NBME PEDs 1 and 2 NBME MASTERY

17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to hospital, paramedics administered O2 and ECG showed *J-wave*. She is lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls = 60, RR = 12, BP = 90/60. There is an odor of ethanol on her breath. Which of the following is most likely explanation for the patient's cardiac findings? a. cocaine toxicity b. ethanol toxicity c. hyperkalemia d. hypocalcemia e. hypothermia f. increased intracranial pressure g. MI

A 3 yr old comes to the ED after an episode of syncope followed by a tonic-clonic seizure. She becomes fully alert, then stops talking, closes her eyes, and has 3-4 rhythmic jerks of her arm. During this second episode, an ECG was recorded that showed P waves at 80/min with no QRS complexes. NSR resumes shortly thereafter. She becomes alert one minute after. Most likely diagnosis? A) Absence seizure B) Adams-Stokes attack C) Adverse effect of medication D) Breath-holding episode E) Carotid artery trauma F) Narcolepsy-cataplexy G) Vasovagal episode H) Ventricular tachyarrhythmia

cause of recurrent infection

mixed metabolic acidosis and resp alkalosis

patchy irregular uptake of radioisotope

What is anotehr name for multinodular goiter

14 day feevr headache and green nasal discharge in a 14 yr old kid. Post pharyngeal wall is erythematous and covered with thin gray mucous

SCID has an abscence of what cells

recurrent infection - bacterial, fungal and viral

Pt has foreign body, next step

kid has fever and right foot pain. itching rash stared between the second and third toes of both feel. PLays sports in highschool. Lymphnode in groin is tender

2 days after delivery a male newborn has dribbling. on PE he has a 6 cm round midline suprapubic pelvic mass

Hep A ab + Hep B core Ab + Hep B surface ag + Hep B surface ab -

2 yr olld boy with anorexia poor coordination and sporadic vomiting over teh last month. Lab shows hypochromic microcytic anemia.

ashleaf spots - Skin hypopigmentation, four periventricular nodules - cortical tubers

what can TMPSMX cause on labs

14 yr old girl pt with suprapubic tenderness for 6 mo. She has a red smooth bulge between the labia. Next step?

pt with anorexia is at risk for what bone morphology?

A low pitched vibratory murmur is heard through the cardiac cycle and is most prominent at the left upper sternal border when the child is in the sitting position. The murmur dissapears when his neck is rotated in the sitting position

5 ear old with fatigue for 3 weeks, acute onset of fever and chills for 2 hours. Traveled to asia 1 month ago and *received chloroquine*. Exam shows *pallor and splenomegaly*. HCT 22, leuko 18, platelets 80. assay for strep assay for heterophile measure PT and PTT Measure AST and ALT thick and thin blood smears

14 yr old girl with downs is evaluated for polycythemia vera. she has cyanosis and clubbing. There is an S2 increased in intensity. she has a large ventricular septal defect and a dilated main pulmonary artery. What is causing the polycythemia?

fundoscopic examination shows an abscence of venous pulsations

A 5lb 5 oz newborn is delivered at 37 weeks gestation to a 32 year old women, gravida 1 para 1, following an uncomplicated delivery. The mom has history of IV drug use and received no prenatal care. She did not take any med during pregnancy. Rapid HIV testing of the mother after delivery is positive. Exam of newborn shows no abnormalities. Which of the following is the best next step to manage the newborn? A) A 6-week course of oral AZT beginning at the 2 week exam B) A 6-week course of oral AZT only if CD4 count decreases to less than 200/mm C) A 6-week course of oral AZT within 12 hours after delivery D) A 6-week course of triple antiretroviral therapy beginning at the 2 week exam E) A 6-week course of triple antiretroviral therapy if the CD4 T count decrease to less than 200/mm F) A 6-week course of triple antiretroviral therapy within 24 hours after delivery

"click" or more precisely "clunk" in the hip may be detected. Ortolani maneuver and the Barlow maneuver main types are the result of either laxity of the supporting capsule or an abnormal acetabulum.

