Pediatrics Nursing Exam-Questions with Answers, Exams of Nursing

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Pediatrics Nursing Exam-Questions with

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A 33-year-old Caucasian man presents with redness, itching, and burning on the back of his hands. He gives a history of clearing "weeds" on his farm yesterday. You ask him to describe the weeds, and he states that they had a cluster of three leaves. There are several tiny blisters with a linear distribution on both of his hands. Question What is the most likely diagnosis? Answer Choices

1. Poison ivy dermatitis
2. Insect bite
3. Sunburn
4. Nickel allergy from his tools
5. Poison sumac dermatitis - Correct Answer 1. Poison Ivy Dermatitis A 16-year-old boy presents with a general itching of his hands and wrists. It started a few weeks after he went to play in a high school soccer tournament. On physical exam, you note several wavy skin-colored ridges on his hands and wrists with excoriations. There are multiple small erythematous papules on flexor surface of wrists. You note that the intertriginous areas of the hands are involved. Question What is the most likely diagnosis? Answer Choices 1 Ringworm 2 Tine corpora’s 3 Spider bite 4 Body lice 5 Scabies - Correct Answer 5. Scabies A 16-year-old girl has moderate facial acne vulgaris that you plan to treat with retinoid- containing creams. What potential condition should you rule out before treating the patient with retinoic acid cream? Answer Choices 1 Graves' disease 2 Pregnancy 3 Psoriasis 4 Contact dermatitis 5 Dermatitis caused by poison ivy - Correct Answer 2. Pregnancy A mother brings her 5-year-old boy to the pediatrician due to multiple blisters on his cheek and nose. Physical examination is remarkable for numerous vesicles and crusted

lesions containing light yellow fluid on both cheeks and around the nose. The child has similar lesions on his right wrist. Question What treatment is most appropriate? Answer Choices 1 Bacitracin ointment 2 Oral dicloxacillin 3 Oral penicillin 4 Oral tetracycline 5 Mupirocin ointment - Correct Answer 2. Oral dicloxacillin A 33-year-old woman presents to the office with multiple vesicles with associated intense itching on her hands and feet. Her past medical history is negative. The patient is a waitress who takes no medication and does not work with chemicals. The vesicles are tense with some scales. There is no erythema or initial incidence of itching. The vesicles have responded well to a limited treatment with a high steroid cream. Question What is this patient's most likely diagnosis? Answer Choices 1 Dyshidrotic eczema 2 Tine pedis 3 Contact dermatitis 4 Bullous pemphigoid 5 Bullous diabetic rum - Correct Answer 1. Dyshidrotic eczema A 3-year-old girl presents with a 2-week history of a pruritic erythematous excoriated rash. Her past medical history is unremarkable. Her only medications include a topical steroid ointment and oral diphenhydramine. She has no known allergies. She lives on a farm on the outskirts of her town. She does not attend daycare and lives with three older siblings and her parents. There are cats and dogs in the house, which appear to be in good health. Her physical exam is significant for small red papules in her interdigital spaces, wrist flexors, anterior axillary folds, and forearms. Scattered red-brown nodules are found in her axillary region. Question What diagnostic study would confirm the diagnosis? Answer Choices 1 Wood lamp examination 2 Skin biopsy 3 Culture of epidermal scrapings 4 Microscopic examination of skin scrapings 5 Potassium hydroxide prep of skin scrapings - Correct Answer 4. Microscopic examination of skin scrapings A 5-day-old female newborn was born 5 weeks prematurely and presents to her first pediatrician's appointment. She did not have any feeding or breathing issues, so mother and child had only a 2-day stay at the hospital. During the cardiovascular examination,

