), blood pressure of 100/65 mm Hg, and pulse of 105/min. Physical examination shows a thin girl with dry mucous membranes but normal skin turgor. Laboratory results are shown: Random blood sugar 410 mg/dL C-peptide undetectable Serum beta-hydroxybutyrate negative Which of the following is the best initial therapy for this patient?

A 3-year-old boy is brought to the physician for evaluation of developmental delay. He could sit alone at 12 months and started walking with support at the age of 2 years. He can name only very few familiar objects and uses simple two-word sentences. He cannot stack more than 2 blocks. His parents report that he does not like playing with other children. He is at the 80th percentile for head circumference, 85th percentile for height, and 50th percentile for weight. He has a long and narrow face as well as large protruding ears. His thumbs can be passively flexed to the ipsilateral forearm. This patient is at increased risk of developing which of the following conditions?

A previously healthy 14-year-old girl is brought to the emergency department by her mother because of abdominal pain, nausea, and vomiting for 6 hours. Over the past 6 weeks, she has also had increased frequency of urination, and she has been drinking more water than usual. She has lost 6 kg (13 lb) over the same time period despite having a good appetite. Her temperature is 37.1°C (98.8°F), pulse is 125/min, respirations are 32/min, and blood pressure is 94/58 mm Hg. She appears lethargic. Physical examination shows deep and labored breathing and dry mucous membranes. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. Urine dipstick is positive for ketones and glucose. Further evaluation is most likely to show which of the following findings?

An 11-month-old boy is brought to a pediatrician by his parents for evaluation of vomiting and watery diarrhea over the last day. The mother informs the pediatrician that the boy had consumed an apple bought from a fruit vendor on the previous day, but that otherwise there has been no recent change in his diet. There is no history of blood in the stool, flatulence, irritability, or poor appetite. There is no history of recurrent or chronic diarrhea or any other gastrointestinal symptoms. On physical examination, his temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 24/min, and blood pressure is 92/60 mm Hg. General examination reveals a playful infant with normal skin turgor and no sunken eyes. The pediatrician explains to the parents that he most likely has acute gastroenteritis and that no specific medication is indicated at present. He also instructs the parents about his diet during the illness and reviews the danger signs of dehydration. He suggests a follow-up evaluation after 48 hours or earlier if any complications arise. Which of the following dietary recommendations did the pediatrician make?

A 28-year-old gravida 1 para 1 woman is being seen in the hospital for breast tenderness. She reports that both breasts are swollen and tender. She is also having difficulty getting her newborn to latch. The patient gave birth 4 days ago by uncomplicated vaginal delivery. During her pregnancy, the patient developed gestational diabetes but was otherwise healthy. She took folate and insulin. She attended all her pre-natal appointments. Upon examination, the patient has a low grade fever, but all other vital signs are stable. Bilateral breasts appear engorged and are tender to palpation. There is no erythema, warmth, or induration. A lactation nurse is brought in to assist the patient and her newborn with more effective breastfeeding positions. The patient says a neighbor told her that breastmilk actually lacks in nutrients, and she asks what the best option is for the health of her newborn. Which of the following components is breastmilk a poor source of?

A clinical study is studying new genetic gene-based therapies for children and adults with sickle cell disease. The patients were informed that they were divided into two age groups since younger patients suffer from different complications of the disease. The pediatric group is more likely to suffer from which of the complications? I. Splenic sequestration II. Avascular necrosis III. Pulmonary hypertension IV. Acute chest syndrome V. Nephropathy

A 4-month-old girl is brought to the physician because she has been regurgitating and vomiting 10–15 minutes after feeding for the past 3 weeks. She is breastfed and formula-fed. She was born at 38 weeks' gestation and weighed 2966 g (6 lb 9 oz). She currently weighs 5878 g (12 lb 15 oz). She appears healthy. Vital signs are within normal limits. Examination shows a soft and nontender abdomen and no organomegaly. Which of the following is the most appropriate next best step in management?

A 2-year-old boy is brought to the emergency department by his mother because of progressive fatigue, abdominal pain, and loss of appetite over the past 3 days. He was treated in the emergency department once in the past year for swelling of his hands and feet. He was adopted as a baby from Sudan and his family history is unknown. He does not take any medication. He is lethargic. His temperature is 37.5°C (99.5°F), pulse is 141/min, respirations are 25/min, and blood pressure is 68/40 mm Hg. Examination shows pale, dry mucous membranes and scleral icterus. Laboratory studies show: Hemoglobin 7.1 g/dL Mean corpuscular volume 93 fL Reticulocyte count 11% Serum Lactate dehydrogenase 194 IU/L Total bilirubin 6.4 mg/dL Direct bilirubin 0.5 mg/dL Haptoglobin 21 mg/dL (N = 41–165) Further evaluation of this patient is most likely to show which of the following findings?

A 3-month-old boy is brought to the physician by his parents for the evaluation of a rash on his scalp and forehead. The parents report that the rash has been present for several weeks. They state that the rash is sometimes red and scaly, especially when it is cold. The patient was born at 36 weeks' gestation and has generally been healthy since. His father has psoriasis. The patient appears comfortable. Examination shows several erythematous patches on the scalp, forehead, and along the hairline. Some patches are covered by greasy yellow scales. Which of the following is the most likely diagnosis?