2. Which of the following is a true statement about acellular pertussis vaccination?

a) In comparison with whole-cell vaccines, acellular pertussis vaccines have superior efficacy.
b) Acellular vaccines are less reactogenic than whole-cell vaccines.
c) Immunocompromised children should not be vaccinated with acellular pertussis vaccines.
d) Both a and b.

4. Which of the following is a true statement about poliovirus vaccination?

a) IPV is less immunogenic than OPV.

b) VAPP is a risk of OPV immunization.
c) VAPP has been described following the administration of IPV.
d) Both a and b.

9. Which of the following is a true statement about pneumococcal vaccination?

a) 7-valent conjugate vaccine is indicated for all children 2 years of age and older.
b) 23-valent polysaccharide vaccine is not immunogenic in children younger than 2 years.
c) Children with congenital immunodeficiencies should receive polysaccharide pneumococcal
vaccination rather than conjugate vaccine.
d) Polysaccharide pneumococcal vaccine is associated with significant adverse reactions, as
compared to conjugate vaccine.

11. An 18-month-old child should typically be able to:

a. Stand on one foot

b. Jump off the floor with both feet
c. Walk up the stairs alternating feet forward
d. Walk backwards

23. A 7-month old infant on parenteral feeding is transferred to your hospital. During the
examination, you note perioral and perianal scaling and erythema.
This most likely is a manifestation of a deficiency of:

a. Vitamin D
b. Zinc
c. Vitamin A
d. Selenium
e. Copper
4. Which of the following statements are true for children?

a) Approximately 90% of infants of mothers with chronic hepatitis B infection acquire the
infection at birth, even if vaccine and Ig are administered within the first 48 hours of birth.
b) The risk for maternal to infant transmission of HCV is increased in mothers who are
coinfected with HIV or who have a high viral load of HCV at the time of delivery.
c) Currently, no effective treatment is available for chronic HBV infection in children.
d) Hepatitis E infection is acquired primarily by parenteral exposure.
e) Both b and d.

2. Which of the following statements is true regarding esophageal meat impactions:

a) The obstruction should be confirmed with barium contrast studies.

b) The administration of meat tenderizers is indicated.
c) Immediate endoscopy (within 2 hours) is indicated in patients who are able to handle their
secretions.
d) Obstruction may indicate underlying esophageal pathology.
e) All of the above.

3. Button batteries should be removed when:

a) They remain in the stomach for 24 hours.

b) They are lodged in the esophagus.
c) Whenever they are ingested.
d) Both a and b.
e) None of the above.

4. Which of the following is true regarding caustic ingestions?

a) Bleach ingestions are usually associated with esophageal injury.

b) Esophageal injury is always associated with oral injury.
c) The risk for esophageal carcinoma is increased following caustic ingestion.
d) All of the above.
e) None of the above.
3. A 3-year-old boy status post-Kasai procedure for biliary atresia at age 12 weeks presents with
a 1-month course of increasing irritability, pruritus, and clumsiness. Records indicate that he has
not gained weight over the past 6 months. On examination, the patient has a wide-based gait,
enlargement of both his liver and spleen and diminished deep tendon reflexes in all the
extremities.
Which nutrient deficiency most likely accounts for these complaints and physical findings?

a. Vitamin A
b. Vitamin B12
c. Vitamin D
d. Vitamin E
e. Zinc

7. An otherwise healthy 6-day-old white female infant is brought to your office for evaluation of
blood in the stool. She was delivered at home without complication and has been exclusively
breast-fed. She has not been examined previously by a physician. On examination, she has what
appear to be areas of ecchymosis over the buttocks and lower extremities. She is mildly
tachycardic and her stool is grossly bloody. Physical examination is otherwise normal.
Of the following, what is the most likely diagnosis?

a. Sepsis
b. Salmonella infection
c. Hemorrhagic disease of the newborn
d. Physical abuse
e. Colonic polyposis

