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PACKRAT Peds – Questions & Accurate Answers
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PACKRAT Peds – Questions & Accurate Answers**(C) Denotes - Right Ans **
6 y/o male presents w/ hemarthrosis of the L knee. Coag studies: PT 12.5s
(normal12-14 sec), INR 1.0, aPTT 58s (normal 18-28 sec), platelet
430,000/microliter (normal 150,000-450,000/microliter), & bleeding time
4m (normal 2-12m). Which is the best tx option for this pt?
A. Desmopressin acetate
B. Corticosteroids
C. Vitamin K
D. Cryoprecipitate 1) (u) A. Desmopressin acetate is indicated in von
Willebrand's disease, which presents with a prolonged bleeding time.
(u) B. Corticosteroids are indicated in immune-mediated thrombocytopenia.
(u) C. Vitamin K deficiency will prolong the PT greater than the aPTT. Vitamin
K supplement is not indicated in this patient.
(c) D.Hemophilia A presents with a prolonged aPTT and normal platelet count
and function. Hemophilia A is treated with factor VIII concentrate or
cryoprecipitate.
A newborn weighs 8 pounds at birth. On average, what should the infant
weigh at 1 year of age?
A. 16 pounds
B. 20 pounds
C. 24 pounds
D. 28 pounds 2) (u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. An infant will triple birth weight within the first year of life. A newborn
that weighs 8 pounds at birth will weigh approximately 24 pounds at 1 year of
age.
(u) D. See C for explanation.
Which of the following is a common symptom associated with
laryngotracheobronchitis (viral croup)?
A. Drooling
B. High fever
C. "Hot potato" voice
,D. Barking cough 3) (u) A. Drooling and a "hot potato" voice are seen with
epiglottitis, not viral croup.
(u) B. Fever is usually absent or low-grade in patients with viral croup.
(u) C. See A for explanation.
(c) D. Viral croup is characterized by a history of upper respiratory tract
symptoms followed by onset of a barking cough and stridor.
A 3 year-old boy is seen in the office with a 5-day history of fever, erythema,
edema of the hands and feet, a generalized rash over the body, bilateral
conjunctival injections, fissuring and erythema of the lips, and cervical
adenopathy. Antistreptolysin A (ASO) titer and throat culture are negative.
The most serious systemic complication associated with this disorder is
A. renal.
B. cardiac.
C. pulmonary.
D. hepatic. u) A. See B for explanation.
(c) B. The patient most likely has Kawasaki syndrome. The major complication
with this disorder is coronary artery aneurysms, which are reported in up to
20% of affected children. The etiology of this disorder is uncertain, although a
bacterial toxin with super antigen properties may be involved.
(u) C. See B for explanation.
(u) D. Children with Kawasaki syndrome may have associated hydrops of the
gallbladder, but liver involvement is not part of this disorder.
A 2 month-old infant presents for a routine health maintenance visit. The
mother has been concerned about the infant's hearing since birth. Physical
examination reveals no apparent response to a sudden loud sound. Which of
the following is the most appropriate diagnostic evaluation?
A. audiometry
B. tympanometry
C. acoustic reflectometry
D. auditory-evoked potentials 5) (u) A. Pure tone audiometry can be used
to screen for hearing deficits in children over the age of 3 years.
(u) B. Tympanometry is used to identify an effusion as the cause of hearing
loss, but in infants over the age of months.
(u) C. Acoustic reflectometry measures the spectral gradient of the tympanic
membrane, but is not used clinically due to concerns about its reliability.
(c) D. Brainstem auditory-evoked potentials evaluate the sensory pathway
and identify the site of any anatomical disruption. The test does not require
, any active response from the patient and is useful in the evaluation of
suspected hearing loss in an infant.
Annual blood pressure determinations should be obtained beginning at the
age of
A. 3 years.
B. 5 years.
C. 12 years.
D. 18 years.. 6) (c) A. Periodic measurements of blood pressure should be
part of routine preventive health assessments beginning at the age of 3 years.
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation
In infants, the eyes should move in parallel without deviation by the age of
A. 2 weeks.
B. 3 months.
C. 6 months.
D. 1 year. 7) (u) A. See C for explanation.
(u) B. See C for explanation.
(c) C. Intermittent alternating convergent strabismus is frequently noted for
the first 6 months of life, but referral is indicated if it persists beyond 6
months.
(u) D. See C for explanation
A 24 year-old male presents for routine physical examination. On physical
examination, you find that the patient's upper extremity blood pressure is
higher than the blood pressure in the lower extremity. Heart exam reveals a
late systolic murmur heard best posteriorly. What is the most likely diagnosis
in this patient?
A. Hypertrophic obstructive cardiomyopathy
B. Patent foramen ovale
C. Coarctation of the aorta
D. Patent ductus arteriosus 8) (u) A. Patients with hypertrophic obstructive
cardiomyopathy do not present with hypertension or weak femoral pulses.
(u) B. The murmur associated with patent foramen ovale is a systolic ejection
murmur heard in the second and third intercostal spaces and patients do not
present with hypertension.
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