1.

A 5-year-old girl is brought to the physician because of temperatures to 40 C (104 F), tachypnea,
and a nonproducti e cough for 1! hours" Four days ago she #as treated #ith an oral antibiotic for suspected pneumococcal pneumonia" $%amination sho#s diminished breath sounds o er the lo#er right lung fields and dullness to percussion at the right costophrenic angle" &hich of the follo#ing is the most li'ely diagnosis( A ) )ronchopleural fistula ) ) $mpyema * C ) +ung abscess , ) -leurodynia $ ) -neumothora%

2. A 5-month-old boy is brought for a follo#-up e%amination" .e #as born at /0 #ee's1 gestation
and has had persistent #hee2ing since shortly after birth despite treatment #ith nebuli2ed and oral bronchodilators and oral corticosteroids" .is diet consists of /! ounces of iron-fortified co#1s mil'-based formula daily" .e appears #ell nourished and happy" 3n e%amination, there is moderate relief of #hee2ing #ith e%tension of the nec'" &hich of the follo#ing is the most li'ely mechanism of this infant1s #hee2ing( A ) Allergic reaction to co#1s mil' ) ) Aspiration of a foreign body C ) Compression of the air#ay by a ascular ring * , ) Concurrent upper respiratory tract infection $ ) -ersistent immaturity of lungs

3. An 14-month-old boy is brought to the emergency department because he has not used his left
arm since he fell #hile #al'ing and holding hands #ith his 4-year-old sister ! hours ago" 3n e%amination, he holds his left upper e%tremity at his side #ith his forearm pronated" 5here is no tenderness of the left lo#er e%tremity, but there is restricted mo ement of the elbo#" 5he remainder of the e%amination sho#s no abnormalities" &hich of the follo#ing is the most appropriate initial step in management( A ) -assi e hypersupination of the forearm * ) ) Application of figure-of-4 strap C ) Administration of analgesics and application of ice , ) Aspiration of the elbo# 6oint $ ) 7n-place splint immobili2ation of the elbo#

4. A 8-month-old girl is brought to the physician for a routine health maintenance e%amination" 9he
#as born #ith a lumbosacral myelomeningocele #hich #as successfully repaired at ! days of age" 5he anterior fontanelle is 8 % 4 cm and bulging, and the posterior fontanelle is / % 4 cm and bulging" 9he has se ere motor and sensory deficits in ol ing both lo#er e%tremities" A head gro#th chart sho#s the follo#ing alues: Age )irth 1 month ! months 4 months 8 months .ead circumference (cm) /4"! /8"8 /4 44 40

&hich of the follo#ing is the most li'ely cause of increased intracranial pressure( A ) Acute cerebral edema ) ) ,ecreased absorption of cerebrospinal fluid C ) ,ilation of cerebral arteries , ) 7ntracranial mass lesion $ ) 3bstruction of lateral sinus F ) 3bstruction of superior ena ca a ; ) 3bstruction of cerebrospinal fluid flo# * . ) 3 erproduction of cerebrospinal fluid

5. A 8-year-old girl is brought to the physician because of a 4-#ee' history of headache, fatigue,
and decreased appetite" ,uring this period, she has had nausea and omiting" At the age of 4 years, she #as diagnosed #ith poststreptococcal glomerulonephritis" 9he is at the 15th percentile for height and the 10th percentile for #eight" $%amination sho#s no abnormalities" .er serum urea nitrogen ()<=) le el is 50 mg>d+" &hich of the follo#ing is most li'ely to limit progression of this patient1s renal failure( A) 7ncreased potassium and sodium bicarbonate inta'e )) ,ecreased sodium and daily calorie inta'e C) +o#-protein diet * ,) 9trict fluid restriction $) ,ialysis