8. A 14-year-old girl presents with an 8-month history of intermittent low-grade fevers and right
lower quadrant pain. Her appetite has been decreasing, as pain worsens with eating. Her weight
and height have decreased from the 50th percentile to below the 10th percentile for her age over
the past 2 years and her parents are concerned that she has developed an eating disorder. On
examination, the patient has mild right lower quadrant pain and fullness. No peritoneal signs are
present. Her stool is Hemoccult positive.
Of the following, the most appropriate initial diagnostic test would be:

a. Abdominal computed tomography (CT) scan to rule out a perforated appendix

b. Barium enema
c. Upper gastrointestinal (GI) series with small bowel follow-through
d. Abdominal ultrasonography
e. Stool culture
1. A 10-year-old patient who presents with a history of intermittent gross hematuria and 1+
proteinuria that is more pronounced during an upper respiratory infection is likely to have which
of the following findings?

a) Low C3 level
b) Calcium oxalate crystals on urinalysis
c) Urine with a specific gravity of 1.020 and a pH of 5.0, and a red blood cell cast on
microscopic examination
d) Evidence of hemolytic anemia with anisocytosis and poikilocytosis and very few platelets
demonstrated on a smear

10. Which of the following statements is false regarding congenital nephrotic syndrome?

a) The prognosis is dismal, with death often occurring within the first year.
b) It can be inherited as an autosomal-recessive trait.
c) It is associated with an abnormally large placenta.
d) It is associated with polyhydramnios.
e) Major causes of death are early renal failure and hyperkalemia.

2. Which of the following conditions is least likely to be associated with goiter?

a) Hashimoto lymphocytic thyroiditis

b) Graves disease
c) Subacute thyroiditis
d) Congenital hypothyroidism

3. Which of the following tests best differentiates subacute thyroiditis from Graves disease?

a) Free T4
b) TSH
c) Radioactive iodide uptake scan
d) Erythrocyte sedimentation rate

5. A low total T4 level and a normal TSH level in an otherwise healthy child is most likely
caused by:

a) Thyroid-binding globulin deficiency

b) Subclinical hypothyroidism
c) Pituitary resistance to T4
d) Subacute thyroiditis
2. You are caring for a 16-month-old girl whose mother has vitamin D-resistant rickets. The
parents want to know if the child has the same disease as her mother.
Which of the following tests would be most helpful in answering this question?

a) Hand and wrist radiography for bone age

b) Determination of the PTH level
c) Determination of the serum phosphorus level
d) Determination of the alkaline phosphatase level

5. Which of the following potential side effects has not been attributed to growth hormone
treatment?

a) Hepatitis
b) Pseudotumor cerebri
c) Growth of nevi
d) Slipped femoral capital epiphysis

13. You are called to the neonatal nursery to see a jittery newborn. The examination reveals a
healthy-looking infant except for microphallus and jitteriness. His blood glucose is 15 mg/dL.
An intravenous bolus of 10% dextrose in water is given and an infusion of dextrose in water is
administered. The next most appropriate step is to:

a. Measure urine 17-ketosteroids

b. Obtain urinalysis for an organic and amino acid screening
c. Measure serum and urine ketones
d. Obtain a cranial computed tomography (CT) scan to look for septo-optic dysplasia
e. Measure serum C-peptide

14. A 4-year-old child is brought to the emergency department with tetany. The serum calcium
level is 6.0 mg/dL, phosphate 9.6 mg/dL, and alkaline phosphatase 586 U/dL.
All of the following statements are true regarding pseudohypoparathyroidism, except:

a. Cranial CT scan may show calcification of the basal ganglia.

b. He is at risk for gonadal dysfunction during adult life.
c. The parathyroid hormone (PTH) levels will be low.
d. He is at risk for moderate learning disability.
e. A slit lamp examination may reveal cataracts.
15. A 1-month-old infant is brought in with constipation and poor weight gain. Examination
reveals facial wasting with an inverted V-shaped upper lip and generalized hypotonia.
The following statements are true regarding this infant's condition, except:

a. Electrocardiography may show cardiac conduction abnormalities.

b. The serum creatine kinase levels will be markedly elevated.
c. He is at risk for the development of diabetes mellitus later.
d. Slit lamp examination of his eyes may show cataracts.
e. He inherited this condition from his mother.

