GENERAL PRACTITIONER EXAM
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A 10 year old boy is noted for his extreme fear of water during his first day of swimming lesions. The teacher helps the child sit on the edge of the pool and splash the water with his feet. She then goes one step further and shows him how to wet his knees. It takes her an hour to have him float on the water while holding his hand. The teacher used which technique to help the child conquer his tear of water?
A 15 year old girl and her 2-month-old infant are brought to a local clinic by the girl´s mother. Although the girl was recently married, she still lives with her mother and attends school. The infant is crying as the physician enters the examining room. Examination of the infant reveals small red spots covering the child´s body. The physician diagnoses the spots as the result of a food allergy and assures the mother that the condition in not life-threatening. “Most of these allergies respond well to simple medication” the physician tells her. Permission to treat the infant should most likely be obtained from which of the following in most cases?
The girl although 15 years old is married and therefore emancipated. This means she is a full adult, and has all the rights and privileges of an adult, including the right to make decisions about her own health care, or the health care of her child. Marriage emancipated.
The physician is empowered to make decisions regarding the child´s care using the “Best Interest Standard” only if the parents or guardian are not available or the parents or guardian seek to deny the child life- or limb-saving care. The doctrine of en locum parent is (choice A) refers to the capacity to render decisions as a parent might in these specified circumstances.
In some states if the girl were unmarried choice C would be the correct answer. In any case since she is married she is an emancipated minor in every state and choice C is incorrect.
The Department of Children and Family Services might be called upon to render a decision choice D) if the child had no parents or legal guardian present. However because the mother is emancipated, there is no need. The father (choice E) could give permission just as the child´s mother could. However the father not present and the mother is.
In which of the following age groups does the presence of high places will most likely frighten a child?
Children less than one year of age are most often scared of loud noises, heights, and lack of physical support. Children one year of age typically begin to experience stranger anxiety and separation anxiety Children between the ages of two and six years are afraid of figments of their imagination (e.g., the bogeyman), as well as animals and the dark. Children who are elementary school age are more afraid of injuring themselves physically or losing a loved one, such as a parent. Adolescents and teens are scared of failing or not being accepted socially.
Testicular enlargement in males occurs during which of the following stages of adolescent development?
Tanner I stage indicates a penis, scrotum, and testes of a normal childhood size. When the testicles begin to enlarge, but the penis size remains the same, the Tanner II stage is designated. It is not until the Tanner III stage that the penis size grows in length, and in the Tanner IV stage penis size grows in breadth. The Tanner V stage indicates an adult size penis and accompanying genitalia.
The most important single method of confirming the adequacy of a baby´s food intake is which one of the following?
The most important single method of confirming the adequacy of a baby´s food intake is which one of the following?
Anxiety most often develops at what age?
Separation anxiety occurs in normal development as infants develop clear preferences for social contact with persons who give them the most care. It usually occurs at six to eight months of age when a child becomes anxious when unfamiliar faces or persons who are not their caretakers approach them.
A child should have developed the ability to walk relatively well by which of the following well child visit?
Typically children under the age of fifteen months do not walk bipedally very well. The fifteen month well baby office visit coincides well with the ability of children to walk on their own.
A child does have no real sense of danger up to which one of the following age?
Up to approximately two years of age, children have no real concept of danger. Therefore, it is imperative during this period to monitor the activities of a playing child.
Predominant Solid food should be introduced to children at which of the following age?
There is a shift to predominantly solid foods at 10 months. Before that, predominantly semi-solid foods are given.