6. A pre iously healthy /-month-old girl is brought to the emergency department because of a /day history of grunting and increasing difficulty breathing" 9he appears ill" .er temperature is /8"0 C (?4 F), pulse is 180>min, and respirations are 08>min" $%amination sho#s grunting, nasal flaring, and mar'ed intercostal retractions" )ronchial breath sounds and occasional bilateral crac'les are heard on auscultation" 9erum studies sho#: Ca!@ 5"8 mg>d+ -hosphorus 11 mg>d+ Al'aline phosphatase !50 <>+ Capillary blood gas analysis on 100A o%ygen: p. 0"/8 -C3! /4 mm .g -3! 48 mm .g An %-ray film of the chest sho#s bilateral, diffuse interstitial infiltrates and absence of the thymic shado#" )ronchoal eolar la age is positi e for numerous -neumocystis carinii" &hich of the follo#ing is the most li'ely mechanism of these findings( A ) Adenosine deaminase deficiency ) ) Consumption of complement C ) ,efecti e opsoni2ation , ) ,estruction of C,4@ 5 lymphocytes $ ) ,e elopmental arrest of maturation of ) lymphocytes F ) ,ysmorphogenesis of the third and fourth pharyngeal pouches * ; ) 7mpaired chemota%is . ) 7mpaired phagocytic o%idati e metabolism

7. A 4-year-old boy is brought to the emergency department !0 minutes after being in ol ed in a

motor ehicle collision" .e #as an unrestrained passenger" 3n arri al, his blood pressure is 110>00 mm .g, pulse is 100>min, and respirations are /!>min #ith grunting and retractions" $%amination sho#s multiple bruises o er the chest" Arterial blood gas analysis #hile breathing 40A o%ygen sho#s: p. 0"/4 -C3! /4 mm .g -3! 88 mm .g An %-ray film of the chest obtained 4 hours later sho#s diffuse infiltrates on the right side" &hich of the follo#ing is the most li'ely diagnosis( A) Acute respiratory distress syndrome )) Aspiration pneumonia C) Fat embolism ,) .emothora% $) -ulmonary contusion *

8. A /-year-old girl is brought to the physician after her mother noted blood on her underpants"
$%amination sho#s genital condylomata acuminata in the perineal, peri-introital, labial, and anal areas" 9ome of the pedunculated condylomata appear to ha e caused the bleeding" 9he has no isible intra aginal condylomata or aginal or anal tears" .er mother has a palmar #art on her hand but no history of condylomata acuminata" .er mother has a boyfriend #ho does not li e #ith them and #ho has ne er been left alone #ith the girl" 5hey li e #ith the mother1s !0-yearold brother #ho only baby-sits the children #hen they are asleep" &hich of the follo#ing is the most appropriate ne%t step in management( A) -sychiatric assessment of the mother )) ,=A typing of the mother1s palmar #art for papilloma irus C) 5reatment of the mother1s palmar #art ,) Baginal, anal, and throat cultures for Chlamydia trachomatis and =eisseria gonorrhoeae in the child* $) +aser therapy of the condylomata acuminata in the child

9. A 18-year-old girl is brought to the physician because of episodes of palpitations o er the past 8
months" 5he episodes occur #hen she runs or plays bas'etball" 9he is other#ise asymptomatic" .er blood pressure is 1!4>48 mm .g, pulse is 04>min, and respirations are 14>min" 9he #eighs 55 'g (1!1 lb) and is 140 cm (01 in) tall" .er arm span is 144 cm (04 in), and the upper segment to lo#er segment ratio is 0"45" .er fingers appear long and are hypere%tensible" A grade 4>8, early diastolic murmur is heard along the upper and middle left sternal border #ith radiation to the ape%" -eripheral pulses are bounding" &hich of the follo#ing is the most li'ely cause of these findings( A) Aortic incompetence * )) Aortic stenosis C) Citral incompetence ,) Citral stenosis $) -ulmonary incompetence F) -ulmonary stenosis ;) 5ricuspid incompetence .) 5ricuspid stenosis