the pediatrician notes that the newborn has a distinct murmur with a rough machine-like quality that is maximal at the second intercostal space at the left sternal border. The murmur starts after S1 and passes through S2 into diastole. Question What study is the first choice to confirm it the most likely diagnosis? Answer Choices 1 Electrocardiography 2 Chest X-ray 3 Cardiac catheterization 4 Chest CT scan 5 Echocardiography - Correct Answer 5. Echocardiography A 16-year-old girl presents with a history of severe nodulocystic acne. She has used topical benzoyl peroxide and topical tretinoin and has undergone numerous courses of oral tetracycline. The acne has not responded to any treatment. You decide to change her treatment plan and prescribe the appropriate next step in management to treat her condition. Question What must be obtained before beginning treatment? Answer Choices 1 Fasting glucose 2 Complete blood count 3 Pregnancy test 4 Blood urea nitrogen and creatinine 5 Serum amylase - Correct Answer 3. Pregnancy test A 4-year-old girl presents with her mother to discuss treatment of her atopic dermatitis. She was diagnosed as an infant, but her case appears to be getting worse despite frequent lubrication with thick emollient creams and medium potency topical corticosteroid use. Mother states that the patient is itching a lot more, especially during the night. Large, single patches of erythematous scaly excoriations, measuring about 3 cm by 4 cm, are present in the flexor surfaces of both the right and left elbows. Question What second-line treatment is a reasonable choice to replace her current regimen now that the disease has become more severe? Answer Choices 1 High-potency topical corticosteroids 2 Topical antihistamines 3 Oral antihistamines 4 Systemic anti-Staphylococcal antibiotics 5 Ketoconazole cream - Correct Answer 1. High-potency topical corticosteroids A 2-week-old female neonate presents for her scheduled newborn visit. The mother notes that the newborn has been feeding poorly and seems to have difficulty catching her breath when crying. On examination, a continuous machine-like murmur is heard at the left first intercostal space.

Question What is the most likely diagnosis? Answer Choices 1 Atrial septal defect 2 Ventricular septal defect 3 Coarctation of the aorta 4 Pulmonary stenosis 5 Patent ductus arteriosus - Correct Answer 5. Patent ductus arteriosus A 1-month-old full-term male infant has been diagnosed with tetralogy of Fallot. His disease is being classified as moderate, and he has been admitted to the neonatal intensive care unit for monitoring. He is now stable and is doing well. During a consultation between the infant's parents and the pediatric cardiologist, treatment options are being discussed. Question What is the pediatric cardiologist likely to recommend as definitive treatment? Answer Choices 1 Chronic oral β-blocking agents 2 No treatment; this disease is self-limiting 3 Closure of ventricular septal defect and pulmonary valvulotomy 4 Closure of atrial septal defect and aortic valvulotomy 5 Closure of atrial septal defect and pulmonary valvulotomy - Correct Answer 3. Closure of ventricular septal defect and pulmonary valvulotomy A 15-year-old girl is referred to a cardiologist's office for workup of hypertension. Her mother reports a normal pregnancy and birth. There is no family history of heart disease. On physical exam, you note BP 140/70 left and right upper extremities, 90/ left and right lower extremities, HR 85/min, RR 20/min. Brachial and femoral pulses are incongruent. You note pulsations in the suprasternal notch. Cardiac auscultation reveals a III/VI systolic ejection murmur. Question What would you expect to see on chest radiography? Answer Choices 1 Right ventricular hypertrophy and large pulmonary arteries 2 Left ventricular hypertrophy and a notch in the aorta 3 Boot-shaped heart with right ventricular prominence 4 Prominence of the aorta, pulmonary artery, and left atrium 5 Increased pulmonic vasculature - Correct Answer 2. Left ventricular hypertrophy and a notch in the aorta A 3-year old boy is brought to the pediatrician with a 2-week history of symptoms of an itchy, red "wound" on the right knee. The mother ignored the wound initially, assuming that the boy got injured while playing on the street, but it did not heal and seems to have worsened. On examination, there are a few intact vesicles and a few ruptured vesicles covered with honey-colored crusts. You suspect non-bullous impetigo. Question