A neonate with dysmorphic facies is twitching abnormally. He then experiences a seizure. Investigations indicate glucose of 90 mg/dL, serum sodium of 140mEq/L, serum potassium of 4.2 mEq/L, and serum calcium of 3.9 mg/dL. Over the next several months, the child is admitted to the hospital twice for candida infections and once for a viral exanthem. Most likely present in this child is
DiGeorge syndrome is due to malformation of epithelial elements of the third and fourth pharyngeal pouches, leading to thymic aplasia or severe hypoplasia, and sometimes absence of the parathyroids. Clinically, the condition is classified as a selective T- cell deficiency, but varying degrees of deficiency of antibody production may also be seen. Affected infants are susceptible to fungal and viral infections, and may exhibit tetany due to severe hypocalcemia. Congenital rubella syndrome is associated with patent ductus arteriosus, pulmonary stenosis, microcephaly, cataracts, and deafness. Trisomy 13, or Patau syndrome, is associated with microphthalmia, microcephaly, polydactyly, cardiac defects, renal defects, umbilical hernia and rocker-bottom feet. Trisomy 18 or Edwards syndrome is associates with mental retardation, low set, ears micrognathia, short neck, overlapping fingers, heart defects, kidney defects, limited hip abduction and rocker bottom feet. Velocardiofacial syndrome is a condition related to DiGeorge syndrome that involves prominent nose retrognathia cleft palate cardiovascular anomalies and learning disabilities. Less frequently these patients also have immunodeficiencies.
A month old infant presents for routine visit. Exam shows a loud holosystolic murmur in the left parasternal region with an associated systolic thrill. The first and second heart sounds are normal. The peripheral pulses are well palpable, and BP is normal in all four extremities. There is no peripheral edema or cyanosis. Rest of the exam is unremarkable. CXR shows cardiomegaly with increased pulmonary vascular markings. Echocardiogram would likely show which finding?
The incidence of Down syndrome in children born to women aged less than 30 years is approximately which of the following?
The incidence is roughly 1 in 1200 births for women less than 30 and this incidence can rise to 1 in 60 by the age of 42.
Maternal age also affects the incidence of hydrocephalus, anencephaly and other chromosomal disorders.
A 5 year old girl is admitted to the Hospital after swallowing an undisclosed number of her mother´s ASA (aspirin) tablets. She is hypotensive, flushed and tachypneic. The acids-base disturbances that she would be most likely having is
Salicylate poisoning can cause vomiting, tinnitus, confusion, hyperthermia, respiratory alkalosis, metabolic acidosis, and multiple organ failure. Diagnosis is clinical, supplemented by measurement of the anion gap, ABGs, and serum salicylate levels. Treatment is with activated charcoal and alkaline diuresis or hemodialysis.
ABGs suggest primary respiratory alkalosis during the 1st few hours after ingestion, later, they suggest compensated metabolic acidosis. ASA toxicity in children leads to high anion gap metabolic acidosis and compensatory respiratory alkalosis; (due to tachypnea). Therefore, the pH will be low or normal (due to compensation), The HCO3 will be low (due to metabolic acidosis) and the pCO2 will be low (due to respiratory compensation).
An infant starts choking while eating his dinner. He become cyanotic agitated with forceful breathing. The most useful first action to do at this time is
For an infant, abdominal thrusts are not performed. Instead, the infant is turned face down, the chest resting on the rescuer´s forearm, with the head lower than the body. The rescuer then strikes the infant “between the shoulder blades 5 times using the heel of the hand (back blows). The strikes should be firm but not hard enough to cause injury. The rescuer then checks the mouth, removing any visible objects. If the airway remains blocked, the rescuer turns the infant face up with the head down, and using the second and third fingers, thrusts “inward and upward on the infant´s breastbone 5 times (chest thrusts). The rescuer then checks the mouth again. Blind sweeps of the throat should not be done initially as they may lodge the obstructing article even further.
In an infant or child who has failure to thrive (FTT), which of the following is most likely to provide the basis for making the correct diagnosis?
In an infant or child who has failure to thrive (FTT), which of the following is most likely to provide the basis for making the correct diagnosis?
Which one of the following would best characterize a child of two years of age?