10. A pre iously healthy 4-year-old girl is brought to the physician because of fe er and refusal to
#al' for 1 day" 9he appears mildly ill" .er temperature is /4"8 C (101"5 F), pulse is 1!0>min, and respirations are !!>min" 5he right 'nee is erythematous and s#ollen" 9he holds her right 'nee in fle%ion and resists any attempted mo ement of her right leg" 9he cries #hen the right 'nee is mo ed" &hich of the follo#ing is the most appropriate ne%t step in management( A) Acetaminophen #ith codeine therapy )) Arthrocentesis * C) )one marro# aspiration ,) )one scan $) 7mmobili2ation and traction F) +yme titer ;) CD7 of the spine .) -hysical therapy 7) Deassurance E) 9erum rheumatoid factor assay F) 9ystemic antibiotic therapy

11. A 14-year-old boy is brought to the physician by his parents because of a !-year history of
increasing academic problems" .is parents say that he has al#ays been hyperacti e and distractible, but no# his academic performance has deteriorated to the point that he is failing ninth grade" .is teachers say that his hyperacti ity is disrupting the classroom" .e #eighs 54 'g (1!0 lb) and is 15! cm (80 in) tall" 9e%ual de elopment is 5anner stage 5G e%amination sho#s macro-orchidism, #hich #as not sho#n on pre ious e%aminations" .e has a high forehead and long, protruding ears" .e e%hibits poor eye contact during the e%amination" -sychoeducational testing sho#s an 7H of 00" &hich of the follo#ing is the most li'ely diagnosis( A) Attention-deficit>hyperacti ity disorder )) Autistic disorder C) ,o#n syndrome ,) Fetal alcohol syndrome $) Fragile I syndrome * F) +esch-=yhan syndrome ;) -er asi e de elopmental disorder, not other#ise specified .) -rader-&illi syndrome 7) Dett1s disorder E) 9eminiferous tubule dysgenesis (Flinefelter1s syndrome)

12. A 5-#ee'-old boy is brought to the physician because of omiting for / days" 9#itching from a
co#1s mil'-based formula to a soy-based formula and one bottle of an electrolyte solution has not decreased his omiting" .is mother says that there is no yello# color to the omitus, but it is forceful and occurs immediately after he has had 1 to ! ounces of liJuid" .e appears to omit more liJuid than he dran'" .e has one mustard-colored seedy stool daily" $%amination sho#s no abnormalities" &hich of the follo#ing is the most li'ely e%planation for his omiting( A) ,uodenal atresia )) ;astroesophageal reflu% C) .ypertrophic pyloric stenosis ,) +actose intolerance * $) -rotein malabsorption F) Dota irus infection

13. A 10-year-old girl is brought to the emergency department because of diffuse, aching abdominal
pain, nausea, and recurrent omiting o er the past 5 hours" 9he has an 4-year history of type 1 diabetes mellitus treated #ith !0 < of =-. and 8 < of regular insulin in the morning and 14 < of =-. and 5 < of regular insulin in the e ening" 9he appears lethargic but is easily arousable" 5here is an ob ious odor of 'etones on her breath" .er blood pressure is 100>00 mm .g, pulse is ?5>min, and respirations are !0>min and deep" 9erum studies sho#: =a@ 14! m$J>+ F@ 5"/ m$J>+ .C3/K 8 m$J>+ ;lucose 010 mg>d+ &hich of the follo#ing laboratory findings is most li'ely to be increased( A ) Arterial p. ) ) 9erum C-peptide le el C ) 9erum magnesium le el , ) 9erum osmolality * $ ) 9erum phosphorus le el

14. A 5-year-old girl #ith a entricular septal defect is scheduled for tonsillectomy in ! #ee's" 9he
has no 'no#n drug allergies" .er temperature is /0 C (?4"8 F)" $%amination sho#s no abnormalities" &hich of the follo#ing is the most appropriate prophyla%is prior to tonsillectomy( A) Amo%icillin * )) Ciproflo%acin C) Difampin ,) 5etracycline $) 5rimethoprim-sulfametho%a2ole F) =o prophyla%is indicated

