8 Year Old Previously Healthy Boy Low Grade Fever Petechiae Splenomegaly

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4. A 4-year-old girl is noticed by her grandmother to have a limp and a somewhat swollen left knee. The parents report that the patient occasionally complains of pain in that knee. An ophthalmologic examination reveals findings as depicted in the photograph. The condition most likely to be associated with these findings is

a. Juvenile rheumatoid arthritis b. Slipped capital femoral epiphysis c. Henoch-Schonlein purpura d. Legg-Calve-Perthes disease e. Osgood-Schlatter disease

5. The previously healthy 4-year-old child pictured presents to the emergency room with a 2-day history of a brightly erythematous rash and temperature of 40°C (104°F). The exquisitely tender, generalized rash is worse in the flexural and perioral areas. The child is admitted and over the next day develops crusting and fissuring around the eyes, mouth, and nose. The desquamation of skin shown occurs with gentle traction. This child most likely has

A (Courtesy Adelaide Hebert, M.D.)
Image Mains Femme
B (Courtesy Adelaide Hebert, M.D.)

a. Epidermolysis bullosa b. Staphylococcal scalded skin syndrome c. Erythema multiforme d. Drug eruption e. Scarlet fever

6. You are counseling an adolescent patient about the long-term management of her asthma while she is away at college. She brought an article she found on the Internet that promotes an herbal supplement purported to be a "safe, natural" treatment for asthma. You recall a recent study in the medical literature showing inhaled steroids to be statistically superior to the advertised herbal supplement at preventing asthma exacerbations at the p < 0.05 level. You explain to her that this means that a. The inhaled steroids are 5% better than herbal treatment b. A critical threshold for medical significance has been reached c. Patients will not benefit from the herbal treatment 5% of the time d. The odds are less than 1 in 20 that the differences observed were only a chance variation e. It would be unethical to use herbal treatment Items 7-8

7. A previously healthy 8-year-old boy has a 3-week history of low-grade fever of unknown source, fatigue, weight loss, myalgia, and headaches. On repeated examinations during this time, he is found to have developed a heart murmur, petechiae, and mild splenomegaly. The most likely diagnosis is a. Rheumatic fever b. Kawasaki disease c. Scarlet fever d. Endocarditis e. Tuberculosis

8. After you make the diagnosis in the previous case, you explain the findings to the family and instruct the family to a. Restrict the child from all strenuous activities b. Give the child a no-salt-added diet c. Ensure that the patient receives antibiotic prophylaxis for dental procedures d. Test all family members in the home e. Avoid allowing the child to get upset

9. A 5-year-old boy who was previously healthy has a 1-day history of low-grade fever, colicky abdominal pain, and a skin rash. He is alert but irritable; temperature is 38.6°C (101.5°F). A diffuse, erythematous, macu-lopapular, and petechial rash is present on his buttocks and lower extremities, as shown in the following figure. There is no localized abdominal tenderness or rebound; bowel sounds are active. Laboratory data demonstrate

Urinalysis: 30 red blood cells per high-powered field,

2+ protein Stool: guaiac positive

Platelet count: 135,000/^L

These findings are most consistent with

(Courtesy Adelaide Hebert, M.D.)

a. Anaphylactoid purpura b. Meningococcemia c. Child abuse d. Leukemia e. Hemophilia B

10. A 4-month-old baby boy has just arrived in the emergency room. He is cold and stiff. History from the parents is that the seemingly healthy infant had been placed in his crib for the night, and when they next saw him, in the morning, he was dead. Physical examination is uninformative. Routine whole-body x-rays are shown. The most likely diagnosis is

Pediatric Child Abuse Petechiae
(Courtesy Susan John,M.D.)

a. Scurvy b. Congenital syphilis c. Sudden infant death syndrome (SIDS)

d. Osteogenesis imperfecta e. Battery

11. A mother brings an 18-month-old to the emergency center with the concern that the child may have ingested a substance. Which of the following is a contraindication to the use of ipecac in this child a. Age less than 5 years b. Breast-feeding c. Ingestion of alkali d. Ingestion of iron e. Concurrent administration of intravenous glucose

12. A mother calls you on the telephone and says that her 4-year-old son bit the hand of her 2-year-old son 2 days previously. The area around the laceration has become red, indurated, and swollen, and he has a temperature of 39.4°C (103°F). Your response should be to a. Arrange for a plastic surgery consultation to be scheduled in 3 days b. Admit the child to the hospital immediately for surgical debridement and antibiotic treatment c. Prescribe penicillin over the telephone and have the mother apply warm soaks for 15 min qid d. Suggest purchase of bacitracin ointment to apply to the lesion tid e. See the patient in the emergency room to suture the laceration

