Growth/Development — MCQs

A 10-year-old boy presents to his pediatrician for a well child appointment. The patient has been doing well in school. He plays on a club basketball team and is also a member of the chess club. He has many friends and is very happy. His parents currently have no concerns for him. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 85/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a tall, muscular young boy. He is in the 99th percentile for weight and height. Cardiopulmonary exam is within normal limits. The patient's abdomen is obese, non-tender, and non-distended. Neurological exam is grossly non-focal. Testicular exam is notable for a right-sided testicular mass. Musculoskeletal exam reveals a normal range of motion and 5/5 strength in his upper and lower extremities. Dermatologic exam reveals acne and facial hair on the patient's face. Which of the following is the most likely underlying diagnosis in this patient?

A 5-year-old child presents with lower-extremity edema for the past 4 days. Three weeks ago, he experienced several days of cough and fever that was treated with acetaminophen. His medical history is unremarkable; he was born after an uneventful term pregnancy. His vaccinations are up to date. At presentation, his blood pressure is 81/42 mm Hg, and heart rate is 111/min. The child is playful and in no acute distress. Physical examination is remarkable only for ocular 'puffiness' and lower-extremity edema. Chest auscultation is clear, and there are no abnormalities during abdominal inspection. A urinalysis shows the presence of proteinuria, but there is no hematuria. What is the most appropriate treatment for this patient?

A 4-day-old male newborn is brought to the physician for a well-child examination. His mother is concerned that he is losing weight. He was born at 40 weeks' gestation and weighed 2980g (6-lb 9-oz); he currently weighs 2830g (6-lb 4-oz). Pregnancy was uncomplicated. He passed stool and urine 8 and 10 hours after delivery. He has been exclusively breast fed since birth and feeds 11–12 times daily. His mother says she changes 5–6 heavy diapers daily. Examination shows an open and firm anterior fontanelle. Mucous membranes are moist. Capillary refill time is less than 2 seconds. Cardiopulmonary examination shows no abnormalities. Which of the following is the most appropriate next best step in management?

A 26-year-old G1P0 female who is 39 weeks pregnant presents to the emergency department in labor. She reports following her primary care physician’s recommendations throughout her pregnancy and has not had any complications. During delivery, the baby’s head turtled back into the vaginal canal and did not advance any further. The neonatal intensivist was called for shoulder dystocia and a baby girl was able to be delivered vaginally 6 minutes later. Upon initial assessment, the baby appeared pale throughout, had her arms and legs flexed without active motion, and had some flexion of extremities when stimulated. Her pulse is 120/min and had irregular respirations. What is this baby’s initial APGAR score?

A 7-year-old girl is brought to the physician because of scant painless bleeding from the vagina 6 hours ago. She has no history of serious illness or trauma. Her older sister had her first period at age 11. The patient is at the 80th percentile for height and 95th percentile for weight and BMI. Examination shows greasy facial skin and sparse axillary hair. Breast development is at Tanner stage 3 and pubic hair development is at Tanner stage 2. The external genitalia appear normal. Serum glucose is 189 mg/dL. Intravenous administration of leuprolide causes an increase in serum luteinizing hormone. Which of the following is the most likely underlying cause of this patient's findings?

A 19-year-old primigravid woman at 32 weeks' gestation comes to the physician because of a 2-day history of headache and blurred vision. She has had no prenatal care. She is diagnosed with pre-eclampsia. Amniocentesis shows a lecithin-sphingomyelin ratio of 0.7. If delivery is induced at this time, the newborn is most likely to show which of the following findings?

A 13-month-old boy is brought to the emergency department by his parents 30 minutes after having a 1-minute seizure. He has had a 1-day history of severe diarrhea and fever and 1 episode of vomiting. He has no history of serious illness. His immunization records are not available. He appears restless and cries when picked up from his mother's lap. His temperature is 38.9°C (102°F), pulse is 150/min, respirations are 30/min, and blood pressure is 90/50 mm Hg. Examination shows a distended abdomen. The extremities are cool to the touch, and his capillary refill time is 2–3 seconds. Further evaluation is most likely to show which of the following?

One week after discharge from the neonatal intensive care unit to a regular pediatric ward, a 1450-g (3-lb 1-oz) male infant has respiratory distress and wheezing. After birth, the patient was intubated and mechanically ventilated for 3 weeks because of hypoxia. He required a 60% fraction of inspired oxygen to achieve adequate oxygen saturation. His temperature is 36.9°C (98.4°F), pulse is 144/min, respirations are 59/min, and blood pressure is 65/35 mm Hg. Physical examination shows labored breathing, intercostal retractions, and crackles at both lung bases. There is bluish discoloration around the lips. An x-ray of the chest shows interspersed areas of atelectasis, granular densities, and hyperinflation. Which of the following is the most likely diagnosis?

A 7-day-old male infant presents to the pediatrician for weight loss. There is no history of excessive crying, irritability, lethargy, or feeding difficulty. The parents deny any history of fast breathing, bluish discoloration of lips/nails, fever, vomiting, diarrhea, or seizures. He was born at full term by vaginal delivery without any perinatal complications and his birth weight was 3.6 kg (8 lb). Since birth he has been exclusively breastfed and passes urine six to eight times a day. His physical examination, including vital signs, is completely normal. His weight is 3.3 kg (7.3 lb); length and head circumference are normal for his age and sex. Which of the following is the next best step in the management of the infant?

A 5-year-old patient is brought to the emergency department by his parents for concerning behavior. His parents relate that over the past 3 weeks, he has had multiple episodes of staring into space, lip smacking, and clasping his hands together. The patient has his eyes open during these episode but does not respond to his parents’ voice or his name. These episodes last between 1-2 minutes after which the patient appears to return back to awareness. The patient is confused after these episodes and appears not to know where he is for about 15 minutes. These episodes occur once every few days and the most recent one happened about 10 minutes before the patient arrived to the emergency department. On arrival, the patient is mildly confused and does not know where he is or what recently happened. He is slow to respond to questions and appears tired. Which of the following is the most likely diagnosis in this patient?