15. A /-year-old boy #ho is .7B positi e is brought for a routine e%amination" .is diet is appropriate
for age" .is medications include three antiretro iral drugs and trimethoprim-sulfametho%a2ole for -neumocystis carinii prophyla%is" +aboratory studies sho#: .emoglobin 4"8 g>d+ Cean corpuscular hemoglobin /4 pg>cell Cean corpuscular hemoglobin concentration /0A .b>cell Cean corpuscular olume 101 Lm/ +eu'ocyte count 5800>mm/ 9egmented neutrophils 80A (many hypersegmented) )ands /A +ymphocytes /0A Ded cell distribution #idth !1A (=M10K18) &hich of the follo#ing is most li'ely to ha e pre ented this patient1s anemia( A) Folic acid supplementation * )) 7ron supplementation C) 5hyroid supplementation ,) Bitamin )1! (cyanocobalamin) supplementation $) Conthly intra enous immune globulin therapy

16. An 4-year-old girl #ith type 1 diabetes mellitus is brought to the emergency department 10
minutes after being in ol ed in a motor ehicle collision" 9he #as in the bac' seat of a small automobile that #as rear-ended" 7nitially, she #as alert during transport and reported bilateral thigh pain, but then she stopped tal'ing, closed her eyes, and became unresponsi e to oiceG on arri al, she responds to no%ious stimuli #ith brief grimaces and no #ithdra#al" .er blood pressure is 40>palpable mm .g, pulse is 144>min, and respirations are !4>min" Air entry is symmetric" 5he pupils are eJual and react to light" =o cardiac murmur is heard" 5he abdomen is soft" 5here is s#elling of the upper portions of both thighs" .er hematocrit is /0A" &hich of the follo#ing is the most appropriate ne%t step in management( A) Ceasurement of arterial blood gases )) I-ray film of the chest C) C5 scan of the head ,) Administration of 50A de%trose in #ater $) 7nfusion of 0"?A saline *

17. A pre iously healthy 18-year-old boy is brought to the emergency department !0 minutes after
an episode of left arm sha'ing that lasted appro%imately / minutes" 3 er the past ! days, he has had fe er and emotional lability" 3n arri al, his temperature is /4"? C (10! F)" .e is somnolent and disoriented to person, place, and time" .e responds poorly to pain" =eurologic e%amination sho#s no other abnormalities" +aboratory studies sho#: .ematocrit /4A +eu'ocyte count 8000>mm/ 9egmented neutrophils 50A +ymphocytes 50A -latelet count !40,000>mm/ Analysis of cerebrospinal fluid sho#s: +eu'ocyte count 1!0>mm/ 9egmented neutrophils !0A +ymphocytes 40A $rythrocyte count /00>mm/ ;lucose 80 mg>d+ -rotein 400 mg>d+ &hich of the follo#ing is the most li'ely cause of this patient1s neurologic findings( A) )acterial infection )) Congenital malformation C) Fungal infection ,) .emorrhage $) 7mmune-mediated demyelination F) -arasitic infection ;) Biral infection *

18. A 15-year-old boy is brought to the emergency department /0 minutes after a !-minute episode
of loss of consciousness after completing a 400-meter race" 3n a#a'ening, he says that he feels fine e%cept for shortness of breath" .e #eighs 4! 'g (140 lb) and is 1?1 cm (05 in) tall" .is blood pressure is 110>00 mm .g, pulse is 00>min and regular, and respirations are 15>min" 5he lungs are clear to auscultation" A grade !>8 systolic murmur is heard at the left sternal border #ith minimal radiation to the nec'G the murmur becomes louder #hen he stands" For each patient #ith loss of consciousness, select the most li'ely diagnosis" A) Aortic stenosis )) Carotid sinus hypersensiti ity C) Con ersion reaction ,) .ypertrophic obstructi e cardiomyopathy * $) .ypoglycemia F) Citral al e prolapse ;) 3rthostatic hypotension .) -ulmonary embolus 7) 9ei2ure E) Baso agal syncope F) Bertebrobasilar insufficiency

