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Pediatrics PACKRAT – Questions With Solutions
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Pediatrics PACKRAT – Questions With Solutions**(C) Denotes - Right Ans **
A 10 year-old female experiences fever and polyarthralgia. On examination
you note a new early diastolic murmur. Laboratory results are positive for
antistreptolysin O. The patient has no known drug allergies. Which of the
following is the recommended prophylaxis for this condition?
A. Doxycycline
B. Erythromycin
C. Benzathine penicillin G
D. Trimethoprim/sulfamethoxazole Right Ans - (u) A. Doxycycline and
Bactrim are not indicated for the prophylaxis of recurrent rheumatic fever.
(u) B. Erythromycin is considered second line for prophylaxis of recurrent
rheumatic fever in a patient with a penicillin allergy.
(c) C. Recurrences of rheumatic fever are most common in patients who have
had carditis during their initial episode and in children. The preferred method
of prophylaxis is Benzathine penicillin G every four weeks.
A 12 year-old boy presents to the office with pain in his legs with activity
gradually becoming worse over the past month. He is unable to ride a bicycle
with his friends due to the pain in his legs. Examination of the heart reveals an
ejection click and accentuation of the second heart sound. Femoral pulses are
weak and delayed compared to the brachial pulses. Blood pressure obtained
in both arms is elevated. Chest x-ray reveals rib notching. Which of the
following is the most likely diagnosis?
A. abdominal aortic aneurysm
B. pheochromocytoma
C. coarctation of the aorta
D. thoracic outlet syndrome Right Ans - (u) A. Abdominal aortic aneurysm
is usually asymptomatic until the patient has dissection or rupture. It is
uncommon in a child.
(u) B. Pheochromocytoma classically causes paroxysms of hypertension due
to catecholamine release from the
adrenal medulla, but does not cause variations in blood pressure in the upper
and lower extremities.
,(c) C. Coarctation is a discrete or long segment of narrowing adjacent to the
left subclavian artery. As a result of the coarctation, systemic collaterals
develop. X-ray findings occur from the dilated and pulsatile intercostal
arteries and the "3" is due to the coarctation site with proximal and distal
dilations.
(u) D. Thoracic outlet syndrome occurs when the brachial plexus, subclavian
artery, or subclavian vein becomes compressed in the region of the thoracic
outlet. It is the most common cause of acute arterial occlusion in the upper
extremity of adults under 40 years old.
A 12 month-old child with tetralogy of Fallot is most likely to have which of
the following clinical features?
A. Chest pain
B. Cyanosis
C. Convulsions
D. Palpitations Right Ans - (u) A. Chest pain is not a feature of tetralogy of
Fallot.
(c) B. Cyanosis is very common in tetralogy of Fallot.
(u) C. Convulsions are occasionally seen as part of severe hypoxic spells in
infancy rather than a feature of tetralogy of Fallot.
(u) D. Palpitations are uncommon in tetralogy of Fallot.
An 8-year-old boy is brought to a physician because of palpitation, fatigue, and
dyspnea. On examination, a continuous machinery murmur is heard best in
the second left intercostal space and is widely transmitted over the
precordium. The most likely diagnosis is
A. ventricular septal defect.
B. atrial septal defect.
C. congenital aortic stenosis.
D. patent ductus arteriosus. Right Ans - (u) A. VSD causes a holosystolic
murmur rather than a continuous machinery-like murmur.
(u) B. ASD causes a fixed split S2 rather than a continuous systolic heart
murmur.
(u) C. Congenital aortic stenosis causes a crescendo-decrescendo systolic
murmur heard best in the second intercostal space.
(c) D. Patent ductus arteriosus is classically described in children as a
continuous machinery-type murmur that is widely transmitted across the
precordium.
,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. Right Ans - (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) D. Children with Kawasaki syndrome may have associated hydrops of the
gallbladder, but liver
involvement is not part of this disorder.
A 9 year-old presents with increasing shortness of breath while playing
basketball recently. On examination, radial pulses are exaggerated while
femoral pulsations are weak. Chest radiograph shows rib notching and a
mildly enlarged heart. Which of the following is the most likely diagnosis for
this patient?
A. Atrial septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Tetralogy of Fallot Right Ans - (u) A. See B for explanation.
(c) B. In older children, the ECG and chest x-ray usually show left ventricular
hypertrophy and a mildly enlargedheart. Rib notching may also be seen in
older children (>8 years old) with large collaterals.
(u) C. See B for explanation.
(u) D. See B for explanation.
A 16 year-old athlete with no past medical history collapses after running 50
yards down the field. He is unresponsive, pulseless and cyanotic. Which of the
following is the most likely cause of this student's collapse?
A. Hypertrophic cardiomyopathy
B. Myocardial infarction
C. Pulmonary embolism
, D. Reactive airway disease Right Ans - (c) A. This presentation is consistent
with hypertrophic cardiomyopathy which may initially be difficult to
diagnose.Infants but not older children frequently present with signs of CHF.
Older children may be asymptomatic, with sudden death as the initial
presentation
(u) B. See A for explanation.
(u) C. See A for explanation.
(u) D. See A for explanation.
A 15 year-old male presents with a 1 week history of hacking non-productive
cough, low grade fever, malaise and myalgias. Examination is unremarkable
except for a few scattered rhonchi and rales upon auscultation of the chest.
The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was
negative. Which of the following is the most likely diagnosis?
Answers
A. acute bronchitis
B. viral pneumonia
C. mycoplasma pneumonia
D. pneumococcal pneumonia Right Ans - (u) A. While the patient's clinical
symptoms of dry cough and rhonchi support this diagnosis, the chest x-ray
would be normal or only show a mild increase in bronchovascular markings,
not infiltrates.
(c) B. The patient's clinical symptoms as well as chest x-ray findings and
negative cold agglutinin titer are most consistent with viral pneumonia.
(a) C. While the gradual onset of symptoms suggest mycoplasma, the negative
cold agglutinin titer makes this less likely.
(u) D. In older children the signs and symptoms of pneumococcal pneumonia
are similar to an adult and consist of an abrupt onset of cough, fever and chills.
The chest x-ray would reveal a lobar consolidation, not interstitial, picture.
A 3 month-old male presents with a hoarse cough and thick purulent
rhinorrhea for the past 2 days. The mother noted that yesterday he appeared
to get worse and seemed to have increasing problems breathing and trouble
feeding. Examination reveals a temperature of 100.2 degrees F and
respiratory rate of 80/minute with nasal flaring and retractions. Lung
examination reveals a prolonged expiratory phase with inspiratory rales. He is
tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-ray
reveals hyperinflation with diffuse interstitial infiltrates. Which of the
following is the most appropriate intervention?
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