16 yr boy old with a painless lump in is right breast. 1cm smooth firm mass under right nipple. no nipple or skin retraction or lymphadenopathy

diarrhea with chicken

An 18-month-old boy is brought to the physician because of diarrhea for 3 days. He attends day care, and several other children at the center have similar symptoms. The water source for the day-care center is a private well. The center has a pet turtle and two canaries. The patient's temperature is 37.7°C (99.9°F). He is well hydrated. The remainder of the examination shows no abnormalities. Examination of the stool for ova and parasites is negative. A stool culture grows no enteric pathogens. *Rotavirus testing is positive.* Laboratory studies show Hemoglobin 12 g/dL Leukocyte count 8400/mm3 Segmented neutrophils 39% Bands 1% Lymphocytes 60% Platelet count 240,000/mm3 Cholera immunization Cooking meats completely Day-care center closure Removing the pets from the day-care center Strict hand-washing techniques at the day-care center Swimming prohibition in the lake Typhoid immunization Use of only disposable diapers at the day-care center Well water filtration

Healthy 16yo from Africa has painless lesion on vulva for 4 days. *Sexually active* with one male and no contraception used. 10-mm, *sharply demarcated, elevated, round lesion* on right labium majus. Base of the lesion is smooth and nonpurulent. Organism?? A. Chlamydia B. Gardnerella Vaginitis C Haemophilus ducrey D. HSV E. HPV F. Neisseria Gonorrhea G. Treponema pallidum H. Trichomonas vaginalis

bowing of legs outward in a kid

anterior bowing of the tibia caused by

9 yr old with bowing of her right leg - right knee bowed outwad on walking. X ray of pt standing shows collapse of the medial aspect of the metaphysis of the proximal tibia

next step in caustic ingestion after stabilization of airway

Previously healthy 3 week old newborn with progressive jaundice for past 6 mos. Stools light in color for past 3 days. Full term with no complications. Formula since birth. Total bilirubin is 14, direct is 6. What is mechanism for condition? Hepatic enzyme deficiency Decreased conjugation of bilirubin Decreased excretion of bilirubin Increased enterohepatic circulation of bilirubin Increased production of bilirubin

holosystolic murmur with mid-diastolic murmur at the apex.

rickets mechanism of deformity

12 yr old boy is shortest boyin class but has a tall dad. how do you confirm the dx

7 month old brought to ER 35 min after seizure onset. *Jerking mvts began in left arm the to right arm and both legs*. Cyanotic. Temp 39.7, pulse 160, resp 30, BP 90/60. upward deviation of eyes. generalized rigidity and hyperextension of neck, back, all extremities. Clonic jerking mvts. oxygen administered. next step? A. acetaminophen B. diazepam C. Glucose D. Naloxone E. Thiamine

when do you give penecillin or pneumoccal vaccine for asplenia?

absent cremestaric reflex on right

14 yr old tired, longer menses and heavier. thyroid gland easily palpated.

A previously healthy 3 year old boy brought to doc b/c fever, sore throat, malaise, poor appetite for 2 days. He says that his throat feels scratchy. There has been no vomiting, diarrhea, rhinorrhea. Active and alert. Temp of 38.7. Exam shows no abnormalities of tympanic membrane or pharynx. Leukocyte count is 9500. A. acetaminophen B. IV antibiotics C. IVIG D. IM ceftriaxone E. Oral antibiotics F. Oral corticosteroid G. Xray chest

tx for diabetic who does intense exercise to reduce diabetes related complications

outcome for post strep glomerulonephritis

A *3 month boy* with 2 day history of fever and irritability. 50th percentile for length weight and head circumference. Temp of 100.6 F, pulse 130, respiration 26/min, BP 85/50. Fussy throughout exam. Urinalysis shows- specific gravity: 1.015 glucose negative protein 1+ RBC 0-3 hpf WBC 20-50 hpf bacteria few gram-negative rods Urine culture shows greater than 100,00 colonies of E.Coli. Started antibiotics. Next appropriate step in diagnosis? intravenous pyelography renal digital subtraction angiography renal ultrasonography ct scan of abdomen renal dimercaptosuccinic acid sca

4 mo female brought for exam. spent few months in hospital, where she was treated for sepsis and respiratory distress syndrome. currently receiving oxygen and diuretic therapy. 5th percentile for length and wight, fever, pulse 104, respirations 32/min, BP of 115/67 in right arm and 105/67 in left arm. breath sounds decreased bilaterally, wheezing heard occasionally. pronounced s2 and precordial heave. hepatomegaly on abdominal exam. ecg shows right axis deviation and right ventricular hypertrophy. normal sized kidneys on ultrasound. cause of increased BP? bronchopulmonary dysplasia coartation of aorta essential HTN Pheochromocytoma Renal artery thrombosis