19. A /-year-old boy is brought to the physician because of a 0-day history of fe er and a painful
s#ollen lymph node in his groin" 5his is his si%th episode of lymph node s#ellingG the pre ious episodes resol ed after drainage and prolonged antibiotic therapy" .e also had pneumonia at the age of 1! months that reJuired chest tube placement for drainage" A maternal uncle died during childhood of recurrent infections" 5he patient is at the 5th percentile for height and #eight" .is temperature is /4"5 C (101"/ F)" $%amination sho#s a #arm, tender, erythematous lymph node in the right inguinal area" 5here are se eral healed incisions o er the inguinal area and nec' from old drainage sites" +aboratory studies sho#: .ematocrit /5A +eu'ocyte count 10,000>mm/ 9egmented neutrophils 85A )ands 10A +ymphocytes !5A -latelet count /50,000>mm/ A ;ram1s stain of the lymph node aspirate sho#s numerous segmented neutrophils filled #ith bacteriaG cultures gro# 9taphylococcus aureus" &hich of the follo#ing is the most li'ely mechanism for these findings( A) Adenosine deaminase deficiency )) Consumption of complement C) ,efecti e opsoni2ation ,) ,estruction of C,4@ 5 lymphocytes $) ,e elopmental arrest of maturation of ) lymphocytes F) ,ysmorphogenesis of the third and fourth pharyngeal pouches ;) 7mpaired chemota%is .) 7mpaired phagocytic o%idati e metabolism *

20. A ne#born is in se ere respiratory distress immediately follo#ing deli ery" 9he #as born at /5
#ee's1 gestation to a /5-year-old #oman, gra ida !, para 1, aborta 1, #ho did not recei e prenatal care" 5he ne#born1s pulse is 80>min, and respirations are irregular and labored" $%amination sho#s pallor #ith perioral cyanosis, anasarca, hepatosplenomegaly, and scattered petechiae" Cord blood hemoglobin is 4 g>d+, and reticulocyte count is 14A" A direct antiglobulin (Coombs1) test is positi e" &hich of the follo#ing sets of blood groups is most li'ely in the mother and her ne#born( Cother A) )) C) ,) $) A, Dh-positi e A, Dh-positi e A, Dh-negati e 3, Dh-positi e 3, Dh-negati e =e#born 3, Dh-positi e 3, Dh-negati e 3, Dh-negati e 3, Dh-negati e 3, Dh-positi e *

21. A /-year-old boy is brought for a follo#-up e%amination" .e 6ust completed a 10-day course of
amo%icillin that has not resol ed his right ear pain" .e appears irritable" .is temperature is /4"? C (10! F)" $%amination sho#s do#n#ard and lateral displacement of the right auricle #ith tenderness to palpation of the posterior auricular areaG his nec' is supple" &hich of the follo#ing is the most appropriate ne%t step in diagnosis( A) )one scan )) C5 scan of the head * C) 5ympanometry ,) +umbar puncture $) 5ympanocentesis

22. A 14-month-old girl is brought to the physician because of a 14-hour history of irritability and
episodes of dra#ing her 'nees to#ard her chest" ,uring this period, she has omited nonbilious fluid t#ice and had a bo#el mo ement containing a small amount of blood" 9he had an upper respiratory tract infection ! #ee's ago" 9he is listless e%cept for intermittent episodes of discomfort" .er temperature is /4 C (100"4 F)" Abdominal e%amination sho#s right-sided tenderness #ithout guarding or reboundG bo#el sounds are present" Dectal e%amination sho#s bright red blood and mucus" An %-ray film of the abdomen sho#s no abnormalities" &hich of the follo#ing is the most appropriate ne%t step in management( A) I-ray film of the upper gastrointestinal tract #ith contrast )) &ater-soluble contrast enema * C) Corticosteroid enemas ,) Admission to the hospital for total parenteral nutrition $) 7mmediate laparotomy