Items 13-14

13. The adolescent shown presents with a 14-day history of multiple oval lesions over her back. The rash began with a single lesion over the lower abdomen (A); the other lesions developed over the next days (B). These lesions are slightly pruritic. The likely diagnosis is

Katy Perry Bikini Body
A (Courtesy Adelaide Hebert, M.D.)
B (Courtesy Adelaide Hebert, M.D.)

a. Contact dermatitis b. Pityriasis rosea c. Seborrheic dermatitis d. Lichen planus e. Psoriasis

14. The most appropriate initial therapy for the patient in the previous question is a. Phototherapy b. High-dose topical steroid therapy c. Systemic antifungal agents d. Coal-tar shampoos e. Observation and topical emollients

Items 15-16

15. A very concerned mother brings a 2-year-old child to your office because of multiple episodes of a brief, shrill cry followed by a prolonged expiration and apnea. You have been following this child in your practice since birth and know that the child is a product of a normal pregnancy and delivery, has been growing and developing normally, and has no acute medical problems. The mother relates that the first episode in question occurred immediately after the mother refused to give the child some juice. The child became cyanotic and unconscious and had generalized clonic jerks. A few moments later the child awakened and had no residual effects. A second episode of identical nature occurred at the grocery store when the father of the child refused to purchase a toy for the child. Your physical examination reveals a totally delightful and normal child. The most likely diagnosis in this case is a. Seizure disorder b. Drug ingestion c. Hyperactivity with attention deficit d. Pervasive development disorder e. Breath-holding spell

16. The most appropriate course of action in the previous case would be to a. Obtain an EEG and neurologic consultation prior to starting anticonvulsants b. Begin anticonvulsants while awaiting the results of an EEG, a neurologic consultation, and a urine drug screen c. Initiate a trial of methylphenidate (Ritalin)

d. Instruct the family to splash cold water on the child's face and begin mouth-to-mouth resuscitation should another episode occur e. Reassure the family of the likely benign nature of the problem and offer counseling for appropriate behavior modification

17. The 3-day-old infant pictured has a facial rash. The most likely diagnosis is

(Courtesy Adelaide Hebert, M.D.)

a. Herpes b. Neonatal acne c. Milia d. Seborrheic dermatitis e. Eczema

18. You are called to the emergency room to see one of your patients. The father of this 3-year-old was spraying the yard with an unknown insecticide. In the emergency room, the child is noted to have bradycardia, muscle fasciculations, meiosis, wheezing, and profound drooling. The most likely agent included in this pesticide is a. Organophosphate b. Chlorophenothane (DDT)

c. Sodium cyanide d. Warfarin e. Paraquat

19. A 2-year-old child (A) presents with a four-day history of a rash limited to the feet and ankles. The papular rash is both pruritic and erythematous. The 3-month-old sibling of this patient (B) has similar lesions also involving the head and neck. Appropriate treatment for this condition includes

B (CourtesyAdelaide Hebert, M.D.)

a. Coal-tar soap b. Permethrin c. Hydrocortisone cream d. Emollients e. Topical antifungal cream

20. An 8-h-old infant develops increased respiratory distress, hypothermia, and hypotension. A CBC demonstrates a WBC of 2500/^L with 80% bands. Which of the following diagnoses is most likely?

(Courtesy Susan John,M.D.)

a. Gonococcal eye infection b. Diaphragmatic hernia c. Group B streptococcal pneumonia d. Transient tachypnea of the newborn e. Chlamydial pneumonia

21. A 16-year-old basketball player complains of pain in his knees. A physical examination reveals, in addition to tenderness, a swollen and prominent tibial tuberosity Radiographs of the area are unremarkable. The most likely diagnosis is a. Osgood-Schlatter disease b. Popliteal cyst c. Slipped capital femoral epiphysis d. Legg-Calve-Perthes disease e. Gonococcal arthritis

22. You are performing a well-child examination on a new patient, the 1-year-old child shown in the picture. Your next action should be to

(Courtesy Kathryn Musgrove, M.D.)

a. Patch the eye with the greater refractive error b. Patch the eye that deviates c. Defer patching or ophthalmologic exam until the child is older and better able to cooperate d. Reassure the mother that he will outgrow it e. Refer immediately to ophthalmology, as central vision may fail to develop if the diagnosis and treatment are delayed