14 yr old girl with high BP and weak femoral pulses, next step

18 mo old with fever, painful swelling of left knee. anemia, leukopenia, thrombocytopenia, combs test +, protein in urine

which one is in INFANTS and which one blanches? strawberry hemangioma, vs cherry hemangioma

A 7 year old fainted while on field trip. Progressively lethargic over past winter, and *complexion darkened*. Her height and weight at 50th percentile. "BP 80/40". Lab test? A. plasma cortisol B. serum glucose C. serum gonadotropin D. serum PTH E. serum TSH

30 mo old kid with left flank mass with normal bone marrow, and normal kidneys on US

4wk old girl brought in because 2weeks of irritability and passing stools streaked with mucus and blood. No vomiting. *2 weeks ago, switched from cow's milk-based formula to soy milk-based formula*. She is at 35%ile for length, weight, and head circum. Weight remains unchanged from 2wks ago. Most appropriate next step is to begin what? A. Electrolyte rehydration solution for 24hrs B. Formula with evaporated milk, water, and corn syrup C. Formula with hydrolyzed casein D. Oral Amoxicillin E. Oral Ranitidine

36 hr baby has jaundice. bilirubin 22. next step

Previously healthy 2yo boy presents with acute fever and inspiratory stridor. Has had rhinorrhea for the last day. Symptoms improve "when mom took him outside to come to the emergency department" [no idea what that is supposed to mean]. Immunizations UTD, exam significant for retractions and stridor, nothing else. A) Alveolar atelectasis B) Edema of the epiglottis C) Narrowing of moderate-sized airways D) Pulmonary parenchymal inflammation E) Subglottic edema

15 yr old girl has multiple areas on her chest and upper back that are lighter than the rest of her skin. she has mild itching over these areas when she plays volley ball. PE shows multiple falt oval, hypopigmented lesions.

8 yr old boy with 9 mo hx of productive cough that is worse at night and SOB during physical activity. colds seem to goto his chest and linger. CXRAY shows mild hyperinflation. next step

A 6-month-old boy gets a UTI and is successfully treated with antibiotics. Renal ultrasonography shows no abnormalities. What is the next appropriate step in management? A) Observe for recurrent symptoms B) Repeat urine culture in 3 months C) IV pyelography D) Voiding cystourethrography E) Cystoscopy

A 2-year-old boy has a 5-day fever of up to 104 F. He appears ill. Temp = 102.2 F, pulse = 130, BP = 90/60. A 3/6 systolic murmur is heard at the left sternal border, though the child has no history of murmur. Splenomegaly present. In addition to echocardiography, which of the following is most likely to confirm the diagnosis? A) ANA B) ESR C) Cardiac enzymes D) Blood cultures E) ECG

A 4-day-old female newborn has lower extremity jaundice and icterus. She has been breastfeeding with normal stool and urine output. Born at term, needed vacuum delivery. She had a large cephalhematoma at birth and currently as well. The newborn is O+, and the mother is A+. Direct Coombs is negative. Total bill is 20.8. What is the next best step in management? A) Cessation of breast feeding B) Supplementation of breast-feeding with formula C) Repeat bili in 6 hours D) Phototherapy E) IV fluid bolus F) Partial exchange transfusion G) No intervention necessary

A 28-month-old boy is brought to the ED 20 minutes after swallowing an unknown amount of drain cleaner. He is crying, drooling, and in respiratory distress with stridor and suprasternal retractions. Temp = 100.4 F, Pulse = 124/min, respirations = 40/min, BP = 122/87. He has blisters on the lips and erythematous areas on the tongue. After stabilizing the airway, what's the best next step? A) Lateral x-ray of the neck and soft tissues B) ECG C) CT of head and neck D) Esophagography E) Fiberoptic endoscopy

13yo girls brought in for 6 weeks of constant abdominal pressure, breast tenderness, and weight gain. Never had menstrual period. Vitals are normal. Breast and pubic hair Tanner 3. Abdominal exam shows a nontender mass below umbilicus. Next step in diagnosis? a. urinalysis b. measure serum alpha-fetorotein c. measure serum beta-hCG d. x-ray of abdomen e. CT scan of pelvice

