A young Hispanic mother brings in her 2-month-old son. She is upset because her neighbors have threatened to call the Child Protective Agency because they think his birthmark is a bruise.

Question 1 A young Hispanic mother brings in her 2-month-old son. She is upset because her neighbors have threatened to call the Child Protective Agency because they think his birthmark is a bruise. Her son was the product of an uneventful pregnancy and spontaneous vaginal delivery. On examination you see a large, smooth-bordered bluish mark on his buttock and lower back. Otherwise his examination is unremarkable.

 

What form of birthmark is this likely to be?

 

Café-au-lait spot

 

Salmon patch

 

Mongolian spot

 

Question 2In newborn infants, closure of the ductus arteriosus usually occurs:

 

After 7 days of life

 

12 – 48 hours after birth

 

During the toddler period

 

Between the second and third months

 

Question 3Developmental changes of puberty are caused mainly by the interaction of the pituitary gland, the gonads, and the:

 

Hypothalamus

 

Islet cells

 

Thymus

 

Thalamus

 

Question 4You are assessing an infant and notice that his nares flare, he has a soft grunt with each breath, and the skin between his ribs is pulled inward with inhalation. What is the significance of these findings?

 

These are indicative of a CNS process.

 

These are indicative of respiratory distress.

 

These are indicative of muscular dystrophy.

 

These are frequently accompanied by stridor.

 

Question 5You note that a child has a positive Gower Sign. This indicates generalized:

 

Bursitis

 

Arthropathy

 

Muscle weakness

 

Muscle hypertrophy

 

Question 6The ability for abstract thinking normally develops during:

 

Infancy

 

Early childhood

 

Adolescence

 

Adulthood

 

Question 7In infants and small children, a capillary refill time of 4 seconds:

 

Is normal

 

Indicates hpovolemia

 

Indicates hypervolemia

 

Indicates renal artery stenosis

 

Question 8A mother brings her 15-month-old daughter to your office for evaluation of a rash and fever. She says the rash started one day and the fever developed the next day. Her daughter has had all of her vaccinations up to 10 months. The mother sheepishly admits that she hasn’t had time to bring her daughter in since her 10-month check-up. On examination you see a mildly sick-appearing toddler with a 102-degree temperature. Looking at her skin you see at least 100 of a variety of papules, vesicles, and ulcers in different stages of development.

 

What illness prevented by proper vaccination does this toddler have?

 

Varicella (chickenpox)

 

Measles

 

Smallpox

 

Question 9You are examining a 5-year-old before he begins school. You notice a systolic, grade II/VI vibratory murmur over the LLSB and apex with normal S2 splitting. He has normal pulses as well. Which of the following is most likely?

 

Tricuspid stenosis

 

Mitral stenosis

 

Still’s murmur

 

Venous hum

 

Question 10One way that a health history for an infant differs from that of an adult is the inclusion of:

 

Nutritional history

 

Chief Complaint

 

Prenatal information

 

personal social information

 

Question 11When the Goodenough-Harris Drawing Test is administered to a child, the evaluator principally observes the:

 

Presence and form of body parts

 

Gender and race of the person drawn

 

Length of time needed to draw a stick man

 

Approximate age and posture of the person drawn

 

Question 12A quiet 3-year-old is brought in for a routine check-up when you notice a fresh bruise in the axilla and bilateral bruises over the upper back that appear slightly older. There are brown bruises over his shins as well. His mother said this happened when he fell off of a couch. What diagnosis should be considered?

 

Von Willebrand’s disease

 

Normal childhood bruises from activity

 

Abuse

 

Seizure disorder

 

Question 13A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness. The ear examination is as follows: external ear, normal appearance and no tenderness with manipulation; canal, normal diameter without evidence of inflammation; tympanic membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is your diagnosis?

 

Otitis externa

 

Cholesteatoma

 

Ruptured tympanic membrane

 

Otitis media

 

Question 14You diagnose an infant in the clinic with Seborrheic Dermatitis. What physical exam findings are most consistent with this diagnosis?

 

Erythema of the scalp

 

Pustules on the scalp

 

Dry, flaking areas on the scalp

 

Ecchymosis on the scalp

 

Question 15You are assessing Tanner staging of the breast in a young woman. You notice projection of the areola and nipple to form a secondary mound above the level of the breast. Which Tanner stage would this be?

 

I

 

II

 

III

 

IV

 

Question 16When measuring the length of an infant, the measurement should extend from:

 

Forehead to feet

 

Crown to tip of toes in prone position

 

Head to toes in upright position

 

Crown to heel in supine position

 

Question 17When examining the skull of a 4-month old baby, you should normally find:

 

Closure of the anterior fontanel

 

Closure of the posterior fontanel

 

Closure of both the anterior and posterior fontanel

 

Overlap of the cranial bones

 

Question 18A 17 year old girl presents to the clinic for a sports physical for cheerleading. Physical examination findings reveal BMI of 15, bradycardia, multiple erosions of tooth enamel, and scabs and scars on her knuckles. You should ask her if she:

 

Is heat intolerant

 

If she binges and vomits

 

If she is constipated

 

Falls a lot

 

Question 19A toddler is able to jump in place and balance on one foot as well. She can also speak in full sentences and feed herself. What is the approximate developmental age of this child?

 

2 years

 

3 years

 

4 years

 

5 years

 

Question 20You are assessing an ill toddler in your office. He responds when spoken loudly to or physically stimulated but then appears to fall back to sleep. This level of consciousness is:

 

Alert

 

Lethargic

 

Comatose

 

Unconscious

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