23. 3n a routine e%amination, a !-year-old boy has a hemoglobin le el of 10"5 g>d+, hematocrit of
/0A, and mean corpuscular olume of 0! Lm/" .e drin's four to fi e 4-o2 bottles of mil' daily" .e maintains a regular diet but does not eat egetables" &hich of the follo#ing is the most li'ely diagnosis( A) Folic acid deficiency )) 7ron deficiency * C) 9ic'le cell disease ,) 5halassemia $) Bitamin )8 deficiency

24. A !4-month-old boy has a history of cyanosis since birth #ith episodes of syncope" $%amination
sho#s cyanosis and clubbing" 5he lungs are clear to auscultation" 5here is a right entricular hea e, a systolic clic', a single 9!, and a grade />8 systolic murmur" &hich of the follo#ing is the most li'ely diagnosis( A) )icuspid aortic al e )) Coarctation of the aorta C) Citral stenosis ,) -atent ductus arteriosus $) 5etralogy of Fallot *

25. A !0-month-old girl is brought to the physician because of fe er and cough for ! days" 9he has
had se eral similar episodes since the age of 4 months" 5hree months ago, she and her family isited her grandmother in Finland for ! #ee's" 9he is at the !5th percentile for length and 5th percentile for #eight" 9he appears thin and pale" .er temperature is /4 C (100"4 F), pulse is 150>min, and respirations are 40>min" $%amination sho#s mild clubbing" &hee2ing and bilateral crac'les are heard at the lung bases" An %-ray film of the chest sho#s strea'y densities bilaterally #ith mild hyperinflation" A) N1-Antitrypsin deficiency )) Cystic fibrosis * C) -neumothora% ,) -ulmonary al eolar proteinosis $) -ulmonary aspergillosis F) -ulmonary hemorrhage ;) -ulmonary tuberculosis

26. A pre iously healthy 18-year-old boy is brought to the physician because of fe er and cough #ith
right-sided chest pain for ! #ee's" 9i% months ago, he isited his grandparents in Albania for ! #ee's" .e #eighs 54 'g (1!0 lb) and is 10/ cm (84 in) tall" .e appears thin and pale" .is temperature is /4"! C (100"4 F), pulse is 08>min, and respirations are /8>min" $%amination sho#s shallo# respirations #ith decreased breath sounds at the right lung base" An %-ray film of the chest sho#s a right pleural effusion and hilar adenopathy" A) N1-Antitrypsin deficiency )) Cystic fibrosis C) -neumothora% ,) -ulmonary al eolar proteinosis $) -ulmonary aspergillosis F) -ulmonary hemorrhage ;) -ulmonary tuberculosis *

27. 0-day-old ne#born is brought for a #ell-child e%amination" .e #as born at home" .is mother has
ta'en acetaminophen for perineal discomfort" 5he ne#born is breast-feeding #ell" .e is at the 05th percentile for length and #eight" $%amination sho#s no abnormalities" After accination #ith hepatitis ), he has prolonged bleeding at the in6ection site" 5here is no family history of e%cessi e bleeding" +aboratory studies sho#: .emoglobin 18 g>d+ +eu'ocyte count 8400>mm/ 9egmented neutrophils 44A )ands !A +ymphocytes 50A -latelet count !40,000>mm/ -rothrombin time !0 sec (7=DM1"8) -artial thromboplastin time 80 sec &hich of the follo#ing is the most li'ely mechanism for these findings( A) Autoimmuni2ation )) )acterial to%ic effect C) Factor B777 deficiency ,) Factor 7I deficiency $) 7mmunoglobulin deficiency F) 7ron deficiency ;) -harmacologic effect .) Biral to%ic effect 7) Bitamin deficiency *