1 week old newborn has 1 day history of difficulty breathing and discoloration of extremities. Appears ill, temp = 97.5, pulse = 160, resp = 52, BP = 60/36 in upper extremities and unobtainable in lower extremities. Skin, mucous membranes, and nail beds are dusky, and there is mottled discoloration of the extremeties. Moderate intercostal retractiosn and grunting. Lungs clear. Holosystolic murmuc along left sternal border. Liver edge palpable 4cm below costal margin. pH = 7.15, CO2 = 28, O2 = 98 Intubation, mechanical ventilation, and iv fluid initiated, but no improvement one hour later. x-ray shows cardiomegaly and pulmonary congestion. Explanation of this condition? a. closure of ductus arteriosus b. deacreased pulm vascular resistance c. increased pulm vascular resistance d. intracardiac right to left shunt e. opening of ductus arteriosus

3yo comes in for rapid breathing and cant catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance on right chest. decreased breatah sounds on right. x-ray shows slight overexpansion of right lung compared with left. no infiltrates or effusions. Best management? a. hyperbaric Oxygen b. CT of chest c. bronchoscopy d. Thoracotomy e. Tube thoracostomy

16yo boy comes for routine health exam. Both maternal and paternal family history includes premature coronary artery disease, HTN, and hyperlipidemia. BMI is 35. Cardiac exam no abnormalities. Fasting serum lipids studies show: Choldesterol (total): 214; HDL: 32, LDL: 144 Triglycerides: 187 Best step in management? a. reduced calorie diet b. weight training program c. Beta-blocking agent therapy d. cholesterol binding resin therapy e. stating

15 month old girl has a 1 day history of rash and fever for the last 3 days. She got the *MMR 10 days ago*. No acute distress, temp is 101.2 F. She has an erythematous maculopapular rash over the face, trunk, and extremities. Which of the following is the most likely explanation for these findings? A) arthus reaction from preexisting antibody to rubella virus B) delayed type hypersensitivity reaction to rubella antigen C) immune complex disease from vaccine preservatives D) replication of a live vaccine virus strain E) viral dissemination in an immunocompromised host

A previously healthy 3 year old girl brought to physician because of a 2-month history of a right-sided limp. The limp is most obvious when she awakens and gradually becomes less noticeable as she plays. She has no recent history of fever, rash, or other illness and has not been exposed to pets or ticks. Today she appears well but walks with a limp. Temp is 98.2 F. No rash, normal pupils, normal red reflex, normal pharynx, normal cardiac exam. Right knee is swollen and warm but not erythematous or tender. The patient holds the right lower extremity in a slightly flexed position and will not fully extend it when she stands or walks. Laboratory studies show: ESR 64 mm/h Serum ANA+ Rheumatoid Factor - ASO titer - Lyme Ab - In addition to the administration of naproxen, what's the best next step? A) slit lamp exam B) Bartonella henselae titer C) Upper GI series D) Arthroscopy E) Surgical Aspiration of the right knee

An 18 hour old female newborn is being evaluated bc of jaundice. She was born at term following an uncomplicated pregnancy and spontaneous vaginal delivery to a 31 year old woman, G2P1. She weighed 3799 g/8 lb 6 oz at birth.* Mother's blood group is O+*. Newborn has urinated twice but has had no bowel movements. Urine is dark yellow. She has had difficulty latching onto the breast correctly. She is alert. Exam shows jaundice of the face and chest. Abdomen is soft. Liver edge palpated 1 cm below the right costal margin, and the spleen tip is palpated 1 cm below the left costal margin. Serum total bilirubin is 11.1 with direct component of 0.1. What's the most likely diagnosis? A) Breast milk jaundice B) Galacatosemia C) Hemolytic disease of the newborn D) Physiologic jaundice of the newborn E) Sickle cell disease

An 8 year old girl brought to physician because of pallor and easy fatigability for the past 2 months. Symptoms began after URI. She was adopted, and her family history is unknown. She appears pale, spleen tip palpated 2 cm below left costal margin. Her HCT is 28%, retic count is 4% with *3+ spherocytes*. Splenectomy is most likely to prevent which of the following complications? A) cholelithiasis B) esophageal varices C) overwhelming sepsis D) painful crises E) pancreatitis

A 10 year old girl is brought to the the emergency department following a generalized tonic clonic seizure. She has a 1 month history of behavior disturbances and a 2 week history of fever, weakness, and painful swelling of the left knee. Her hemoglobin concentration is 9, leukocyte count is 3800, platelet count is 65K. Coomb's test is positive. UA shows protein and microscopic blood. What's the most likely diagnosis? A) Hodgkin disease B) Henoch Schonlein Purpura C) Mononucleosis D) Systemic lupus erythematosus E) Viral encephalitis