3. A full-term newborn with a history of polyhydramnios presents shortly after birth with
tachypnea, asymmetric breath sounds, and a scaphoid abdomen. An arterial blood gas study
reveals hypoxemia and a mixed metabolic and respiratory acidosis.
The most likely diagnosis is:

a) Congenital cystic adenomatoid malformation of the lung

b) Esophageal atresia with tracheoesophageal fistula
c) Pulmonary sequestration
d) Pleural effusion
e) Congenital diaphragmatic hernia

1. Of the following, the organism least likely to cause early-onset neonatal sepsis is:

a) L. monocytogenes
b) Group B streptococci
c) Streptococcus pneumoniae
d) E. coli

2. All of the following are important causes of late-onset neonatal sepsis, except:

a) Streptococcus pyogenes
b) Coagulase-negative staphylococci
c) S. aureus
d) Gram-negative bacilli
e) Candida albicans

3. Which of the following is a true statement concerning early-onset group B Streptococcus

(GBS) neonatal sepsis?

a) Pneumonia and apnea are the most common clinical findings.

b) Meningitis is present in 80% of the cases.
c) The case fatality rate is lower than with late-onset GBS infection.
d) Septic shock occurs in 75% of the cases.
e) The mean age of onset is 72 hours of life.
6. A 1-year-old infant has chorioretinitis, which has progressed throughout the first year of life,
and cerebral calcifications. The most likely congenital infection in this child is:

a) Rubella
b) CMV infection
c) Syphilis
d) Toxoplasmosis

12. A 1-month-old infant is seen in the outpatient clinic for a routine visit. The mother gives a
history of poor feeding and unsatisfactory weight gain. She states that the infant's 5-year-old
sibling had a similar history at this age. On further questioning, the mother reveals that the
sibling has delayed development. On examination, the infant has facial dysmorphic features that
include maxillary hypoplasia and an absent philtrum.
Which of the following is true regarding the infant's condition?

a. It is rarely associated with congenital heart disease.

b. The infant is at minimal risk for developmental delay.
c. Future pregnancies are not at risk.
d. Major/minor components of this condition are expressed in 1 to 2/1,000 live births.
e. None of the above.

2. All of the following cardiac conditions can present with heart failure in the first 6 weeks of
life, except:

a) Complete atrioventricular canal defect

b) Coarctation of the aorta
c) Pulmonary stenosis
d) Ventricular septal defect
e) Hypoplastic left heart syndrome

4. An ACE inhibitor would be indicated for which of the following?

a) Pulmonary stenosis
b) Dilated cardiomyopathy
c) Atrial septal defect
d) Hypertrophic cardiomyopathy
e) Aortic stenosis

4. The most common presentation of coarctation of the aorta in infancy and childhood is:

a) Supraventricular tachycardia
b) Syncope
c) Hypertension and absent femoral pulses
d) Endocarditis
e) Congestive heart failure
6. The most common cause of syncope in childhood is:

a) Tachycardias associated with Wolff-Parkinson-White syndrome

b) Long QT syndrome
c) Breath-holding spells
d) Hypertrophic cardiomyopathy
e) Neurocardiogenic syncope

9. Appropriate therapy for patients who have neurocardiogenic or vasovagal syncope includes:

a) β-Blockers
b) Increased intake of fluids and sodium
c) Mineralocorticoids
d) All of the above

1.While performing ultrasonography on the mother of a 31-week fetus, an obstetrician notes that
the heart rate ranges from 62 to 66 beats/minute. The fetal growth appears normal, and no
structural cardiac anomalies are identified. On performing echocardiography, the fetal atria
appear to be contracting at 140 beats/minute, with a ventricular rate of 65 beats/minute.
Which of the following is the next step in the management of this fetus/infant?

a. Administer β-agonist drug therapy to the mother.

b. Assess the cardiac status of the infant following labor and delivery.
c. Counsel the parents that intrauterine fetal death is likely.
d. Perform amniocentesis to confirm lung maturity, and if the lungs are mature, perform an
immediate cesarean section.
e. Repeat fetal echocardiography and ultrasonography in 1 week