23. You are seeing a 2-month-old infant, brought by her father for a well-child examination. He has concerns about maintaining a safe environment for his child. In providing age-appropriate anticipatory guidance, you tell him that a. He should set his water heater to 71°C (160°F) to ensure the sterility of dishes and clothes, thereby decreasing the risk of infections b. His 2-month-old should not be given solid food at this time c. Pillows in the crib should be soft to provide a comfortable sleeping environment d. Infants should be placed on their stomachs to sleep, as this decreases the risk of choking if they spit up e. An infant should never be left unattended in the bathtub until she learns to sit on her own, and then only for brief periods of time

24. An infant who sits with only minimal support, attempts to attain a toy beyond reach, and rolls over from the supine to the prone position, but does not have a pincer grasp, is at a developmental level of a. 2 months b. 4 months c. 6 months d. 9 months e. 1 year

25. A 5-year-old boy presents with the severe rash pictured as follows. The rash is pruritic, and it is especially intense in the flexural areas. The mother reports that the symptoms began in infancy (when it also involved the face) and that her 6-month-old child has similar symptoms. The most likely diagnosis of this condition is

(Courtesy Adelaide Hebert, M.D.)

a. Seborrheic dermatitis b. Superficial candidiasis c. Psoriasis d. Eczema e. Contact dermatitis

26. Appropriate treatment for the condition described in the previous question includes

(Courtesy Adelaide Hebert, M.D.)

a. Coal-tar soaps and shampoo b. Topical antifungal cream c. Ultraviolet light therapy d. Moisturizers and topical steroids e. Topical antibiotics

27. An 18-month-old infant has an intensely pruritic scalp, especially in the occipital region, with 0.5-mm lesions noted at the base of hair shafts, as shown in the picture. The mother of this infant has been using the same hairbrush for herself and for her other two children (ages 2 months and 36 months). Which of the following therapies should be avoided?

(Courtesy Adelaide Hebert, M.D.)

a. Treatment of all household contacts with 1% lindane (Kwell)

b. Use of 1:1 vinegar-water rinse for hair for nit removal c. Washing of all clothing and bedding in very hot water d. Replacement of all commonly used brushes e. Advice to the mother that treatment will again be necessary in 7 to 10 days

28. You are called by a general practitioner to consult on a patient admitted to the hospital 4 days ago. The patient is a 7-month-old white boy with poor weight gain for the past 3 months, who has not gained weight in the hospital despite seemingly adequate nutrition. His guardian is his maternal aunt, as his mother is in jail for unknown reasons. You take a detailed diet history from the guardian, and the amounts of formula and baby food intake seem appropriate for age. Physical examination reveals an active, alert infant with a strong suck reflex who appears wasted. You note generalized lymph-adenopathy with hepatomegaly. In addition, you find a severe case of oral candidiasis that apparently has been resistant to treatment. Which of the following is the most appropriate next step in the evaluation or treatment of this child?

a. Increase caloric intake because this is probably a case of underfeeding b. Order HIV PCR testing because this is likely the presentation of congenitally acquired HIV

c. Draw blood cultures because this could be sepsis d. Perform a sweat chloride test because this is probably cystic fibrosis e. Send stool for fecal fat because this is probably a malabsorption syndrome

29. A 2-year-old boy has been vomiting intermittently for 3 weeks and has been irritable, listless, and anorectic. His use of language has regressed to speaking single words. In your evaluation of this patient, the least likely diagnosis to consider is a. Subdural hematoma b. Brain tumor c. Tuberculous meningitis d. Food allergy e. Lead poisoning

30. Among the following, the least likely risk factor for hearing impairment is a. A maternal history of use of phenytoin during pregnancy b. A family history of hearing impairment c. Craniofacial abnormalities d. Birth weight less than 1500 g e. Neonatal hyperbilirubinemia

Items 31-32

31. An 8-month-old infant has a 2-day history of diarrhea and poor fluid intake. You diagnose a 10 to 15% dehydration. Which of the following fluids is appropriate to begin immediate resuscitation?

a. D5 % normal saline

D5 V2 normal saline Normal saline Whole blood DiqW

32. In this patient, you decide to give 20 mL/kg of the chosen fluid. A reasonable period of time over which to infuse this fluid is a. 2.5 min b. 60 min c. 4 h d. 8 h e. 24 h