38 week AGA neonate with features of *Down syndrome*, Apgars 6 and 9, AFVSS. Exam reveals hypotonia, pulse ox is 92% on room air. What is the next step? A) Measure CK and MRI of the brain B) CXR and blood cultures C) ECG and karyotype D) PGE1 and O2 supplementation E) Surfactant + IV amp/gent

A 10 mo girl brought by parents for well child check up. Parents concerned b/c of recent lazy eye development. Born at 38 wks, following an uncomplicated pregnacy and required Oxygen by Nasal cannula for the first day of life. No hx of serious illnes. Vital signs within normal limitis. Examination of the Left eye shows hyphema and esotropia. Conjuctiva is not injectied and there is no discharge. The *left pupil appears white on reflex testing*. The remainder of the exam shows no abnromailties. What is the most likely cause of these findings? a) congential cataract b) glaucoma C) retinoblastoma D) Retinopathy of prematurity E) Retintis pigementosa

2yo has 2week history of irritability, poor appetite, occasional cough, and reluctance to walk. Has had 2kg weight loss since her last exam 6mo ago. No history of reuccrent respiratory illness, constipation, vomiting, or diarrhea. Appears uncomfortable and quiet. 7th%ile for height and 25%ile for weight. Temp = 100.2, Pulse: 140, RR: 24, and BP: 145/100. Bluish discoloration under both eyelids. Cardiac and abdominal exam normal. Labs: Hgb: 10.5 Leukocyte: 8300 (Neu: 40%, Lymph: 55%) Plate: 240,000 *Lateral x-ray of chest shows mass in posterior mediastnum*. Diagnosis? A. anthroax B. Congenital heart disease C. CF D. Dermatomyositis E. Neuroblastoma F. Pulmonary Sequestration G. Thymoma H. TB

A previously healthy 7 y.o brought to peds b/c 1 week history of low grade fever and fatigue and a 3 day history of rash and moderate pain and swelling of ankles. Rash first appeared on ankles but has spread over his legs during the past 24 hrs. Tep 38.2. Exam shows palpable petechiae and confluent purpuric areas over lower extremities. Ankles are swollen and mildly tender. A. ankylosing spondylitis B. Behcet syndrome C. dermatomyositis D. henoch schonlein purpura E. Juvenile rheumatoid arthiritis F. Kawasaki G. Psoriatic arthiritis H. Reactive arthritis I. Sarcoidosis J. Sjogren K. SLE L. scleroderma

Previously healthy 1 month old boy brought to ER 2 hrs after onset of *bilious vomiting*. Less active than usual and feeding poorly. Last bowel 1 day ago. Born at 38 weeks. Appears ill. Tep of 38, pulse 180, resp 60, BP 70/40. *Abdomen firm and distended*. bowel sounds decreased. normal rectal tone. *small amt of stool in rectal vault*. occult blood positive. A. hirschsprung B. gastroenteritis C. hypertrophic pyloric stenosis D. intussusception E. midgut vovulus

Previously healthy 9 mo male with Tmax of 40 degrees Celsius, fussiness, and decreased PO intake for past 5 days. No sick contacts. Current temp 39.6. Exam shows cracked, fissured lips, redness of oral mucosa and conjunctiva, and single enlarged cervical LN. Maculopapular rash on trunk and extremities, and dorsal edema of hands. What next? Acetaminophen IV Abx IVIG IM ceftriaxone PO Abx PO corticosteroids CXR

*14 yo female with amenorrhea*. Pubic and axillary hair at 11 yo; breast dev at 12 yo. as tall as a 8yo. decreased femoral pulses, BP is 140/100. Breast Tanner stage 2; Pubic hair Tanner stage 4. Modest. Axilllary hair. Next step? Measure serum prolactin concentration (wrong) Karyotype analysis Measure serum insulin concentration CXR EEG

14 yo male with 3 mos of "dragging" sensation of Left scrotum. 30 weeks GA. Born with Left scrotal hydrocele which resolved. Both testes are descended. Left scrotum hangs lower, left soft tissue mass that feels like *bag of worms*. Mass disappears in supine position. If untreated, what is a complication? Testicular torsion (wrong) Distant mets Incarceration Infertility Testicular carcinoma Torsion of appendix of testis

7 yo with 7 days of bloody diarrhea. Generalized fatigue for past 2 days. Afebrile. BP 105/65. Exam shows pallor and scleral icterus. No hepatomegaly. Retic count 12 %. MCV I0. WBC 18. Hb 6. Plts 50. What is the diagnosis? ALL Bone marrow suppression G6PD deficiency Sickle cell disease HUS Iron deficiency Thalassemia