At two years of age, a child is likely to begin to use words such as “I,” “me,” and “you,” and often talks incessantly. Choice A occurs at 18 months. At two years, the child is likely to turn pages of a book singly. Choices C and D, and E usually occur at three years of age.
A 5 month old infant is found to be hypercalcemic and oliguric secondary to nephrocalcinosis. Which one of the following vitamin toxicity may be possible in this infant?
Vitamin D toxicity is associated with hypercalcemia, as well as constipation, and sometimes nephrocalcinosis. Vitamin E toxicity may cause a necrotizing enterocolitis and hepatitis in children. Vitamin K toxicity, although uncommon, may cause vomiting and hemolysis, as well as albuminuria and hemoglobinuria. Pantothenic acid toxicity is associated with diarrhea. Pyridoxine toxicity, while very rare, is associated with peripheral sensory neuropathy.
Which of the following is NOT a clinically important indicator of the normal development of an infant?
| The limb placement reflex occurs when the front of the leg below the knee or the arm below the elbow is brought into contact with the edge of the table and the child lifts the limb over the edge. It is not of clinical importance. The startle reflex, or Moro reflex, occurs when a sudden movement of the neck initiates rapid abduction and extension of the arms with the opening of the hands followed by arms which come together as in an embrace. The palmar reflex occurs when the infant´s palm is stimulated and his or her hand closes. The Babinski, or plantar, reflex is flexor in normal infants. The rooting reflex occurs when the infant puckers his or her lips in response to perioral stimulation. |
Which of the following age groups have fear of imaginary dragons and ghosts?
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According to Piaget´s Stages of Cognitive Development, at which of the following stage do children begin to exhibit the ability to utilize metaphoric thought and analogies?
During the stage of formal operations, which, if achieved, is done between the ages of 12 and adulthood. An individual becomes able to deal effectively with abstract thoughts and ideas. In addition, the individual is effectively able to utilize metaphor and analogy as a means of communication and understanding. It is important to note that not all individuals will achieve this level of complex thought. Some individuals will be halted at the concrete operations stage, never quite being able to comprehend or use the abilities that are achieved during the formal operations stage.
In which of the following age group the presence of high places will most likely frighten a child?
Children less than one year of age are most often scared of loud noises, heights, and lack of physical support. Children one year of age typically begin to experience stranger anxiety and separation anxiety. Children between the ages of two and six years are afraid of figments of their imagination (e.g., the bogeyman), as well as animals and the dark. Children who are elementary school age are more afraid of injuring themselves physically or losing a loved one, such as a parent. Adolescents and teens are scared of failing or not being accepted socially.
A child should have first developed the ability to indicate his/her wants and desires by which of the following well child visit?
By the age of 15 months, most children have developed the ability to indicate their wants and desires either through verbal or non verbal actions.
The use of whole cow´s milk is inappropriate for infant feeding during which one of the following periods?
The use of whole cow´s milk to feed infants is inappropriate for the first six months of life.
Pneumovax inoculation is NOT needed by which one of the following groups?
All of the other groups are at increased risk for pneumococcal pneumonia and its potentially life threatening sequelae and should be vaccinated.
LEAST likely effective method to control enuresis in a child is?
In a child who exhibits enuresis, it is important not to be negative regarding the child´s bed wetting state. Keeping track of “wet” and “dry” nights will allow the child to visualize progress that he has made, which can then be rewarded. Getting a child to urinate directly before going to bed may also be a good idea. The child needs to understand his medical problem and, only in this way can blame and guilt be removed from the child´s psyche. It is not a good idea to punish a child for a “wet” night because the added stress only exacerbates the frequency of enuresis.
An infant´s height is found to be double its birth length during a well child visit. The most likely time for the infant to have achieved this length is which one of the following?
As a general rule of thumb, at the age of four years, an infant is approximately twice his birth length. Given a 20-inch infant at birth, a child is approximately 40 inches in length at the age of four years. At the age of three years, a child is approximate three feet tall.
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