Answer and Explanation 5

5.  Choice B is the incorrect answer.  The ductus arteriosis connects the aorta to the pulmonary artery.  It shunts the majority of blood away from the lungs by virtue of pressure gradients and high oxygen affinity by the maternal hemoglobin.  The foramen ovale is an opening between the left and right atria that closes within the first 24 hours.  There is a higher pressure in the right heart than the left during fetal circulation.  This reverse after birth when negative pressure breathing starts and the baby starts to breath on their own.

Question 5

5.  Which of the following is incorrect regarding fetal circulation?

A.  There is higher pressure in the right side of the heart than the left in fetal circulation

B.  The ductus venosum connects the aorta to the pulmonary artery

C.  The foramen ovale is an opening between the right atrium and the left atrium

D. The majority of the blood is shunted away from the lungs by the ductus arteriosis by a higher pressure gradient during fetal circulation.

Answer and Explanation 4

4.  Choice B is the correct answer.  Cocksackie virus is the virus that causes hand foot and mouth disease.  It usually produces a fever and has a viral prodrome.  Erythema multiforme produces target shaped lesions and can have a viral etiology (herpes) among other causes.  Adenovirus and ECHO virus do not really have any distinct rashes associated with them.

Question 4

4.  What is the virus responsible for the rash shown below in the photograph?

A.  Adenovirus

B.  Cocksackie Virus

C.  Erythema Multiform

D.  ECHO Virus

Answer and Explanation 3

3.  Choice A is the correct answer.  This patient is presenting with a history concerning for pyloric stenosis.  The current recommendation for diagnostic imaging in abdominal ultrasound.  Typically pyloric stenosis presents around 6 weeks as projectile vomiting refractory to anti-emetics.  The highest incidence is in caucasian males.  Ranitidine would be helpful in GERD which does not present like this.  KUB would be helpful to screen for a volvulus, midgut malrotation, or toxic megacolon.  A scrotal ultrasound would be helpful if you were suspicious for undescended testicles or testicular torsion.

Question 3

3.  Your patient is  a 6 week old caucasian male presents with vomiting that has persisted for the last 6 days. He is clinically dehydrated.  His vitals are as follows temp 97.7, pulse-125, Sat 99%, BP-92/53. Treatment seems to be refractory to anti-emetics.  Based upon this information what is the next best management option?

A.  Order an ultrasound of the abdomen

B. Order a KUB

C.  Start the patient on rantidine

D.  Order a scrotal ultrasound

Answer and Explanation 2

2.  Choice B is the correct answer.  Infectious mononucleosis usually gives a fever, exudative tonsillitis, and leukocytosis.  Differential will reveal atypical lymphocytes. It is not unusual to have an associated hepatitis with a mononucleosis infection.  Kawasaki's is usually not a  consideration until 5 days of high fever and the children usually are younger.  Most CMV infections are asymptomatic.

Question 2

2.  A 13 year old female presents with a fever 103, sore throat, arthralgias, and headache for 3 days.  Physical exam reveals exudative pharyngitis and cervical lymphadenopathy. Liver Transaminases are elevated.  CBC shows a WBC of 12,600.  Given this information, what is the most likely diagnosis?

A.  Kawasaki's

B.  Infectious Mononucleosis 

C.  CMV infection

D.  Rubella

Answer and Explanation 1

1.  Choice D is the correct answer.  Phototherapy is indicated for indirect bilirubin levels between 16-18 mg/dl.  Exchange transfusions are usually not indicated until the indirect bilirubin levels are over 20.  This child should not be discharged and needs to be treated because if levels reach above 20 kenicterus can develop and can be neurotoxic.

Question 1

1.  Your patient is a 1 day old infant born to a group B strep negative mother at 39 weeks via vaginal delivery.  He presents with jaundice.  Peripheral indirect bilrubin was measured and came back at 17 mg/dl.  He is currently being breast fed.  Given this information, what is the best management option?

A.  Discharge the patient home.  This should resolve itself in a couple days.

B.  Admit the patient to the hospital, start normal saline infusion at maintenance and repeat labs in the morning.

C.  Start the patient on exchange transfusions.

D.  Start the patient on phototherapy