What treatment will you prescribe? Answer Choices 1 Antibiotic ointment 2 Steroid ointment 3 Emollient cream 4 Oral antibiotics 5 Oral steroids - Correct Answer 1. Antibiotic ointment A preterm female infant born to a 32-year-old woman with no known past medical illnesses presents for the infant's 1-week follow-up. The mother reports that the patient is behaving normally and is feeding well. The physical exam is remarkable for a murmur, which is located at the second left intercostal space. The murmur is continuous throughout cardiac systole; it is diastolic, non-radiating, and of a "machinery" quality. There is also a widened pulse pressure. The skin and mucosa are without cyanosis, and there is no evidence of fluid retention. Question Based on the physical exam finding, what is the most likely diagnosis? Answer Choices 1 Atrial septal defect 2 Ventricular septal defect 3 Tetralogy of Fallot 4 Patent ductus arteriosus 5 Pulmonary stenosis - Correct Answer 4. Patent ductus arteriosus A 47-year-old Caucasian woman presents for evaluation of a 4-week history of dyspnea. Symptoms started when on vacation in Colorado. She initially attributed the symptoms to the altitude, but she continued to have shortness of breath with mild activity after returning home: walking more than 100 feet, walking up one flight of stairs. Symptoms resolve with rest. She also reports mild exceptional chest tightness and easy fatigability. She denies paroxysmal nocturnal dyspnea, orthopnea, edema, palpitations, and syncope. Past medical history includes usual childhood illnesses, no previous surgeries, and no known allergies. She takes a daily multivitamin and occasional Tylenol for headache. She does not smoke, rarely drinks alcohol, and denies use of recreational drugs. Physical exam shows temp 96.9°F, pulse 80 and regular, respirations 16, and BP 136/82. O2 sat is 96% on room air. The patient is an alert Caucasian woman i - Correct Answer 1. Atrial Septal Defect A 2-month-old female infant presents for a well-child visit. Her mother states that she is concerned about the patient's lack of interest in feeding and her rapid breathing spells. You acknowledge these concerns, and during the physical examination, you note severe tachypnea, bounding peripheral pulses, and a rough machinery murmur that is auscultated best near the second left intercostal space. Question What is the most likely diagnosis? Answer Choices

1 Atrioventricular septal defect 2 Patent ductus arteriosus 3 Coarctation of the aorta 4 Ventricular septal defect 5 Still murmur - Correct Answer 2. Patent ductus arteriosus You are currently on an inpatient pediatric hospitalist team; you see a preterm infant who has signs of failure to thrive. Other signs and symptoms found during the history and physical examination include tachypnea, bounding peripheral pulses, and a rough machine-like murmur. Question Considering the most likely diagnosis at this time, what clinical intervention should be initiated? Answer Choices 1 Ampicillin 2 Indomethacin 3 Prednisone 4 Furosemide 5 Dopamine - Correct Answer 2. Indomethacin A 4-year-old boy presents with skin eruptions, fever, and diarrhea. Skin eruptions developed 1 week ago after exposure to multiple mosquito bites that left weepy crusted areas. Over the past 2 days, the boy has become quiet, sleepy, and febrile and has had a few loose stools. His past medical history is non-contributory, and his immunizations are current. On examination, you find a child in a mild distress; his temperature is 39°C. Heart rate is 100/min, and respirations are 22/min. On the skin of the arms and trunk, you notice multiple excoriations: a few fragile thin-roofed flaccid transparent bullae with a clear yellow fluid that turns cloudy and dark yellow. Several bullae are ruptured, leaving behind rims of scales around erythematous moist bases, but no crusts. You also notice patches of skin of brown-lacquered appearance, with collarets of scale and peripheral tube-like rims. Question What is the primary me - Correct Answer 1. Inhibition of peptidoglycans synthesis A 5-year-old boy has three honey-colored crusted lesions with surrounding erythema on his legs. The swabs taken from the lesions were sent to the microbiology laboratory. The results show yellow colonies grown on blood agar with hemolysis. The colonies are coagulase-positive and manifold-positive. Question What is the most likely diagnosis? Answer Choices 1 Mollusca contagious 2 Varicella zoster 3 Impetigo 4 Herpes zoster