33. You are seeing an established patient, a four-year-old girl brought in by her mother for vaginal itching and irritation. She is toilet trained and has not complained of frequency or urgency, nor has she noted any blood in her urine. Her mother noted she has been afebrile and has not complained of abdominal pain. Mom denies the risk of inappropriate contact; the girl also denies anyone "touching her there." Your physical examination of the perineum is significant for the lack of foul odor or discharge. You do note some erythema of the vulvar area, but the hymenal ring is intact, without evidence of trauma. The appropriate course of action should be to a. Refer to pediatric gynecology for removal under anesthesia of a suspected foreign body in the vagina b. Reassure the mother, and counsel her to stop giving the girl bubble baths, have the girl wear only cotton underwear, and improve hygiene c. Refer to social services for suspected physical or sexual abuse d. Swab for gonorrhea and plate on chocolate agar e. Treat with an antifungal cream for suspected yeast infection

34. A 20-month-old child is brought to the emergency department because of fever and irritability and refusal to move his right lower extremity. Physical examination reveals a swollen and tender right knee that resists passive motion. The most important test to confirm the impression of septic arthritis is a. Examination of joint fluid b. X-ray of the knee c. Erythrocyte sedimentation rate (ESR)

d. Complete blood count (CBC) and differential e. Blood culture

35. A 16-year-old high school boy sustained an abrasion of the knee after a fall while Rollerblading in the school yard. School records reveal that his last DPT booster was at age 6. In this situation, which of the following is appropriate?

a. Tetanus toxoid b. Adult tetanus and diphtheria toxoid (Td)

c. DPT booster d. Tetanus toxoid and tetanus immune globulin e. No immunization

36. A five-year-old boy is brought into the emergency room immediately after an unfortunate altercation with a neighbor's immunized Chihuahua that occurred while the child was attempting to dress the dog as a superhero. The fully immunized child has a small, irregular, superficial laceration on his right forearm that has stopped bleeding. His neuromuscular examination is completely normal, and his perfusion is intact. Management should include a. Antimicrobial prophylaxis b. Tetanus booster immunization and tetanus toxoid in the wound c. Copious irrigation d. Primary rabies vaccination for the child e. Destruction of the dog and examination of brain tissue for rabies

37. Aunt Mary is helping her family move to a new apartment. During the confusion, 3-year-old Jimmy is noted to be stumbling about, his face flushed and his speech slurred. The contents of Aunt Mary's purse are strewn about on the floor. In the emergency room, Jimmy is found to have a rapid heartbeat, blood pressure of 42/20, and dilated pupils. ECG shows prolonged QRS and QT intervals. Jimmy suddenly starts to convulse. His condition is most likely to be the result of poisoning with a. Barbiturates b. Tricyclic antidepressants c. Diazepam d. Organophosphates e. Arsenic

38. As a city public health officer, you have been charged with the task of screening high-risk children for lead poisoning. The best screen for this purpose is a. Careful physical examination of each infant and child b. Erythrocyte protoporphyrin levels (EP, FEP, or ZPP)

c. CBC and blood smear d. Blood lead level e. Environmental history

39. Universal immunization of infants with a three-dose series of intramuscular, genetically engineered hepatitis B surface antigen vaccine is recommended. Implementation of this recommendation should decrease the incidence of which of the following?

a. Neonatal hyperbilirubinemia b. Alcoholic liver disease c. Dubin-Johnson syndrome d. Hepatocellular carcinoma e. Hydrops of the gallbladder

40. New parents ask you how to reduce the chance of their baby suffering from sudden infant death syndrome (SIDS). You tell them to place the child in which of the following for sleep?

a. Supine position b. Prone position c. Seated position d. Trendelenburg position e. A hammock

41. A mentally retarded 14-year-old boy has a long face, large ears, micropenis, and large testes. Chromosome analysis is likely to demonstrate which of the following?

a. Trisomy 21

b. Trisomy 18

c. Trisomy 13

d. Fragile X syndrome e. William syndrome

42. A 5-month-old child presents to the emergency room with generalized tonic clonic seizure activity of about 30-min duration that stops upon the administration of lorazepam. The most helpful information to gather from the mother would be a. Whether the child has had congestion without fever for the past 3 days b. Whether the child is developmentally normal, as are his siblings c. Whether the mother has been diluting the infant's formula to make it last longer d. The number of pets at home e. Whether the mother works as a secretary in an energy trading firm

DIRECTIONS: Each group of questions below consists of lettered options followed by numbered items. For each numbered item, select the appropriate lettered option(s). Each lettered option may be used once, more than once, or not at all. Choose exactly the number of options indicated following each item.