28. A healthy 0-year-old boy is brought to the physician 1 #ee' after he #as e%posed for se eral
hours to a child #ith chic'enpo%" 5he patient and his healthy sister ha e not had chic'enpo%" 5hey ha e not recei ed aricella accine" &hich of the follo#ing is the most appropriate management for the patient and his sister at this time( A) Administer acyclo ir as prophyla%is )) Administer immune globulin, intra enously C) Administer aspirin therapy if esicles appear ,) Ad ise the parents to 'eep the siblings home from school to pre ent e%posing their classmates $) 7nform the parents that a esicular rash may appear at any time o er the ne%t ! #ee's *

29. A 8-year-old boy is brought to the physician by his mother because of progressi e isual loss o er the
past year" 3 er the past ! years, he has had deterioration of his hearing, speech, #riting, and intellectual performance" .is maternal uncle had similar symptoms" Bisual acuity is !0>!00 bilaterally" Funduscopic e%amination sho#s optic atrophy" .is hearing is mar'edly impaired" 5here is #ea'ness and spasticity of all e%tremities" ,eep tendon refle%es are e%tremely hyperacti e" )abins'i1s sign is present bilaterally" 3n mental status e%amination, he is not oriented to place, year, month, or the names of his siblings" An CD7 of the brain sho#s mar'ed symmetric #hite matter disease in ol ing all lobes" ,iagnostic studies are most li'ely to sho# #hich of the follo#ing( A) Abnormally decreased serum cholesterol le el )) Acanthocytes on blood smear C) An e%cess of ery long chain fatty acids* ,) =ormal ner e conduction studies $) Bitamin $ deficiency

30. A 5-year-old boy is brought to the emergency department /0 minutes after he fainted at home
after standing up from a sitting position" .is symptoms began / days ago #ith diarrhea and omiting" .e has had no urine output for 14 hours" .e is alert but Juiet" .is temperature is /0"5 C (??"5 F), blood pressure is 05>45 mm .g, pulse is 1!0>min, and respirations are !4>min" $%amination sho#s dry lips and tenting of the s'in" 5here is no abdominal tenderness" )o#el sounds are hyperacti e" 5he remainder of the e%amination sho#s no abnormalities" .is capillary refill time is 5 seconds" 7ntra enous bolus doses of 0"?A saline are administered" )ladder catheteri2ation yields 5 m+ of urine" <rinalysis is most li'ely to sho# #hich of the follo#ing( A) )lood )) $rythrocyte casts C) .yaline casts * ,) +eu'ocyte casts $) 3%alate crystals

31. A !-year-old boy is brought to the physician because of fe er and cough for ! days" .e had
9treptococcus pneumoniae meningitis at the age of 1 year, 9" pneumoniae bacteremia at the age of 14 months, and pneumonia at the age of !! months" 5#o maternal uncles died before the age of ! years from Oinfection"O .is temperature is /?"4 C (10/"8 F), pulse is 150>min, and respirations are 80>min" $%amination sho#s subcostal retractions on inspiration" +aboratory studies sho#: .emoglobin 10 g>d+ +eu'ocyte count /8,000>mm/ 9egmented neutrophils 00A )ands !0A +ymphocytes 4A Conocytes !A -latelet count !40,000>mm/ 9erum 7gA P5 mg>d+ 7g; /0 mg>d+ 7gC P5 mg>d+ An %-ray film of the chest sho#s an infiltrate in the left upper lobe" &hich of the follo#ing is the most appropriate ne%t step in management( A) Dee%amination in 1! #ee's )) -rednisone therapy only C) -rednisone, incristine, do%orubicin, asparaginase, and methotre%ate therapy ,) Qido udine (AQ5), lami udine (/5C), and ritona ir therapy $) 7ntra enous immunoglobulin infusion * F) )one marro# transplantation ;) 5hymus transplantation

