All practice questions

Match each clinical presentation of acute poisoning or overdose with the most appropriate targeted antidote or therapeutic intervention.

A pediatric clinic is updating its health maintenance protocols to align with the latest American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) guidelines. The clinic director is reviewing the timeline of universal preventive care interventions for healthy, full-term pediatric patients with no significant family history of disease. Arrange the following routine preventive care interventions in chronological order, starting with the intervention recommended at the earliest age.

Match each clinical and radiographic presentation in a newborn with the most likely underlying neonatal respiratory disorder.

A 10-month-old boy is brought to the clinic by his parents due to fever, irritability, and crying when laid down to sleep. The symptoms began 2 days ago following a mild viral upper respiratory tract infection. His temperature is 39.1°C (102.4°F), heart rate is 130/min, and respiratory rate is 28/min. Otoscopic examination reveals bulging, intensely erythematous tympanic membranes bilaterally with absent mobility on pneumatic otoscopy. He has no known medical conditions, takes no daily medications, and has no known drug allergies. He has not received any antibiotics since birth. Which of the following is the most appropriate next step in management?

A 58-year-old man is evaluated on hospital day 6 for new-onset right lower extremity swelling and pain. He was admitted 6 days ago for a severe exacerbation of chronic obstructive pulmonary disease and has been receiving intravenous corticosteroids, bronchodilators, and subcutaneous unfractionated heparin for deep vein thrombosis prophylaxis. His respiratory status has significantly improved, but today he reports worsening right calf pain. Vital signs are temperature 37.2°C (99.0°F), blood pressure 130/80 mmHg, pulse 92/min, and respirations 16/min. Physical examination shows a swollen, erythematous, and tender right calf. Laboratory studies from today show a hemoglobin of 13.2 g/dL, leukocyte count of 8,500/mm³, and platelet count of 90,000/mm³. His platelet count on admission was 240,000/mm³. A lower extremity venous duplex ultrasound reveals a noncompressible right popliteal vein. Which of the following is the most appropriate next step in management?

A $3$-year-old girl is evaluated in the hospital on day $4$ of admission for acute mastoiditis. She initially presented to the emergency department with a $3$-day history of high fever, severe left ear pain, and outward displacement of the left auricle. On admission, she underwent tympanostomy tube placement and was empirically started on intravenous vancomycin and ceftriaxone. Cultures of the purulent middle ear fluid obtained during the procedure grew Streptococcus pneumoniae. Susceptibility testing reveals the organism has a penicillin minimum inhibitory concentration (MIC) of $0.06$ $\mu$ g/mL (highly susceptible). It is also susceptible to clindamycin, ceftriaxone, and levofloxacin. Currently, the patient has been afebrile for $48$ hours, the postauricular erythema has resolved, and she is tolerating a regular diet. The medical team plans to discharge her today to complete a $14$-day total course of antimicrobial therapy as an outpatient. Which of the following is the most appropriate oral pharmacotherapy to prescribe for discharge?

A full-term newborn develops visible scleral icterus and facial jaundice at 36 hours of life. Arrange the following steps in the correct chronological order for the standard evaluation and escalating management of neonatal hyperbilirubinemia.

Match each pediatric clinical vignette with the most appropriate next step in management.

Match each clinical exposure scenario with the most appropriate post-exposure prophylaxis or next step in management.

A 38-year-old man with a history of hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations presents with a 10-day history of progressively worsening headache and low-grade fevers. He is hemodynamically stable. He is alert and fully oriented. Neurologic examination reveals a mild right-hand pronator drift but no papilledema or signs of meningeal irritation. An MRI of the brain with contrast reveals a $2.5$-cm ring-enhancing lesion in the left frontal lobe with moderate surrounding vasogenic edema but no midline shift. Arrange the following management steps in the most appropriate chronological order.

Match the following classic infectious disease clinical presentations with their most appropriate first-line antimicrobial therapy.

Match each clinical exposure scenario with the most appropriate post-exposure prophylaxis (PEP) regimen.

Match each pediatric respiratory or upper airway infectious clinical presentation with its most likely causative pathogen.

A 7-month-old boy is brought to the clinic in January by his parents due to a 3-day history of nasal congestion, clear rhinorrhea, and a low-grade fever. Over the last 24 hours, he has developed a harsh cough and rapid breathing. The patient was born at term and has received all age-appropriate vaccinations. His temperature is 37.9°C (100.2°F), heart rate is 135/min, respiratory rate is 58/min, and oxygen saturation is 95% on room air. Physical examination demonstrates nasal flaring, mild intercostal retractions, and diffuse bilateral wheezing with fine crackles. Which of the following is the most appropriate next step in management?

An outpatient physician evaluates a young adult with a known systemic autoimmune disorder who presents complaining of profound generalized muscle weakness over the last week. The patient, who has a well-documented history of severe dry eyes, dry mouth, and positive anti-Ro/SSA antibodies, reports that she has been unable to climb the stairs in her home due to bilateral leg heaviness. She takes no medications other than artificial tears and has had no recent diarrhea, vomiting, or changes in diet. Her blood pressure is $112/72\ \text{mmHg}$, and pulse is $84\text{/min}$. Physical examination reveals symmetric proximal muscle weakness in the upper and lower extremities with diminished deep tendon reflexes.