5 Erythema infectious - Correct Answer 3. Impetigo A 16-year-old girl has had acne breakouts since age 10, and both she and her mother have noted the breakouts worsening significantly every year. She notes worsening of her breakouts around her menses each month, but she states she has multiple lesions consistently throughout the month. She has a history of using diet modification, topical retinoid, benzoyl peroxide, and two types of oral antibiotics without improvement. Physical examination of the patient reveals extensive open and closed comedowns on the forehead, cheeks, and chin. Painful cystic lesions are present throughout. Isotretinoin is now considered. Question How often will this patient need to have a serum pregnancy test once the treatment regimen has begun? Answer Choices 1 Every week 2 Every 3 weeks 3 Every 4 weeks 4 Every 6 weeks 5 Every 8 weeks - Correct Answer 3. Every 4 weeks A 16-year-old Caucasian girl presents with a 6-month history of blackheads and whiteheads on her face. On examination, there are a few papules and pustules on her cheeks; there are no nodules. Her mother reports having similar spots on her face at this age. Question What is an appropriate first-line medication for this patient? Answer Choices 1 Tretinoin 2 Isotretinoin 3 Doxycycline 4 Minocycline 5 Triamcinolone - Correct Answer 1. Tretinoin A 15-year-old boy presents for follow-up for acne vulgaris. He has been using benzoyl peroxide and retinoic acid for the past 4 months. He returns for a re-evaluation, as his acne appears to have worsened. He states his diet has not changed significantly, and his past medical history is unremarkable. His mother had significant acne as an adolescent. Physical examination reveals large papules and pustules on the forehead, cheeks, chin, and upper back. No nodulocystic cystic lesions are noted. Question What is the most appropriate next step in management? Answer Choices 1 Intraregional steroid injections 2 Abstinence from chocolate 3 Increased skin washing 4 Oral doxycycline

5 Oral isotretinoin - Correct Answer 4. Oral doxycycline A 15-year-old boy is being treated at the dermatologist for lesions on his cheeks, forehead, chin, upper chest, and upper back with a history that has been progressively getting worse. Upon physical exam, open and closed comedowns are present on the patient. Additionally, inflamed papules and some scarring are present. All labs are within normal limits. Question What is the most likely diagnosis? Answer Choices 1 Acne vulgaris 2 Contact dermatitis 3 Folliculitis 4 Malaria 5 Rosacea - Correct Answer 1. Acne vulgaris A woman presents with her 6-year-old adopted daughter due to excessive scratching of the scalp and ears. The woman states that she washes the girl's hair frequently, but it hasn't been helpful; the woman is very frustrated for her daughter. On examination of the scalp, excessive excoriations are noted on the posterior neck and post auricular regions bilaterally. No cervical lymphadenopathy is noted. Nits are also observed on the shaft of the hair. Question What is the appropriate treatment for this patient? Answer Choices 1 Remove all household pets. 2 Treat with permethrin. 3 Treat with topical steroid. 4 Treat with oral antibiotics. 5 Treat with oral antifungals. - Correct Answer 2. Treat with permethrin A 6-week-old male infant presents with his mother. His mother reports that he has spells of turning "blue all over," especially when eating. On exam, he appears fatigued. He is noted to have clubbing of his fingers. Cardiac exam reveals a harsh systolic crescendo- decrescendo murmur in left upper sternal border. A chest X-ray reveals right ventricular hypertrophy. Question What is the most likely diagnosis? Answer Choices 1 Ventricular septal defect 2 Transposition of great vessels 3 Coarctation of the aorta 4 Tetralogy of Fallot 5 Atrial septal defect - Correct Answer 4. Tetralogy of Fallot

