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- Dec 2, 2010
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Below are 3 questions paraphrased from the NBME practice exam (not the real pediatrics shelf exam). The one you buy for $20 from the NBME online at https://nsas.nbme.org/home. Questions are not copied word for word. Would just like to get your opinion on their answers.
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16 year old boy w/ painless lump in his right breast. Sexual development is Tanner stage 4. THere is a 1-cm, smooth, firm mass under the nipple and no nipple or skin retraction and no axillary lymphadenopathy. What's the likely diagnosis?
A) Accessory breast tissue
B) Carcinoma
C) Cystic mastopathy
D) Fibroadenoma
E) Physiologic pubertal development
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Female newborn 4 days old brought to pediatrician because her skin is yellow. She's been breastfeeding. She had a cephalohematoma at birth. Exam shows cephalhematoma, scleral icterus and LE jaundice. Newborn is type O, Rh-positive. Mom is type A, Rh-positive. DIrect Coombs = negative. Serum total bilirubin is 21 mg/dL. WHat's the next step?
A) Cease breast feeding
B) Supplment breast feeding with formula
C) Draw second bilirubin conc.
D) PHototherapy
E) IV fluids
F) Partial exchange trans
G) No intervention
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1 week old newborn brought in because of difficulty breathing and acrocyanosis. He was born at term, no complications. He appears ill. Temp is 97.5 F, Pulse 160, RR 52 BP 60/36 in the UE but ABSENT in LE. Skin, mucous membranes and nail beds appear dusky and there is mottling. THere are IC retractions and grunting. Lung sound clear. 3/6 holosystolic murmur at L. sternal border. Liver edge 4 cm below RCM. ABG reads pH 7.15, PCO2 29, PO2 99.
Baby is intubated and iV fluids started. There is no improvement 1 hour later. CXR shows cardiomegaly and pulmonary congestion. What is the most likely explanation?
A) Closure of ductus
B) Decreased PVR
C) Increased PVR
D Intracardiac Right-to-Left shunt
E) Opening of ductus
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++
16 year old boy w/ painless lump in his right breast. Sexual development is Tanner stage 4. THere is a 1-cm, smooth, firm mass under the nipple and no nipple or skin retraction and no axillary lymphadenopathy. What's the likely diagnosis?
A) Accessory breast tissue
B) Carcinoma
C) Cystic mastopathy
D) Fibroadenoma
E) Physiologic pubertal development
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Female newborn 4 days old brought to pediatrician because her skin is yellow. She's been breastfeeding. She had a cephalohematoma at birth. Exam shows cephalhematoma, scleral icterus and LE jaundice. Newborn is type O, Rh-positive. Mom is type A, Rh-positive. DIrect Coombs = negative. Serum total bilirubin is 21 mg/dL. WHat's the next step?
A) Cease breast feeding
B) Supplment breast feeding with formula
C) Draw second bilirubin conc.
D) PHototherapy
E) IV fluids
F) Partial exchange trans
G) No intervention
-----------------------------------------------------
1 week old newborn brought in because of difficulty breathing and acrocyanosis. He was born at term, no complications. He appears ill. Temp is 97.5 F, Pulse 160, RR 52 BP 60/36 in the UE but ABSENT in LE. Skin, mucous membranes and nail beds appear dusky and there is mottling. THere are IC retractions and grunting. Lung sound clear. 3/6 holosystolic murmur at L. sternal border. Liver edge 4 cm below RCM. ABG reads pH 7.15, PCO2 29, PO2 99.
Baby is intubated and iV fluids started. There is no improvement 1 hour later. CXR shows cardiomegaly and pulmonary congestion. What is the most likely explanation?
A) Closure of ductus
B) Decreased PVR
C) Increased PVR
D Intracardiac Right-to-Left shunt
E) Opening of ductus
