Reference Nelson Textbook of Pediatrics 17th edition参考教材纳尔逊儿科第十七版.docx
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Reference Nelson Textbook of Pediatrics 17th edition参考教材纳尔逊儿科第十七版.docx
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ReferenceNelsonTextbookofPediatrics17thedition参考教材纳尔逊儿科第十七版
Reference:
Nelson,TextbookofPediatrics,17thedition
CaseI.Nos.1-2
A3yearoldnormalchildwasadmittedtoahospitalbecauseofsimplefebrileconvulsions
1.Routinemanagementofthecaseincludes:
A.carefulsearchforcauseoffever(0.5)
B.shorttermanti-convulsantprophylaxis(0.5)
C.Phenobarbitalmaintenancetopreventrecurrence
D.Lumbarpuncture
2.Theanti-convulsantthatmaybeeffectiveintheacutemanagementofprolongedfebrileseizuresis:
A.rectalDiazepam(0.33)
B.rectalPhenobarbital(0.33)
C.IntravenousPhenobarbital(0.33)
D.IntravenousPhenytoin
CaseII.Nos.3-4
Atwo-weekoldbabywasnotedtohavearapidlyincreasingheadcircumference.Atbirth,headcircumferencewas40cms,againstachestcircumferenceof34cms.Presentphysicalexaminationshowedaheadcircumferenceof45cms,wide,bulginganteriorfontanel,gapingsutures,dilatedscalpveinsanda(+)settingsunsign.
3.Iftheocciputisprominent,theprimaryconsiderationis:
p1489
A.Aqueductalstenosis(0.33)
B.Chiarimalformation(0.33)
C.Dandy-Walkermalformation(0.33)
D.Hydranencephaly
4.ThisdrugwillreducetherateofCSFproduction:
p1490
A.Dexamethasone
B.Acetazolamide(1.0)
C.Prednisone
D.Mannitol
CaseIII.Nos.5–9
A9yearoldchildwasbroughttotheOPDclinicbecauseofdeteriorationinschoolpreformance,frankdementia,myoclonicjerksandcerebellarataxia.Hehadnoimmunizationandcontractedmeaslesat10monthsofage,varicellaat2yearsandmumpsat5years
5.Themostlikelydiagnosisis:
p844
A.progressiverubellapanencephalitits
B.subacutesclerosingpanencephalitis(1.0)
C.post-varicellaencephalitis
D.adrenoleukodystrophy
6.Theseizuresarebestcontrolledby:
p1498
A.Carbamazepine(0.5)
B.Valproate(0.5)
C.Phenytoin
D.Lamotrigine
Administrationofthisdrugmayprolongthechild’ssurvival:
p844
A.Methisoprinol
B.Inosiplex(0.5)
C.Taurine
D.Intravenousimmunoglobulin(0.5)
Themostimportanthormoneregulatingrenalcalciumexcretionis:
p200
A.DihydroxyvitaminD(0.33)
B.Calcitonin(0.33)
C.Parathyroidhormone(0.33)
D.Thyrotoxin
A2yearoldfemalewasnotedtobeoliguricfor24hours.ShewasbroughttotheERwithCreatininelevelsof350mmol/l.Serumpotassiumlevelwas6.5mmol/l.Whatpossiblemaneuvercaninduceanegativepotassiumbalanceanddecreaseserumpotassiumlevels?
A.Asodiumbicarbonateinfusion(0.25)
insulin/glucoseinfusion(0.25)
calciumgluconate(0.25)
kayexalate(0.25)
10.A1yearoldbabyboywasbroughttotheERduetoseizure.OnPE,thebabywas
seemtohaveflexedwrist,fingersextended,thumbsadductedoverthepalmsandthefeetextendedandadducted.Whatisthepossiblecauseoftheseizures?
P224
A.grandmalseizure(0.25)
B.meningitis(0.25)
C.benignfebrileseizures(0.25)
D.hypocalcemia(0.25)
11.A3yearoldboyhasbeenhavingdiarrheafor5daysalreadywithstoolingof3–5xperday,voluminous,wateryincharacter.OnPE,hewasnotedtobeinmoderatedehydration,withserumsodiumleverof160mmol/l.PatientwashydratedwithD5water,however,after2hoursofhydration.Thepatientwentintoaseizure.Whatisthepossiblecauseoftheseizure?
A.Patientdevelopedsubduraleffusionduetothehyperosmolality
B.Thereisanexcessmovementofwaterintocerebralcellsduringrehydrationcausingcerebraledema
C.Thepatienthadlatemanifestationofhypernatremia(0.5)
D.Patienthadmeningitis(0.5)
12.A2yearoldmalewasseenintheERduetofeverof5daysduration.Thiswasassociatedwithvomitingandanorexia.Therewerenocough,coldsassociated.CBCrevealedleukocytosiswithpredominanceofSegmenters.UrinalysisrevealedTNTCpuscellsand5-10/hpfRBC.Impression:
UTI.ThegoldstandardforthediagnosisofUTIis:
A.UrineCultureandsensitivity(1.0)
B.Leukocyteesterasetest
C.Urinalysis
D.Nitritetest
13.A6yearoldmalewasseenintheERduetoTeacoloredurineof2daysduration.Thiswasassociatedwithperiorbitaledema,abdominaldistentionandgrade2pittingedemaofthelowerextremities.
