NBME CMS Peds 31-40

A healthcare worker is exposed to a patient with a confirmed case of Bordetella pertussis. Which of the following is the MOST appropriate infection control measure to prevent transmission?

A previously healthy 2-year-old presents to the emergency department unresponsive with shallow respirations at a rate of 61/min and an oxygen saturation of 90%. The patient has a strong odor of alcohol on their breath Given the patient's presentation, what is the MOST appropriate next step in management?

A newborn is born to a mother with unknown prenatal care. The newborn appears healthy, and initial Apgar scores are normal. The mother's hepatitis B surface antigen (HBsAg) status is pending. Which of the following is the MOST appropriate course of action regarding hepatitis B prophylaxis for the newborn?

A 3-day-old girl with Down syndrome is being evaluated for constipation. Her mother reports that she has not passed any stool since birth. On physical examination, the infant is noted to have hypotonia and a soft, nontender abdomen. What is the MOST likely underlying cause of this patient's condition?

A 25-year-old female presents with a malar rash, oral ulcers, arthritis, proteinuria and hematuria. The physician suspects systemic lupus erythematosus (SLE) with lupus nephritis. What diagnostic test is MOST important to determine the appropriate management?

A 2-year-old toddler is brought to the emergency department after reportedly ingesting multiple medications found in an open bottle. The child is somnolent, with a respiratory rate of 10 breaths per minute, heart rate of 50 beats per minute, and pinpoint pupils. Which of the following medications is the MOST likely cause of these findings?

A 3-month-old infant presents with fever, lethargy, and a petechial rash. The infant is hypotensive and has prolonged capillary refill. Initial blood gas shows a metabolic acidosis with a pH of 7.32. Which of the following is the MOST appropriate initial step in the management of this infant?

A 60-year-old male presents with progressive shortness of breath and lower extremity edema. On physical exam, a diastolic murmur is auscultated along the left sternal border, and the patient has a widened pulse pressure and bounding peripheral pulses. Which of the following pathophysiologic mechanisms is MOST likely contributing to this patient's condition?

A 2-week-old infant is brought to the emergency department with bilious vomiting. An upper gastrointestinal (GI) series reveals that the small bowel is located on the right side of the abdomen. Which of the following conditions is the MOST likely diagnosis?

A 7-year-old child is brought to the pediatrician due to recurrent episodes of painless rectal bleeding. Physical examination reveals hyperpigmented macules on the buccal mucosa and lips. Which of the following is the MOST appropriate next step in the evaluation of this patient?

In managing a preterm infant requiring mechanical ventilation, which strategy BEST minimizes the risk of bronchopulmonary dysplasia (BPD)?

A 6-year-old child with a history of recurrent sinopulmonary infections and failure to thrive is diagnosed with cystic fibrosis. Which of the following interventions is MOST critical to improve long-term pulmonary outcomes?

A previously healthy 16-year-old male presents to the emergency department complaining of acute, severe testicular pain. Physical examination reveals a swollen, tender testicle with an absent cremasteric reflex. Which of the following is the MOST appropriate next step in management?

A 4-year-old child with a known peanut allergy accidentally ingests peanut butter. He develops hives, angioedema, and wheezing. After administering intramuscular epinephrine, which of the following is the MOST appropriate next step in management?

A 10-year-old girl presents with a 2-day history of fever, sore throat, and difficulty swallowing. On physical examination, she is noted to have a 'hot potato' voice, trismus, and unilateral tonsillar swelling with uvula deviation. What is the MOST likely diagnosis?

A 1-month-old infant presents with non-bilious projectile vomiting after feeding. On physical examination, an olive-shaped mass is palpated in the epigastric region. What is the MOST likely diagnosis?

A 3-year-old child presents with hematuria, edema, and hypertension following a recent upper respiratory infection. Urinalysis reveals red blood cell casts and proteinuria. Which of the following is the MOST likely diagnosis?

A 12-year-old girl presents with fatigue, weight loss, and delayed puberty. Laboratory testing reveals elevated anti-endomysial and anti-tissue transglutaminase antibodies. Which of the following is the MOST appropriate next step in management?

A 9-month-old infant is brought to the emergency department with inconsolable crying and drawing his legs up to his abdomen. Physical examination reveals a sausage-shaped mass in the right lower quadrant. What is the MOST likely diagnosis?

A toddler is evaluated for recurrent skin and soft tissue infections. Laboratory workup reveals normal B cell counts but absent T cells and hypogammaglobulinemia. What is the MOST likely underlying immunodeficiency?

A child diagnosed with ALL is undergoing induction chemotherapy. The physician is MOST concerned about tumor lysis syndrome when lab values show:

A newborn presents with ambiguous genitalia. Karyotype analysis reveals a 46,XX chromosome pattern. Further evaluation reveals the presence of a uterus and ovaries. Which of the following is the MOST likely underlying cause of this condition?

According to the American Academy of Pediatrics, what is the recommended age to begin screening for autism spectrum disorder (ASD) in all children?

During a well-child visit for a 4-year-old, the parent expresses concern about their child's frequent nightmares. The child is easily consoled after the nightmares and remembers the dreams vividly. Which of the following is the MOST appropriate initial recommendation?

A 6-year-old female presents with a pruritic rash predominantly located in the flexural areas of the elbows and knees, as well as on the neck. There is a family history of asthma and allergic rhinitis. What is the MOST likely diagnosis?

A child is bitten by a stray dog with unknown vaccination status. After appropriate wound care, what is the MOST appropriate next step in management regarding rabies prophylaxis?

A 15-year-old male presents to the clinic with complaints of progressive proximal muscle weakness. Physical examination reveals calf pseudohypertrophy. What is the MOST likely diagnosis?

A 17-year-old girl is brought to the emergency department after a syncopal episode. She reports a history of dieting and excessive exercise. Her EKG shows a prolonged QT interval. Which of the following electrolyte abnormalities is MOST likely contributing to her condition?

A 5-year-old child is diagnosed with idiopathic thrombocytopenic purpura (ITP). Platelet count is 15,000/µL, but is otherwise asymptomatic. What is the MOST appropriate initial treatment?

A 9-year-old child is evaluated for short stature. The child's height and weight are below the 5th percentile. Laboratory testing, including thyroid function tests and complete blood count, is normal. Which of the following is the MOST appropriate next step in the evaluation?

A child with severe hemophilia A is scheduled for a minor surgical procedure. Which of the following is the MOST appropriate pre-operative management?

An infant who is born at 28 weeks gestation demonstrates signs of respiratory distress in the delivery room. Despite the use of continuous positive airway pressure (CPAP), the infant's oxygen saturation remains low, and his work of breathing is increased. Which of the following is the MOST appropriate next step in management?

Which of the following is the MOST common cause of secondary hypertension in children?

A 6-month-old infant presents with microcytic anemia. The infant is exclusively breastfed and has not started on complementary foods. Which of the following is the MOST likely cause of the anemia?

A 14-year-old boy presents with concerns about a recent growth spurt and breast development. Physical examination reveals gynecomastia. Which of the following is the MOST appropriate initial step in management?

A previously healthy 12-year-old girl is found unresponsive in her bedroom. On examination, her breathing is shallow and labored, and her pupils are constricted. There are no obvious signs of trauma. A friend mentions that the girl has been struggling with depression recently. Which of the following is the MOST appropriate IMMEDIATE step in managing this patient?