7. In addition to a prolonged QT interval, an individual with Jervell and Lange-Nielsen syndrome

is most likely to have:

a. Alopecia universalis
b. Cranial bruits
c. Hepatosplenomegaly
d. Rotary nystagmus
e. Sensorineural hearing loss

9. The upper limit of a normal corrected QT interval (QTc) is:

a. 0.40 second in boys

b. 0.40 second in girls
c. 0.46 second in boys
d. 0.46 second in girls
e. 0.46 second in boys and girls
11.A 14-year-old girl falls during a race. She is unconscious and cyanotic and has no pulse, but
she revives spontaneously within seconds. Both the patient and family histories are benign.
Results of a physical examination, chest roentgenography, echocardiography,
electroencephalography, and exercise electrocardiography during a treadmill stress test are
normal.
Which of the following is the most appropriate next step in management?

a. Order a 30-day electrocardiographic event recorder.

b. Perform cardiac catheterization studies.
c. Perform 24-hour ambulatory electrocardiographic monitoring.
d. Perform tilt-table testing.
e. Reassure the family that cardiac causes have been excluded.

17. During the preschool physical examination of a 4-year-old child, you note a grade 2/6 high-
pitched continuous murmur in the third right intercostal space while the patient is in the sitting
position. The murmur is ablated by compressing the child's neck veins.
Of the following, the most likely diagnosis is:

a. Aortic stenosis and insufficiency

b. Arteriovenous malformation
c. Patent ductus arteriosus
d. Still murmur
e. Venous hum murmur

20.Following an uncomplicated delivery, cyanosis develops in a 3.7-kg term infant during the
first hour of life. The findings at 3 hours of age include cyanosis, heart rate of 140 beats/minute,
respiratory rate of 56 breaths/minute, and no heart murmurs. The pulse oximetry reading in room
air is 70% in the right hand and 75% in the foot; with a 100% fraction of inspired oxygen (FIO2)
by head hood, the oxygen saturation remains 70% in the hand but increases to 90% in the foot.
The chest roentgenographic findings are normal.
These findings are most consistent with:

a. Primary pulmonary hypertension of the newborn

b. Pulmonary valve atresia
c. Transient tachypnea of the newborn
d. Transposition of the great arteries
e. Truncus arteriosus

24. Regarding digoxin therapy, which of the following is a true statement?

a. Digitalizing dose is 10 µg/kg.

b. Maintenance dose is 5 to 10 µg/kg per day.
c. Levels should be monitored for therapeutic effect.
d. Hyperkalemia enhances digoxin toxicity.
e. Overdose is treated with hemodialysis.
25. Signs of digoxin toxicity include all the following, except:

a. Short PR interval
b. Anorexia
c. Lethargy
d. Supraventricular arrhythmias
e. Ventricular arrhythmias

26. In an infant with a left-to-right shunt, which of the following is a true statement?

a. Oxygen can be deleterious.

b. Caloric needs are reduced.
c. Rales accompany congestive heart failure.
d. Afterload reduction is contraindicated.
e. Intravenous furosemide is ineffective.

28.A systolic ejection murmur is detected in a highly competitive 16-year-old high school athlete
during a routine examination required before participation in sports. The electrocardiogram
demonstrates a sinus bradycardia (50 beats/minute) and borderline left ventricular hypertrophy.
Echocardiography reveals mildly enlarged left and right ventricles with a ventricular shortening
fraction of 40% (normal >28%).
Of the following, the most likely explanation for these findings is:

a. Autonomic dysfunction
b. Cardiovascular response to athletic training
c. Early evidence of dilated cardiomyopathy
d. Early evidence of hypertrophic cardiomyopathy
e. Myocarditis