Items 43-48

Many rashes and skin lesions can be found first in the newborn period. For each of the descriptions listed below, select the most likely diagnosis.

a. Sebaceous nevi b. Salmon patch c. Neonatal acne d. Pustular melanosis e. Erythema toxicum f. Seborrheic dermatitis g. Milia

43. A 1-week-old child's mother complains that the child has a transient rash that has splotchy areas of erythema with a central clear pustule. Your microscopic examination of the liquid in the pustule reveals eosinophils. (SELECT 1 DIAGNOSIS)

44. An adolescent boy complains of a splotchy red rash on the nape of his neck, discovered when he had his head shaved for football season. The rash seems to get more prominent with exercise or emotion. His mother notes that he has had the rash since infancy, but that it became invisible as hair grew. He had a similar rash on his eyelids that resolved in the newborn period. (SELECT 1 DIAGNOSIS)

45. A nurse calls you to evaluate an African American baby that seems to have a bacterial skin infection, with many scattered pustules full of a milky fluid. Upon examining a pustule, it easily wipes away, revealing a hyper-pigmented spot. (SELECT 1 DIAGNOSIS)

46. The obstetrical resident on call asks you to evaluate an area of a new-born's scalp that seems to have no hair and is scaly and yellowish. (SELECT 1 DIAGNOSIS)

47. A newborn's mother complains that her infant seems to have very small white dots all over his nose. The dots do not wipe off with bathing, but they are also not erythematous. (SELECT 1 DIAGNOSIS)

48. A newborn's father complains that his son has dandruff, with many waxy flakes of skin on the scalp. When he scrapes the lesions, hair often comes off with the flakes of skin. In addition, the baby has flaking of the eyebrows. (SELECT 1 DIAGNOSIS)

Items 49-53

For each otherwise normal child presented, choose the sleep disturbance most consistent with the history.

a. Night terrors b. Nightmares c. Learned behavior d. Obstructive sleep apnea e. Somniloquy

49. A 3-year-old boy awakens every night around 2:00 a.m. screaming incoherently. His parents note that he is agitated, seems awake but unresponsive, and goes back to sleep within a few minutes. He has no memory of the episodes in the morning.

50. A 15-month-old toddler continues to wake up crying every night. Her parents give her a nighttime bottle, rock her, and sing to her to help her go back to sleep. Her parents are exhausted and ask you if she is having bad dreams.

51. Parents hear over their baby monitor that their 5-year-old girl regularly calls out during the night. When the parents check on her, she is sleeping comfortably and is in no apparent distress.

52. A 4-year-old boy occasionally wakes in the middle of the night crying. When his parents check on him, he seems visibly frightened and tells his parents that dogs were chasing him.

53. A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise.

Items 54-58

For each of the injuries listed below, select the age at which it is most likely to occur.

a. 6 months b. 1 year c. 2 years d. 6 years e. 10 years

54. Asphyxiation and choking (SELECT 1 AGE)

55. Drowning in a swimming pool (SELECT 1 AGE)

56. Pedestrian injury (SELECT 1 AGE)

57. Baby-walker injuries (SELECT 1 AGE)

58. Accidental poisoning (SELECT 1 AGE) Items 59-62

For each disorder below, select the dietary deficiency that is likely to be responsible.

a. Caloric deficiency b. Thiamine deficiency c. Niacin deficiency d. Vitamin D deficiency e. Vitamin C deficiency f. Vitamin B12 deficiency g. Vitamin B6 deficiency h. Biotin deficiency i. Riboflavin deficiency

59. Progressive weight loss, constipation, muscular atrophy, loss of skin turgor, hypothermia, and edema (SELECT 1 DEFICIENCY)

60. Dermatitis, diarrhea, and dementia (SELECT 1 DEFICIENCY)

61. Congestive heart failure, peripheral neuritis, and psychic disturbances (SELECT 1 DEFICIENCY)

62. Enlargement of costochondral junction, craniotabes, and scoliosis (SELECT 1 DEFICIENCY)

Items 63-66

Identify the syndrome based on the clinical presentation.

a. Waardenburg syndrome b. Prader-Willi syndrome c. Marfan syndrome d. Treacher Collins syndrome e. Down syndrome

63. A 2-year-old boy has speech delay but otherwise normal intelligence and development. He has a broad nasal bridge, white forelock, hetero-chromic irises, and a ventriculoseptal defect diagnosed by echocardiogram. His mother wears a hearing aid and also has a white forelock.