Laboratory studies reveal the following:
Serum sodium: $140\ \text{mEq/L}$
Serum potassium: $2.1\ \text{mEq/L}$
Serum chloride: $114\ \text{mEq/L}$
Serum bicarbonate: $14\ \text{mEq/L}$
Blood urea nitrogen: $14\ \text{mg/dL}$
Serum creatinine: $0.9\ \text{mg/dL}$
Urine pH: $6.8$

Which of the following best describes the underlying pathophysiology of this patient's laboratory abnormalities?

A 54-year-old female patient is seen during morning rounds on the inpatient medical ward following 48 hours of treatment. She was initially admitted for a high fever, productive cough, and right-sided pleuritic chest discomfort. At the time of admission, a chest radiograph demonstrated a dense consolidation in the right lower lobe, prompting empiric therapy with intravenous ceftriaxone and oral azithromycin. Her past medical history is notable for chronic obstructive pulmonary disease.

This morning, the patient reports significant symptomatic improvement and is tolerating an oral diet. Vital signs demonstrate a temperature of 37.1°C (98.8°F), blood pressure of 124/80 mmHg, heart rate of 76/min, and a respiratory rate of 16/min with an oxygen saturation of 98% on room air. Pulmonary auscultation reveals decreased breath sounds at the right lung base but no wheezing or rhonchi.

The hospital laboratory reports that the sputum culture collected upon admission has grown *Streptococcus pneumoniae*. The antimicrobial susceptibility profile is as follows:

Which of the following is the most appropriate next step in this patient's pharmacologic management?

A 4-year-old girl is brought to the pediatric clinic for a routine well-child visit. She has a history of perinatally acquired HIV infection. Her mother admits they have struggled with adherence to her antiretroviral therapy regimen over the past year. Her most recent laboratory studies from two weeks ago show an HIV viral load of 150,000 copies/mL and a CD4 T-lymphocyte count of 250 cells/mm³ (CD4 percentage of 11%). She recently recovered from a mild upper respiratory tract infection but has no symptoms today. Vital signs are within normal limits for her age. Review of her immunization record indicates she received all age-appropriate vaccines during infancy and toddlerhood, but she is currently due for her 4-year preschool boosters. During the physical examination, the girl is observed hopping on one foot and successfully copying a cross drawn by the physician. Her mother notes that she frequently engages in cooperative play with other children at daycare. Which of the following is the most appropriate plan for this patient today?

A 24-day-old male neonate, born at 27 weeks gestation, is currently in the neonatal intensive care unit (NICU). Birth weight was $950 \text{ g}$. His hospital course has been complicated by respiratory distress syndrome requiring mechanical ventilation for the first two weeks of life, and he is currently on continuous positive airway pressure (CPAP). A peripherally inserted central catheter (PICC) has been in place since birth for parenteral nutrition.

Over the past 12 hours, the infant has developed temperature instability with a temperature of $38.3^\circ\text{C}$ ($100.9^\circ\text{F}$), recurrent episodes of apnea, and poor feeding tolerance. Vital signs show a heart rate of $185\text{/min}$, respiratory rate of $65\text{/min}$, and blood pressure of $42/24 \text{ mmHg}$. Physical examination is notable for hypotonia, a full anterior fontanelle, and sluggish pupillary reflexes.

A full sepsis evaluation is performed. Lumbar puncture yields cloudy cerebrospinal fluid (CSF). CSF analysis reveals:

Serum glucose is $65 \text{ mg/dL}$. Blood and urine cultures have been obtained.

Which of the following is the most appropriate empiric intravenous antimicrobial regimen for this patient?

A 76-year-old woman is evaluated in the clinic for a routine wellness visit. She resides in an assisted living facility and has no acute complaints. Her medical history is notable for hypertension, osteoarthritis, and well-controlled type 2 diabetes mellitus. Vital signs are within normal limits. She specifically denies dysuria, urinary frequency, urgency, or suprapubic pain. A screening urinalysis obtained by the facility staff prior to the visit reveals trace leukocyte esterase, positive nitrites, and 15-20 white blood cells/hpf. A subsequent urine culture grows $>10^5$ CFU/mL of *Escherichia coli*. Which of the following is the most appropriate next step in management?

A 48-hour-old full-term male newborn is evaluated in the nursery prior to discharge due to the appearance of a new rash. He was born via an uncomplicated spontaneous vaginal delivery to a 26-year-old primigravid woman. The mother received regular prenatal care, and her screening tests for group B *Streptococcus*, hepatitis B, HIV, and syphilis were negative. She has no history of genital herpes. The infant has been breastfeeding well and has normal urine output and bowel movements. Vital signs show a temperature of 37.0°C (98.6°F), heart rate of 142/min, and respiratory rate of 42/min. Physical examination reveals an alert, vigorous infant. There are numerous blanching, erythematous macules and papules, many of which contain central 1- to 2-mm yellow-white pustules, widely distributed across the chest, back, and proximal extremities. The palms and soles are completely spared. The remainder of the examination is unremarkable. Which of the following is the most appropriate next step in management?