Growth/Development — MCQs

A previously healthy 2-year-old boy is brought to the emergency room by his mother because of persistent crying and refusal to move his right arm. The episode began 30 minutes ago after the mother lifted him up by the arms. He appears distressed and is inconsolable. On examination, his right arm is held close to his body in a flexed and pronated position. Which of the following is the most likely diagnosis?

A 4-week-old infant is brought to the physician by his mother because of blood-tinged stools for 3 days. He has also been passing whitish mucoid strings with the stools during this period. He was delivered at 38 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. He was monitored in the intensive care unit for a day prior to being discharged. His 6-year-old brother was treated for viral gastroenteritis one week ago. The patient is exclusively breastfed. He is at the 50th percentile for height and 60th percentile for weight. He appears healthy and active. His vital signs are within normal limits. Examination shows a soft and nontender abdomen. The liver is palpated just below the right costal margin. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. A complete blood count and serum concentrations of electrolytes and creatinine are within the reference range. Which of the following is the most appropriate next step in management?

A 5-year-old male is brought to the pediatrician by his mother, who relates a primary complaint of a recent history of five independent episodes of vomiting over the last 10 months, most recently 3 weeks ago. Each time, he has awoken early in the morning appearing pale, feverish, lethargic, and complaining of severe nausea. This is followed by 8-12 episodes of non-bilious vomiting over the next 24 hours. Between these episodes he returns to normal activity. He has no significant past medical history and takes no other medications. Review of systems is negative for changes in vision, gait disturbance, or blood in his stool. His family history is significant only for migraine headaches. Vital signs and physical examination are within normal limits. Initial complete blood count, comprehensive metabolic panel, and abdominal radiograph were unremarkable. What is the most likely diagnosis?

A 14-month-old boy is brought to the physician by his mother because of an abdominal bulge that has become more noticeable as he began to walk 2 weeks ago. The bulge increases on crying and disappears when he is lying down. He was born at 39 weeks' gestation by lower segment transverse cesarean section. He has met all developmental milestones. He has been breast-fed since birth. He appears healthy and active. Vital signs are within normal limits. Examination shows a nontender, 1-cm midabdominal mass that is easily reducible. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?

A 12-year-old boy is brought to the physician because of increased frequency of micturition over the past month. He has also been waking up frequently during the night to urinate. Over the past 2 months, he has had a 3.2-kg (7-lb) weight loss. There is no personal or family history of serious illness. He is at 40th percentile for height and weight. Vital signs are within normal limits. Physical examination shows no abnormalities. Serum concentrations of electrolytes, creatinine, and osmolality are within the reference range. Urine studies show: Blood negative Protein negative Glucose 1+ Leukocyte esterase negative Osmolality 620 mOsmol/kg H2O Which of the following is the most likely cause of these findings?

A 3-year-old girl with no significant past medical history presents to the clinic with a 4-day history of acute onset cough. Her parents have recently started to introduce several new foods into her diet. Her vital signs are all within normal limits. Physical exam is significant for decreased breath sounds on the right. What is the most appropriate definitive management in this patient?

A 15-day-old girl presents to the pediatrician for a well visit. Her mother reports that she has been exclusively breastfeeding since birth. The patient feeds on demand every one to two hours for 10-15 minutes on each breast. The patient’s mother reports that once or twice a day, the patient sleeps for a longer stretch of three hours, and she wonders whether she should be waking the patient up to feed at those times. She also reports that she sometimes feels that her breasts are not completely empty after feeding. The patient voids 4-5 times per day and stools 2-3 times per day. Her mother occasionally saw red streaks in the patient’s diaper during the first week of life. The patient was born at 39 weeks gestation via a vaginal delivery, and her birth weight was 2787 g (6 lb 2 oz, 16th percentile). One week ago, the patient weighed 2588 g (5 lb 11 oz, 8th percentile), and today the patient weighs 2720 g (6 lb, 8th percentile). Her temperature is 98.7°F (37.1°C), blood pressure is 52/41 mmHg, pulse is 177/min, and respirations are 32/min. She has normal cardiac sounds, her abdomen is soft, non-tender, and non-distended. Which of the following is the best next step in management?

A 3-year-old boy presents to the clinic for evaluation of leg pain. This has been persistent for the past 3 days and accompanied by difficulty walking. He has also had some erythema and ecchymoses in the periorbital region over the same time period. The vital signs are unremarkable. The physical exam notes the above findings, as well as some swelling of the upper part of the abdomen. The laboratory results are as follows: Erythrocyte count 3.3 million/mm3 Leukocyte count 3,000/mm3 Neutrophils 54% Eosinophils 1% Basophils 1% Lymphocytes 43% Monocytes 3% Platelet count 80,000/mm3 A magnetic resonance image (MRI) scan of the abdomen shows a mass of adrenal origin. Which of the following is the most likely cause of this patient's symptoms?

A 6-month-old girl is brought to the physician for a well-child examination. She was born at 37 weeks' gestation. Pregnancy and the neonatal period were uncomplicated. The infant was exclusively breastfed and received vitamin D supplementation. She can sit unsupported and can transfer objects from one hand to the other. She babbles and is uncomfortable around strangers. She is at 40th percentile for length and at 35th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. In addition to continuing breastfeeding, which of the following is the most appropriate recommendation at this time?

A six-month-old male presents to the pediatrician for a well-child visit. The patient’s mother is concerned about the patient’s vision because he often turns his head to the right. She has begun trying to correct the head turn and places him on his back with his head turned in the opposite direction to sleep, but she has not noticed any improvement. She is not certain about when the head turning began and denies any recent fever. She reports that the patient fell off the bed yesterday but was easily soothed afterwards. The patient is otherwise doing well and is beginning to try a variety of solid foods. The patient is sleeping well at night. He is beginning to babble and can sit with support. The patient was born at 37 weeks gestation via cesarean delivery for breech positioning. On physical exam, the patient’s head is turned to the right and tilted to the left. There is some minor bruising on the posterior aspect of the head and over the sternocleidomastoid. He has no ocular abnormalities and is able to focus on his mother from across the room. Which of the following is the best next step in management?