64. A 17-year-old boy is well over 6 feet tall and has long slender limbs, hypermobile joints, myopia, and a midsystolic click on physical examination.

65. A 6-year-old boy weighs 150 lb and has small hands and feet, almond-shaped eyes, and hypogonadism.

66. A 4-year-old has conductive hearing loss, micrognathia, down-slanting palpebral fissures, abnormally shaped ears, and normal intelligence.

Items 67-70

For each case listed below, match the most likely diagnosis.

a. Legg-Calve-Perthes disease b. Slipped capital femoral epiphysis c. Osteomyelitis d. Septic arthritis of the hip e. Transient synovitis

67. An afebrile, obese 14-year-old boy has developed pain at the right knee and a limp.

68. A 6-year-old boy has developed a limp and has limited mobility of the hip, but denies pain and fever.

69. A 2-year-old refuses to walk, has fever, has significant pain with external rotation of the right leg, and has an elevated white blood cell count.

70. A 3-year-old refuses to walk, is afebrile, had an upper respiratory tract infection a week ago, has right hip pain with movement, and has a normal white blood cell count.

Items 71-75

For the most likely toxic substance involved in the cases below, match the appropriate treatment.

a. Atropine and pralidoxime (2-PAM)

b. N-acetylcysteine (Mucomyst)

c. Meso-2,3-dimercaptosuccimic acid (DMSA succimer)

d. Naloxone (Narcan)

e. Sodium bicarbonate

71. Over the last several weeks, a 2-year-old girl has exhibited developmental regression, abnormal sleep patterns, anorexia, irritability, and decreased activity. These symptoms have progressed to acute encephalopathy with vomiting, ataxia, and variable consciousness. The family recently moved, and they are in the process of restoring the interior of their home. (SELECT 1 TREATMENT)

72. After a fight with her boyfriend, a 16-year-old girl took "some pills." At presentation she is alert and complains of emesis, diaphoresis, and malaise. Her initial liver function tests, obtained about 12 h postingestion, are elevated. Repeat levels at 24 h show markedly elevated AST and ALT, along with abnormal coagulation studies and an elevated bilirubin. (SELECT 1 TREATMENT)

73. You are called to the delivery room. A newborn infant seems lethargic and has poor tone with only marginal respiratory effort, but his heart rate is above 100 beats per min. The mother had an uncomplicated pregnancy, and delivery was uncomplicated and vaginal 10 min after spontaneous rupture of membranes. The mother received only pain medications while in labor. (SELECT 1 TREATMENT)

74. A 4-year-old girl comes into the emergency room after eating a bottle full of small, chewable pills she found while at her grandfather's house. She has an increased respiratory rate, elevated temperature, and vomiting, and is disoriented. She is intermittently complaining of "a bell is ringing" in her ears. She has a metabolic acidosis on an arterial blood gas. (SELECT 1 TREATMENT)

75. After helping his father in the yard, a 14-year-old boy complains of weakness and feels like his muscles are twitching. He begins to drool, and then collapses in a generalized tonic clonic seizure. Upon the arrival of EMS, his heart rate is found to be 40 beats per min and his pupils are pinpoint. (SELECT 1 TREATMENT)

Items 76-78

For the most likely toxic substance involved in the cases below, match the appropriate treatment.

a. Deferoxamine mesylate b. Diphenhydramine (Benadryl)

c. Acetazolamide and sodium bicarbonate d. Ethanol e. Dimercaprol (BAL)

76. A 14-year-old male presents after taking a "happy pill" that his friend gave him. He is alert and oriented, but complains of a muscle spasm in his neck, making his head lean on his right shoulder. You also notice he is arching his back in an unusual manner. (SELECT 1 TREATMENT)

77. A 2-year-old boy found a bottle of his mother's prenatal vitamins and consumed the majority of them. He now has hematemesis and abdominal pain. He is febrile, and labs reveal a leukocytosis and hyperglycemia. (SELECT 1 TREATMENT)

78. A 17-year-old is brought into the emergency department by his friends at about 10:00 a.m. They were at a party the night before and drank some "homemade" alcohol. He is disoriented and confused, and has an anion-gap acidosis. He begins to have seizures as he is placed on a stretcher. (SELECT 1 TREATMENT)

Items 79-83

Excess vitamin intake has been shown to have deleterious effects. Match the vitamin with the toxic effect.

a. Kidney stones b. Sensory neuropathy c. Edema d. Hyperostosis e. Calcification of the heart f. Decreased cerebrospinal fluid pressure g. Erythema of skin

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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