32. A pre iously healthy 1/-year-old girl is brought to the physician because of a !-month history of
intermittent abdominal pain and loose stools" 9he has had a !"/-'g (5-lb) #eight loss during this period due to a decreased appetite, but she drin's up to 1 liter of fruit 6uice daily" At her last isit ? months ago, she #as at the 50th percentile for height and the 50th percentile for #eight" 9he is no# at the 50th percentile for height and the 10th percentile for #eight" .er temperature is /0"4 C (100 F), pulse is 40>min, and respirations are 14>min" $%amination sho#s no other abnormalities" 5est of the stool for occult blood is positi e" +aboratory studies sho#: .emoglobin 4"5 g>d+ +eu'ocyte count ?100>mm/ 9egmented neutrophils 55A +ymphocytes /5A Conocytes 10A -latelet count 850,000>mm/ $rythrocyte sedimentation rate 05 mm>h 9erum =a@ 1/? m$J>+ ClK 101 m$J>+ F@ /"! m$J>+ .C3/K !/ m$J>+ <rea nitrogen ()<=) 4 mg>d+ ;lucose 0/ mg>d+ Creatinine 0"! mg>d+ A barium enema sho#s patches of ulcerations along the pro%imal colon #ith reflu% of dye into the terminal ileum" &hich of the follo#ing is the most appropriate ne%t step in management( A) $liminate fruit 6uice from the patient1s diet )) 9#itch to a gluten-free diet C) .!- receptor bloc'ing agent therapy ,) -rednisone and aminosalicylate therapy * $) )o#el resection

33. An other#ise healthy 4-month-old girl is brought to the physician because of a birthmar' on her
arm that has increased in si2e o er the past se eral #ee's" $%amination sho#s a / % !-cm, bright red, raised, soft, nontender, compressible patch o er the left forearm" &hich of the follo#ing is the most appropriate ne%t step in management( A) 5opical corticosteroid therapy )) )iopsy C) +aser therapy ,) $%cision $) =o inter ention is necessary *

34. A 0-year-old girl is brought to the physician in 9eptember because of fe er and sore throat for 1
day" 9he is in the third #ee' of second grade" .er temperature is /4"8 C (101"5 F)" $%amination sho#s an erythematous pharyn% and slightly enlarged tonsils #ithout e%udate" 5here is no significant cer ical lymphadenopathy" A rapid test for group A streptococcus is negati e" &hich of the follo#ing is the most appropriate ne%t step in management( A) Conospot test * )) 5hroat culture C) 7ntramuscular penicillin therapy ,) 3ral erythromycin therapy $) 3ral penicillin therapy

35. A 8-month-old girl is brought to the physician because of poor feeding and labored breathing for
! months" 9he has had recurrent respiratory tract infections since birth" $%amination sho#s a toand-fro murmur in the second left intercostal space, a loud 9!, bounding peripheral pulses, and a #idened pulse pressure" &hich of the follo#ing is the most li'ely diagnosis( A) Atrial septal defect (ostium primum type) )) Atrial septal defect (ostium secundum type) C) Atrio entricular canal ,) Coarctation of the aorta $) .ypoplastic left heart syndrome F) -atent ductus arteriosus * ;) 5etralogy of Fallot .) 5ransposition of the great arteries 7) 5ricuspid atresia E) Bentricular septal defect

36. A 8-month-old boy is brought to the physician because of respiratory distress for 1 day" .e had a
persistent dry cough / days ago" .e has not had a fe er or nasal discharge, but he has had chronic #atery stools" .e is at the 50th percentile for height and 10th percentile for #eight" .e appears ill and is in respiratory distress" .is temperature is /0 C (?4"8 F), pulse is 140>min, and respirations are 04>min" -ulse o%imetry sho#s an o%ygen saturation of 00A #hile breathing room air" $%amination sho#s #hite plaJues on the mucous membranes of his mouth and diffuse adenopathy" 5here are intercostal retractions, and diffuse crac'les are heard throughout all lung fields" 7n addition to o%ygen and antibiotic therapy, #hich of the follo#ing is the most appropriate ne%t step in management( A) 9tool culture for bacterial pathogens )) <rinalysis C) .7B testing * ,) Huantitati e measurement of immunoglobulins $) =itroblue tetra2olium testing F) -latelet morphology e aluation ;) 5ympanocentesis