A 32-year-old man with a past medical history of allergic rhinitis and asthma that is well- controlled complains of recurrent pruritus associated with an erythematous rash in the flexural areas of his elbows and knees. The lesions seem to become worse when he scratches them and when he is under stress. He denies any recent insect bites, travel, fever, chills, new clothing, or detergent use. Physical examination reveals rough- appearing erythematous plaques in the bilateral antecubital and popliteal fossae, with areas of excoriations within the lesions. Question What intervention is most appropriate at this time? Answer Choices 1 Triamcinolone 0.1% applied to the lesions once or twice daily 2 Cephalexin 500 mg by mouth every 12 hours 3 Acyclovir 200 mg by mouth 5 times per day 4 Tacrolimus ointment 0.03% applied to the lesions twice daily 5 Prednisone 40 mg by mouth daily tapered over 2-4 weeks - Correct Answer 1 Triamcinolone 0.1% applied to the lesions once or twice daily A 4-year-old boy presents with poor weight gain, small size for his age, and dyspnea upon feeding. His mother notes that the child suffers from frequent upper respiratory tract infections. On physical exam, the child is underweight for his age. You note a precordial bulge, a prominent right ventricular cardiac impulse, and palpable pulmonary artery pulsations. You also find a widely split and fixed second heart sound as well as a mid-diastolic rumble at the left sternal border. Question What pharmacologic agent would be most appropriate in the medical management of this patient at this time? Answer Choices 1 Lasix (furosemide) 2 Coumadin (warfarin) 3 Procardia (nifedipine) 4 Inderal (propranolol) 5 Indocin (indomethacin) - Correct Answer 1 Lasix (furosemide) A 4-year-old boy presents with a rash on his feet, ankles, wrists, and gluteal areas; the rash is accompanied by severe itching, particularly at night. His 6-month-old sister has a similar rash on her neck and head. On examination, you find pruritic erythematous popular and papulopustular skin changes between the web spaces of the fingers; changes are also seen on the flexor aspects of the wrists and in the genital and gluteal areas. On superficial epidermis, you find several short elevated red tortuous lines; they have a small vesicle at the tip. Question What treatment you will suggest? Answer Choices 1 Permethrin cream 2 Hydrocortisone cream

3 Clindamycin lotion 4 Selenium sulfide lotion 5 Tar soap - Correct Answer 1 Permethrin cream A 3-year-old boy who weighs 14 kg presents with a 2-week history of severe itching all over the body that is more severe at night. Physical examination reveals gray thread- like serpentine lines with papules at the ends. There is a generalized popular and papulovesicular rash with few pustules. The lesions are more confluent between the webs of the fingers and toes and on the flexor surface of the wrists, axilla, genitalia, feet, and buttocks. Scrapings from the skin show an arthropod with four pairs of legs, hemispheric body, and brown spines and bristles on the dorsal surface. Question What is the treatment of choice for this child? Answer Choices 1 Malathion 0.5% lotion 2 Permethrin 5% cream 3 Crotamiton 10% cream 4 Invermectin 3 mg orally 5 Benzyl benzoate 25% cream - Correct Answer 2 Permethrin 5% cream A mother brings in her 5-year-old son due to papular and pustule lesions on his face. A serous honey-colored fluid exudes from the lesions. You suspect impetigo. A Gram stain reveals spherical gram-positive arrangements in irregular grape-like clusters. Question What organism is most likely causing this patient's condition? Answer Choices 1 Staphylococcus epidermises 2 Staphylococcus aurous 3 Peptostreptococcus 4 Streptococcus pneumonia 5 Haemophilus influenza - Correct Answer 2 Staphylococcus aurous A 33-year-old man presents for an initial visit to a new primary care office. He has not seen a healthcare provider in the past 5 years. His past medical history reveals a coarctation of the aorta repair at age 13, after which he saw a cardiologist yearly until age 18. Since then, he has not had insurance and has only sought care for urgent problems in acute care clinics. Question What is a common complication of coarctation that primary care should regularly monitor this patient? Answer Choices 1 Anemia 2 Palpitations 3 Orthostatic hypotension 4 Hypertension 5 Hypertriglyceridemia - Correct Answer 4 Hypertension

