(Courtesy of Adelaide Hebert, MD.)
a. Fried foods must be avoided.
b. Frequent scrubbing of the affected areas is key.
c. Topical antibiotics are of no value.
d. Topical benzoyl peroxide is a mainstay of treatment.
e. This rash is solely a disease of the adolescent.
482. A 15-year-old athlete is in your office for his annual physical examination before the start of football season. He has no complaints, has suffered no injuries, and appears to be physically fit. On his heart examination, you note a heart rate of 100 beats per minute, and a diffuse point of maximal impulse (PMI) with a prominent ventricular lift. He has a normal S1 and S2, with an S4 gallop. He has no murmur sitting, but when he stands you clearly hear a systolic ejection murmur along the lower left sternal edge and the apex. For which of the following conditions is this examination most consistent?
a. Wolff-Parkinson-White (WPW) syndrome
b. Valvular aortic stenosis
c. Valvular pulmonic stenosis
d. Myocarditis
e. Hypertrophic cardiomyopathy
483. You are the sideline physician for a local high school football team. During a district playoff game, the starting quarterback is sacked for a loss on third down. As the punter heads out onto the field, the quarterback is slow to come to the sidelines. He seems confused and dazed. Aside from his confusion, his examination is normal. After 10 minutes, he is lucid and wants to get back into the game. Based on published guidelines, which of the following is your correct course of action?
a. Allow the player back in the game.
b. Hold the player out for at least 30 minutes.
c. Hold the player out for the rest of the game.
d. Hold the player out for this game and the next game.
e. Send the player to a hospital for evaluation.
484. A 16-year-old girl, accompanied by her mother, is in your office for a well-adolescent visit. The mother asks about drug and alcohol abuse. You explain that the warning signs of abuse include which of the following?
a. Excessive concern for weight and body configuration
b. Improved school performance
c. Recent changes from age-appropriate, acceptable friends to younger associates
d. Deterioration in personal habits, hygiene, dress, grooming, speech patterns, and fluency of expression
e. Improvement in relationships with adults, siblings, and authority figures
485. The recent suicide of a well-known high school cheerleader in your community has generated an enormous amount of community concern and media coverage. A girl who was close friends with the deceased makes an appointment and comes in to your office to discuss the event with you. You ask, and she denies suicidal ideation, but she has many questions about suicide. Correct statements about adolescent suicide include which of the following?
a. Girls tend to use more lethal means.
b. The number of attempted suicides is much higher among boys.
c. Those who are successful often have a history of a prior attempt or prior serious suicidal ideation.
d. Inquiry by pediatricians, high school teachers, parents, or friends about suicidal thoughts typically precipitates the act.
e. The number of suicides in adolescents 10 to 19 years of age has decreased significantly since the 1950s.
486. A 16-year-old girl is in your office for a preparticipation sports examination. She plans to play soccer in the fall, and needs her form filled out. Which of the following history or physical examination findings is usually considered a contraindication to playing contact sports?
a. Congenital heart disease, repaired
b. Obesity
c. Absence of a single ovary
d. Absence of a single eye
e. Diabetes mellitus
487. A 15-year-old boy is in the office for a preparticipation sports physical examination before he begins playing with the varsity football team at his school. Although he is a skilled receiver, he will be one of the smallest players on the field and is concerned about the potential for injury. He asks how to bulk up. Appropriate advice to increase muscle mass includes which of the following?
a. Taking extra vitamins
b. Doubling protein intake
c. Using anabolic steroids
d. Increasing muscle work
e. Taking ergogenic medication
488. An 18-year-old male college student is seen in the student health clinic for urinary frequency, dysuria, and urethral discharge. Which of the following test is likely to confirm the etiology of his symptoms?
a. Identification of viral DNA by polymerase chain reaction (PCR)
b. Clean catch urine with >105 Gram negative, lactose fermenting rods
c. Positive results on a nucleic acid amplification test
d. Rapid plasma reagin (RPR) test results of 1:4
e. Reactive enzyme immunoassay (EIA) with confirmatory immunoblot or immunofluorescence assay
489. A 19-year-old male college student returns from spring break in Fort Lauderdale, Florida, with complaints of acute pain and swelling of the scrotum. Physical examination reveals an exquisitely tender, swollen right testis that is rather hard to examine. The cremasteric reflex is absent, but there is no swelling in the inguinal area. The rest of his genitourinary examination appears to be normal. A urine dip is negative for red and white blood cells. Which of the following is the appropriate next step in management?