A 12-hour-old female newborn becomes irritable, has difficulty breathing, and then has a 2-minute generalized tonic-clonic seizure. She was born at 36 weeks' gestation by cesarean delivery for a breech presentation and weighed 3997 g (8 lb 13 oz). *Her mother had gestational diabetes poorly controlled with diet*; she refused insulin therapy. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Examination shows decreased tone and lethargy. Pulse oximetry shows an oxygen saturation of99%. An ECG shows a *prolonged QT interval*. In addition to measurement of serum glucose concentration, the most appropriate next step is measurement of which of the following serum concentrations? Bicarb Bilirubin Calcium Mg TSH

A 17-year-old girl comes for a precollege physical examination. She is not sexually active. Her menses occur at regular 28-day intervals. She has smoked one-half pack of cigarettes daily for 3 years and drinks 1 oz of alcohol weekly. Her 50-year-old mother was diagnosed with breast cancer 1 year ago. Her father and grandfather died of heart disease during their 30s. Her blood pressure is 130/70 mm Hg while sitting. Which of the following is the most appropriate screening test?" Serum lipid studies UA Mammo CXR Stress Test

A* 5-year-old boy* is brought to the physician by his parents because of a painful limp for 3 weeks. He has no history of serious illness or trauma and has not had any other symptoms. Developmental milestones are appropriate for age. On examination, he is unable to bear his full weight on the right and winces when he is asked to stand on his right foot. Flexion and internal rotation of the right hip are decreased. Muscle strength is 4/5 on abduction of the right hip. AP x-rays of the pelvis show a dense, contracted right femoral capital epiphysis. The left femoral capital epiphysis appears normal. Which of the following is the most likely diagnosis Congenital hip dysplasia Osgood-Schlatter disease Diastematomyelia Femoral anteversion Proximal focal femoral deficiency Fibular hemimelia Septic arthritis of the hip Jumper's knee Slipped capital femoral epiphysis Legg-Calvé-Perthes disease Spondylolisthesis of L4 on L5 Metatarsus adductus Tibial hemimelia

18 month boy, intermittent ab pain, no vomiting or diarrhea, lethargic. Soft, contender abdomen. Mass palpated in RLQ. decreased bowel sounds. Red stool, occult blood positive. X-ray of abdoment shows no air in ascending or transverse colon. Next step management? air contrast enema upper gastrointestinal series meckel scan upper endoscopy laparotomy

14 y/o boy w/ 1 year history of learning disability, hyperactivity, short attention span, can't concentrate in homework, generalized tonic clonic seizure at 8 yrs. PE shows nine lesions with coffee stain like appearance on chest and abdomen. Small areas of increased pigmentation in the axillae and small skin tags over chest, abdomen, and back. Diagnosis. hereditary hemorrhagic telangiectasia Neurofibromatosis, type 1 sturge-weber syndrome tuberous sclerosis von hippel disease

9 y/o acute appendicitis brought by adult neighbor to ED. neighbor offers to sign consent form for the operation on behalf of childs parent who cant be reached. management by doc? A) perform operation because it's an emergency and no consent is required B) perform operation, because a responsible adult has given consent C) perform the operation only if the child gives consent D) delay the operation until the parent can be contacted, while closely monitoring the child's status

26 y/o lady gives birth to newborn vaginally 42 weeks gestation. Spontaneous and no complication. Fetal growth restriction was noted by third trimester. Mother didn't travel, smoke, drink, or use drugs during pregnancy, and no pets in household. Initial exam showed hepatosplenomegaly. X-ray shows *periventricular intracranial calcification*. Most likely agent? cytomegalovirus herpes simplex virus 1 parvovirus rubella virus treponema pallidum

A 16 y/o boy brought to doc cuz of 2 week history of increasing pain, swelling, and rash over right knee and 1 week of moderate pain and redness in both eyes. Fever of 100F. Eyes have *injected conjunctivae with mucopurulent discharge*. Diffuse, macular, erythematous rash over lower extremities and *marked swelling of the right knee*. Range of motion of the right knee is limited by pain. There is *erythema and edema of the urethral meatus*. Most likely diagnosis? ankylosing spondylitis behcet syndrome dermatomyositis Henoch schonlein purpora juvenile rheumatoid arthritis mucocutaneous lymph node syndrome (kawasaki disease) psoriatic arthritis reactive arthritis sjogren syndrome SLE Systemic sclerosis (scleroderma)