Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled five cases from Kaplan Medical involving young children. Each question comes with an expert explanation of the answer. You can check out all posts in this series.

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Think you can answer these questions involving children? Find out now.   

Turkish boy has yellowness in eyes 

A 5-year old boy (III-1) of Turkish descent is brought to his physician because of yellowness in his eyes. The patient's mother explains that this appeared after taking a long-term antibiotic that the physician prescribed for his severe chest infection. The physician performs a detailed analysis of his family that includes relatives who the mother knows have become ill when given the same antibiotic. What is his diagnosis?

Girl has repeat episodes of syncope 

A 4-year-old girl with an intellectual disability and seizures develops repeated episodes of syncope. Physical examination demonstrates numerous 1–5 mm erythematous papules distributed across the bilateral malar eminences. Echocardiogram shows a mass in the left ventricle. The mass is resected and pathologic examination is consistent with a benign neoplasm consisting of striated muscle. Which abnormality is most likely present in the patient? 

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What disorder is the boy at risk for? 

A 3-year-old boy is found to have an abnormal red reflex in his left eye on routine examination. Funduscopic examination shows a proliferative retinal mass. After surgical removal of the specimen, pathologic examination reveals small, round cells with hyperchromatic nuclei, some rosette arrangement and isolated regions of necrosis. There is no involvement of the optic nerve or tumor extension into adjacent brain tissue. The patient undergoes eye enucleation without surgical complications. As the child ages, what disorder is he also at risk for developing? 

Increased thirst and bed-wetting 

A 7-year-old girl is brought to the physician by her parents because of increased thirst and bed-wetting. She has lost 2.3 kg (5 pounds) in the past month despite an increased appetite. Her temperature is 37 °C (98.6 °F), pulse is 74 beats a minute, respirations are 14 a minute, and blood pressure is 116/70 mm Hg. Physical examination is unremarkable. A urinary dipstick test shows that glucose is present in the urine. Which laboratory findings in serum is most likely? 

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3-year-old boy has trouble walking 

A 3-year-old boy is brought to the physician because of difficulty walking up stairs and muscle fatigue. His parents have noted a progressive decline in his motor abilities over the last 5-6 months. He has also had delays in speech development. His temperature is 37 °C (98.6 °F), pulse is 104 beats per minute, respirations are 25 per minute, and blood pressure is 88/48 mm Hg. On physical examination, the patient has enlargement in the muscles of his calves and a waddling gait.  

There is weakness in his proximal muscles and when arising from the floor, the patient uses his hands to push himself to an upright position. Laboratory studies show an elevated creatinine kinase. The mode of inheritance of this boy’s disease is most similar to what inherited disease? 

For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series

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