A 15-year-old Caucasian boy presents with a 2-week history of recurrent breakouts on his face. His mother states that the condition is worse during football season. He currently uses over-the-counter products with no improvement. Examination of the face reveals a combination of inflammatory papules, pustules, and comedowns on the face, with a concentration on the forehead and temples. Question In addition to prescription medication, what instructions should be given to the patient to manage his acne? Answer Choices 1 Aggressively squeezes bumps on face as they appear. 2 Wash face three times daily. 3 Clean football helmet after use. 4 Use ointments to moisturize face. 5 Avoid washing face. - Correct Answer 3 Clean football helmet after use. A 16-year-old boy presents to his primary care physician with skin lesions. The lesions are scattered over his forehead, nose, and chin. He denies facial flushing and pruritus. The following presentation is seen on examination. Refer to the image. Question What is the most likely diagnosis? Answer Choices 1 Rosacea 2 Acne vulgaris 3 Contact dermatitis 4 Erythema multiform 5 Impetigo - Correct Answer 2 Acne vulgaris While rounding on a 2-hour-old male neonate at the hospital, his mother remarks that although her pregnancy and delivery were unremarkable and the baby was term, she has attempted to initiate breastfeeding even though the neonate "doesn't seem interested." On heart auscultation of the neonate, a late systolic murmur that radiates to the back is appreciated. Vital signs while the baby is awake are BP 90/50 mm Hg in the right arm and 58/42 mm Hg in the right lower extremity, HR 140, RR 40, axillary temp 37.0° C, and O2 sat 90% on room air. Question What is the most likely diagnosis? Answer Choices 1 Aortic stenosis 2 Ventricular septal defect 3 Coarctation of the aorta 4 Patent foramen oval 5 Tetralogy of Fallot - Correct Answer 3 Coarctation of the aorta A newborn child is routinely evaluated in the pediatrician's office 1 month after delivery. The mother reports that the patient is behaving normally and is feeding well. The

physical exam is remarkable for a murmur, which is located at the second left intercostal space. The murmur is continuous throughout cardiac systole and diastole, non- radiating, and of a "machinery" quality. There is additionally a widened pulse pressure. The skin and mucosa are without cyanosis, and there is no evidence of fluid retention. Question What is the most likely diagnosis? Answer Choices 1 Ventricular septal defect 2 Atrial septal defect 3 Transposition of the great arteries 4 Tetralogy of Fallot 5 Patent ductus arteriosus - Correct Answer 5 Patent ductus arteriosus A 10-year-old girl presents with her mother and reports "really bad dandruff that itches like crazy." The child states that all of her friends at school have it too. Upon physical examination of the hair and scalp, you note numerous oval grayish-white sesame seed capsules 1-2 mm in size deposited on the hair shaft near the scalp. Small red bumps and sores on the scalp appear to be due to the patient scratching. Question What is the most likely diagnosis? Answer Choices 1 Pediculosis 2 Psoriasis 3 Seborrhea dermatitis 4 Trichorrhexis noose 5 Atopic dermatitis - Correct Answer 1 Pediculosis A 7-year-old boy presents with a 3-day history of intense pruritus on his wrists, fingers, and antecubital fossae. It began on his fingers and has moved proximally. According to his mother, they are raised red eruptions and some have scabbed over. She states he has never had this before and it is keeping him up at night. He recently started at a new school. Question What procedure would be most helpful in confirming your diagnosis? Answer Choices 1 Wood lamp inspection 2 Skin scraping with KOH preparation 3 Skin scraping with immersion oil 4 Punch biopsy 5 Skin culture with Gram stain - Correct Answer 3 Skin scraping with immersion oil A 20-year-old man has had a 1-month duration second-line acne therapy; he now presents with skin that looks worse and has more inflammation and cystic development. This patient has now progressed to severe acne. Question What is the most appropriate next step?