Impression:
AcuteGlomerulonephritis/PSGN
Poststreptococcalglomerulonephritisismostcommoninchildrenaged:
P1740
A.5-10yearsold(0.5)
B.2-4yearsold(0.5)
C.13-18yearsold
D.1-2yearsold
14.ThebestsingleantibodytitertodocumentcutaneousstreptococcalinfectioninPSGNis:
A.DeoxyribonucleaseBantigen(DNase)
B.ASOtiter(1.0)
C.Streptozymetest
D.Phadebacttest
Atermneonatewithanuncomplicatedbirthhistorywasnotedtobecyanoticduringthefirstfewdaysoflife.Onexamination,therewascentralcyanosisandabsenceofheartmurmur.Chestx-rayshowednormalheartsizeanddiminishedpulmonaryvascularmarkings.Mostlikelydiagnosisis
A.PulmonaryValveAtresia(0.5)
B.TetralogyofFallot
C.TruncusArteriosus,typeI
D.TranspositionofGreatArterieswithVSD(0.5)
A3montholdboywasnotedtobecyanoticoncryingwhenhewas2monthsold.Thisbecamepersistentandmorepronouncedonexertion.Onphysicalexamination,thebabywascyanoticwithagrade2–3/6systolicejectionmurmuratthe3rd–4thICSLPSB.Thisbabyissufferingfrom
A.PulmonaryValveAtresia
B.TetralogyofFallot
C.TranspositionofGreatArteries,noVSD(0.5)
D.TricuspidValveAtresia(0.5)
A4montholdbabygirlwasbroughtforconsultationbecauseoffrequentcoughandcoldsaccompaniedbyinabilitytoconsumehermilkformula,fastbreathingduringfeedingandchestretractions.Amurmurwasheardaccompaniedbyboundingperipheralpulsesandwidepulsepressure.Themostlikelydiagnosisis
A.AtrialSeptalDefect
B.VentricularSeptalDefect
C.PatentDuctusArteriosus(1.0)
D.PulmonicStenosis
A2yearoldboypresentedwithahistoryof5daysfeveraccompaniedbyirritability,bilateralconjunctivalinjection,unilateralcervicallymphadenopathy,rashesinthediaperareaandcongestedbuccalmucosa.Inordertopreventcomplication,thisboyshouldbegivenhighdoseaspirinand
A.Digoxin
B.Penicillin(0.5)
C.Diuretics
D.Intravenousimmunoglobulin(0.5)
A6yearoldchildwasdiagnosedasacaseofacuterheumaticfeverandreceivedtendayscourseofaqueouspenicillin.InordertopreventtherecurrenceofgroupAstreptococcalinfection,thischildshouldreceivep876-879
A.Benzathinebenzylpenicillin1.2millionunitsintramuscularonce
B.Benzathinebenzylpenicillin1.2millionunitsintramuscularevery21-28days(1.0)
C.Oralpenicillin250mgtwiceadayfor10days
D.Oralerythromycin250mgtwiceadayfor10days
A10yearoldboywhopresentswithdifficultyinbreathingaccompaniedbyadisplacedPMItotheleft,apicalandsystolicthrillandgrade4/6holosystolicmurmurattheapex,ismostlikelysufferingfromaninsufficientp1570
A.Aorticvalve
B.Mitralvalve(1.0)
C.Pulmonicvalve
D.Tricuspidvalve
ChildrenwithsmallVentricularSeptalDefectareatriskforthiscomplication
A.Hypoxicspells(0.5)p1509
B.Heartfailure
C.PulmonaryArteryHypertension(0.5)
D.InfectiveEndocarditis
Case1Nos.22–24
Lito,a5yearoldchild,wasseekingenrollmentinanurseryschool.Boththeteacherandtheschoolphysicianevaluatedhimforgrowthanddevelopment.BirthhistoryrevealedthatLitowasbornprematurelyat34weekswithaweightof1924gramsandalengthof42cms.Headcircumferencewas31cms.Theexpectedanthropometricmeasurementsincludes:
22.Weightthathasincreasedatleast_________frombirth
A.4x
B.6x(0.5)
C.8x(0.5)
D.10x
23.Anincreasedinlengthof
A.22inches(0.25)
B.24inches
C.26inches
D.28inches
24.Idealheadcircumferenceforageis
A.40cms
B.42cms
C.44cms(1.0)
D.46cms
Case2.Nos.25-29
Buboyisa7montholdinfantbroughttottheclinicforawellbabyvisit.Hisgrandmotherrecalledthathisbirthweightwas6lbsbutwasnotawareofthebirthlengthandheadcircumference.
25.Buboy’sideallengthis
A.24inches(0.25)
B.27inches(0.25)
C.31inches(0.25)
D.35inches(0.25)
26.Theexpectedincreaseinhisheadcircumferenceis:
A.2cms(1.0)
B.4cms
C.6cms
D.8cms
27.Buboy’sidealweightat6monthsis
A.11lbs
B.13lbs(1.0)
C.15lbs
D.17lbs
28.WhenBuboy’sisofferedanobjectheisexpectedto
A.usehisindexfingertogetit
B.gettheobjectanddropit(0.5)
C.casttheobject
D.transfertheobjectformhandtohand(0.5)
29.Themotormilestoneexpectedforageis
A.sittingproppeduponhands
B.crawling(0.5)
C.Pullinguptostand(0.5)
D.Cruising
30.A9yearoldboyissufferingfromgreasyfoulwaterystoolof2weeksdurationaccompaniedwithabdominalcrampsandabdominaldistention.YouareentertainingthepossibilityofGiardiasisbutthestoolexaminationsdonethricewerenegative.Thenextbestproceduretodois:
A.abdominalultrasound
B.entero–testorstringtest(1.0)
C.duodenalbiopsy
D.polymerasechainreaction
31.A2yearoldgirlwasbroughtinforconsultationbecauseofwaterystoolandvomitingof3daysduration.Modifiedacidfaststainingofthestoolrevealeda2-6micrometerredoocysts.Themostlikelydiagnosisinthiscaseis:
p1128
A.giardiasis
B.balantidiasis(0.5)
C.
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