Formative Evaluation [page 23]

221. You are seeing a 3-year-old patient who has a neck mass that has been present for 4 days. She had a fever to 40oC (104oF). Physical examination reveals a unilateral, tender, 2 x 2 cm. anterior cervical lymph node with overlying erythemia. There is no f fluctuance. The girl is eating well and appears nonotoxic. Your best management plan is to :   A. Admit her to the hospital and begin therapy with intravenous oxacillin B. Consult surgery for an excisional biopsy C. Perform a needle aspiration for cultur and gram stain D. Prescribe a 10-day course of oral cephalexin and have her return if there is no improvement E. Reassure her mother that this most likely is infectious mononucleosis and will resolve without therapy

222. You are evaluating a 3-month-old baby who has cervical lymphadenopathy. The history is remarkable for recent fever and poor feeding. Physical examination reveals a smooth, mobile, fluctuant lymph node in the right anterior triangle. Findigns on the remainder of the physical examination are normal. Of the following, the most likely etiologic agent is :   A. Adenovirus B. Epstein-Barr virus C. Human immunodeficiency virus D. Staphylococcus aureus E. Streptococcus agalactiae

223. An 8-year-old boy presents with a left-sided neck mass that has enlarged over the past 4 weeks. He denies weight loss or fatigue, but does report occasional fever. His grandmother has a kitten, but he denies any scratches. Physical examination reveals a unilateral, slightly tender, 3 x 3 cm. anterior cervical lymph node with no overlying erythemia. He has mild bilateral conjunctival injection, but other findings on the examination are unremarkable. Of the following, the most likely cause of his lympadenopathy is :   A. Cat-scratch disease B. Chronic human immunodeficiency virus infection C. Kawasaki disease D. Malignancy E. Staphylococcus aureus

224. You are seeing a 10-year-old girl who has a 2-month history of unilateral lymph node enlargement. There is no history of weight loss, fever, or animal exposure. Physical examination reveals bilateral 2 x 2 cm. nontender lymph nodes with overlying violaceous discoloration. There is no other lymphadenopathy. Of the following, the most appropriate next step is to :   A. Begin therapy with oral erythromycin B. Consult surgery for an immediate surgical excision C. Obtain Epstein-Barr virus titers D. Perform a needle aspiration E. Place a purified protein derivative for tuberculin and begin antimycobacterial therapy if results are positive

225. The presenc eof lymphadenopathy in which of the following areas most likely suggests malignancy as the etiology?   A. Anterior cervical triangle B. Posterior cervical triangle C. Preauricular region D. Submandibular region E. Supraclavicular region

226. A 14-year-old girl who has severe bulimia presents with abdominal pain with guarding, distention, decreased bowel sounds, and low-grade fever. As part of your evaluation, you obtain a serum amylase activity level, which is three times the upper limit of normal for your laboratory. Your next step in interpreting this result would be to measure :   A. Amylase B. Fecal fat C. Immunoreactive trypsinogen D. Isoamylase E. Lipase

227. Among the following, the surgical treatment of choice for infected pancreatic necrosis is :   A. Biliary tree diversion B. Catheter placement for abdominal lavage C. Panreatic debridement D. Partial pancreatic resection E. Total pancreatic resection

228. เด็กแรกคลอดที่มีอาการหอบเขียวหลังคลอดทันที ข้อมูลอะไรที่ชี้นำให้เปลี่ยนการ resuscitation จากการให้ oxygen ndermask เป็นการให้ผ่าน endotracheal tube   A. ท้องแฟบ B. ทรวงอกข้างที่เป็นไม่เคลื่อนไหว C. คลำได้ trachea เอียงไปด้านข้าง D. ฟังเสียง breath sound ไม่ได้ E. ฟังได้เสียง heart sound ชัดเจนทางด้านขวา

229. Complication ที่พบบ่อยในเด็กหลังการผ่าตัดรักษา diaphragmatic hernia คือ   A. Reopen PDA B. Recurrence C. Contralateral pneumothorax D. Contralateral atelectasis E. Contralateral emphysema

230. Serum alpha fetoprotein พบได้สูงใน tumor ใดต่อไปนี้   A. Hepatoblastoma B. Neuuroblastoma C. Germ cell tumor D. Wilms' tumor E. A and C are correct

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