a. Administration of antibiotics after culture of urethra for Chlamydia and gonorrhea
b. Reassurance
c. Intravenous fluid administration, pain medications, and straining of all voids
d. Ultrasound of the scrotum
e. Laparoscopic exploration of both inguinal regions
490. A 16-year-old girl presents with lower abdominal pain and fever. On physical examination, a tender adnexal mass is felt. Further questioning in private reveals the following: she has a new sexual partner; her periods are irregular; she has a vaginal discharge. Which of the following test results is most likely to be seen in this scenario?
a. Appendiceal fecalith on plain radiograph of abdomen.
b. Thickened and fluid-filled fallopian tubes with free pelvic fluid on ultrasound
c. Four centimeter fluid filled mass arising from the left ovary
d. Multicystic lesions throughout the right kidney
e. Calcified mass in left ureter with proximal ureter dilatation and mild hydronephrosis
491. The parents of a 16-year-old girl complain that she does not get enough sleep. They recently discovered that she stays awake most nights until 1:00 am reading and text messaging her friends. She wakes at 6:30 am for school, and complains of sleepiness during the day. On weekends she sleeps until noon. Her parents have tried taking away her computer and phone, but she still would go to bed at the same time. The parents are looking for advice in dealing with their “night owl” daughter. Which of the following is an appropriate piece of advice for this family?
a. Teens need less sleep than adults.
b. Effects of puberty on melatonin cause a phase delay with later sleep onset.
c. Most teens get an adequate number of hours of sleep each night.
d. Daytime sleepiness is a clear manifestation of an inadequate number of hours of sleep.
e. Sleeping in on weekends should repay the “sleep debt.”
Questions 492 to 495
Listed below are various clinical vignettes in which the patient has a genital ulcer. Match each vignette with the appropriate diagnostic tests for disease confirmation. Each lettered option may be used once, more than once, or not at all.
a. A 16-year-old female has a positive RPR of 1:64 and an ulcer on her labia.
b. A 19-year-old female has a few small papules on her labia and perineum. The papules become pustular, eroded, and ulcerated over the next few days; at the same time, the patient develops painful, tender inguinal lymphadenopathy.
c. A 19-year-old male has recurrent episodes of painful, erythematous, small vesicles, and ulcers on his glans penis.
d. A 15-year-old male had a painless papule on his genitals that resolved, but he has now developed a unilateral draining inguinal lymphadenitis.
492. Confirmation with a test such as the fluorescent treponemal antibody absorption (FTA-ABS) test.
493. Tzanck preparation for multinucleated giant cells, culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, or PCR to test for presence of viral DNA.
494. Detection of the organism from a lesion via culture or nucleic acid amplification testing (NAAT), or complement-fixing antibody titers of >1:16.
495. Detection of the bacteria with special chocolate agar medium (~80% sensitive) or as a diagnosis of exclusion when testing for other etiologies proves negative. Alternatively, use of indirect immunofluorescence using monoclonal antibodies or PCR may be available.
Questions 496 to 500
Listed below are common adolescent activities that may result in injury. Match each with the injury with which the activity is most commonly associated. Each lettered option may be used once, more than once, or not at all.
a. A 15-year-old competitive swimmer
b. A 17-year-old high school quarterback
c. A 17-year-old starting center for a high school basketball team
d. A 14-year-old long-distance runner
e. An 11-year-old ballerina
f. A 16-year-old high school wrestling champion
g. A 14-year-old snow skier
h. An 18-year-old college hockey star
496. Patellar tendinitis and Osgood-Schlatter disease
497. Injuries almost exclusively related to the shoulder, including rotator cuff tendinitis
498. Delayed menarche and eating disorder
499. Hyperextension of the thumb and sprains of the anterior cruciate ligament
500. Shoulder subluxation, knee injuries, and dermatologic problems such as herpes simplex, impetigo, and staphylococcal furunculosis or folliculitis
The Adolescent
Answers
475. The answer is b.
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