Answer Choices 1 Stop all medications and review in 2 weeks. 2 Perform skin biopsies. 3 Perform blood cultures. 4 Add oral isotretinoin after stopping medication for 2 weeks. 5 Add emollient cream and a sulfur-based cleanser. - Correct Answer 4 Add oral isotretinoin after stopping medication for 2 weeks. A 5-year-old boy presents with an erythematous skin rash associated with intense itching. The boy's mother has noticed that her son's rash has been recurrent, with 3- episodes per year. The itching and rash increases after consumption of certain foods. On examination, erythematous raised papules are seen on the cheek, trunks, and upper arms. Question What is most likely associated with the boy's condition? Answer Choices 1 Gluten enteropathy 2 Asthma 3 Vitamin A deficiency 4 Psoriasis 5 Raised dengue titers - Correct Answer 2 Asthma A 6-week-old boy presents at your pediatric practice office, brought by his mother. She reports that for the past week he has not been feeding well and he breaks out into a cold sweat on his forehead while feeding. Upon further questioning, she reports that he becomes extremely breathless, irritable, and extremely pale after extended periods of crying. The mother reports a normal vaginal delivery and denies any problems with her son at the time of discharge from the hospital following his birth. She reports a family history of congestive heart failure. Vitals are as follows: pulse 130-regular, respiration 34-regular, blood pressure R arm 96/62 L arm 92/54 and R leg 70/42 L leg 74/40. Cardiac exam reveals 4+ carotid pulses bilaterally, 2+ brachial pulses bilaterally and absent femoral pulses bilaterally. A loud harsh systolic ejection murmur is noted at the base of the heart. The EKG reveals normal sinus rhythm with l - Correct Answer 2 Coarctation of the aorta A 1-month-old infant is evaluated for rapid breathing, feeding difficulty, lethargy, and poor weight gain. Physical exam is notable for tachypnea, tachycardia, a cardiac gallop, and a medium-pitched systolic murmur best heard posteriorly in the interscapular area with radiation to the left axilla, apex, and anterior precordium. A prominent anterior chest heave is also observed. The lower extremities demonstrate a 12 mm Hg pressure difference compared to the upper extremities. There are delayed femoral pulsations; upper extremity pulsations are normal. Question What is the best next step in management? Answer Choices

1 Blood pressure monitoring to compare upper extremities 2 Evaluation by a cardiovascular surgeon 3 Cardiac catheterizations for non-surgical approach 4 Initiation of anti-hypertensive 5 Omission of routine pre-surgery antibiotic prophylaxis - Correct Answer 2 Evaluation by a cardiovascular surgeon A 32-year-old man with no significant past medical history presents with a 2-month history of increased dyspnea upon exertion; the dyspnea becomes apparent after walking 10 city blocks. He denies associated symptoms, such as fever, chills, and changes in weight, chest pain, abdominal pain, nausea, and vomiting. He also denies any history of cigarette smoking, occupational risk factors, sick contacts, and recent travel. His physical exam reveals normal vital signs and no distension of his jugular vein, but there is a prominent right ventricular impulse along the lower-left sternal border that is associated with a palpable pulmonary artery. There is also a mid-systolic ejection murmur at the upper left sternal border that does not vary in intensity with respiration. There is a fixed split second heart sound. The remainder of his examination is normal. Question What is the most likely diagnosis? Answer Choices 1 Patent duck - Correct Answer 2 Atrial septal defect A young woman presents with her daughter, who appears to be about 6 years old. You note that the child's eyes are downcast and she is scratching her scalp. On closer inspection, you note a tiny white wingless insect and tiny eggs attached to the hair shafts. The child's mother also notes that the same insects are present in the girl's eyelashes. Question What is the most likely diagnosis? Answer Choices 1 Lice 2 Scabies 3 Thrush 4 Ringworm 5 Dandruff - Correct Answer 1. Lice A mother has brought her 9-year-old daughter to you because the child has been suffering from a 1-week history of intense itching on her scalp since she returned from a summer camp with a group of other children. Physical examination shows a number of nits attached to the hair shafts and a few full-grown lice on the scalp. Due to scratching, there are raw excoriated areas on the scalp with a few areas of pyoderma. Occipital group of lymph nodes are enlarged. Question What is the treatment of choice for this child? Answer Choices 1 Permethrin 5% topical

2 Malathion 0.5% in isopropanol topical 3 Permethrin 1% topical 4 Ivermectin topical 5 Benzyl benzoate 25% topical - Correct Answer 3 Permethrin 1% topical