29. The most common cause of syncope in young children is:

a. Automonic dysfunction associated with prolonged standing

b. Breath-holding spells
c. Cataplexy
d. Panic attack associated with hyperventilation
e. Prolonged QT syndrome
1. The stinging insect most likely to cause an anaphylactic reaction is:

a) Honeybee
b) Wasp
c) Yellow jacket
d) White-faced hornet
e) Imported fire ant

2. A 7-year-old girl presents with a history of episodic severe swelling at areas of trauma without
pruritus. Her father has a similar history. The single best screening test for her condition should
determine:

a) C3 level
b) C1 inhibitor level
c) Total serum hemolytic complement (CH50)
d) C4 level
e) Serum IgE concentration

4. Patients with which of the following reactions are candidates for bee venom skin testing and
immunotherapy?

a) Immediate large local swelling at the sting site with redness and swelling of the entire
extremity
b) Immediate large local reaction at the sting site with urticaria over the entire body
c) Moderate swelling at the sting site with the development of diffuse urticaria and joint pain 5
days later
d) Immediate swelling at the sting site with wheezing (in a patient with asthma)

9. Which of the following is not true regarding reactions to radio-contrast media?

a) Mast cell degranulation is involved.

b) Pretreatment with antihistamine reduces the severity.
c) Cross-allergenicity to iodine or seafood is not present.
d) Reactions are mediated by IgE.
e) Reactions are more likely with high-osmolarity radioactive contrast.

2. A 15-month-old female infant has been hospitalized for several serious infections caused by
Staphylococcus aureus, including osteomyelitis, hepatic abscess and pneumonia with
pneumatocele formation. What is the most likely diagnosis?

a. Wiskott-Aldrich syndrome
b. Selective immunoglobulin A (IgA) deficiency
c. Leukocyte adhesion deficiency
d. Common variable immunodeficiency (CVID)
e. Chronic granulomatous disease (CGD)
7. The mother of a 3-month-old breast-fed infant asks you about recommendations for the
introduction of new foods to the infant's diet. The 4-year-old brother of the infant has a history
significant for egg allergy including an anaphylactic reaction.
What should you tell the mother?

a. No restrictions on the introduction of new foods to the infant's diet

b. Delayed introduction of cow's milk protein until 4 months of age
c. Delayed introduction of eggs until 12 months of age
d. Delayed introduction of tree nuts until 24 months of age
e. Delayed introduction of peanut until 3 years of age

13. A 17-year-old boy has a history of an adverse reaction to radiocontrast media (RCM) 2 years
ago that included diffuse pruritus and urticaria accompanied by hypotension.
Which statement is true regarding his adverse reaction to RCM?

a. History of this type of reaction is an absolute contraindication to further administration of

RCM.
b. He should avoid RCM and iodine, such as in iodine cleaning solutions and shellfish.
c. He should receive high-osmolar, ionic RCM for the next procedure.
d. He should receive antihistamines and prednisone prior to the next procedure with RCM.

14. Two days ago, an 8-year-old boy completed a 10-day course of oral amoxicillin. He also
developed fever, malaise, arthralgia of multiple joints, nausea and diarrhea two days ago. Today,
he developed urticaria.
By the Gell and Coombs classification of human hypersensitivity,
what type of adverse reaction is he experiencing?

a. Type I
b. Type II
c. Type III
d. Type IV

4. Which of the following is a true statement concerning breath-holding spells?

a) They are most common in children 2 to 5 years of age.

b) Bradycardia is a common feature of the cyanotic type of breath-holding spell.
c) Loss of consciousness may be a feature.
d) Future behavioral problems are common sequelae.
3. Which of the following is a true statement concerning TS?

a) Infantile spasms are commonly seen in patients with TS.

b) The mode of inheritance of TS is AR.
c) Hypopigmented macules develop during adolescence.
d) The presence of seizures early in life is not a predictor of mental retardation.

4. Which of the following is a true statement concerning SWS?

a) The port wine stain associated with this syndrome is commonly bilateral.
b) Ophthalmic and CNS manifestations always accompany the nevus.
c) Seizures are a common complication of the syndrome.
d) A chromosomal abnormality has been proved for this syndrome.

1. The following are all inherited as an X-linked-recessive trait, except:

a) DMD
b) BMD
c) EDMD
d) Myotonic dystrophy

4. Ophthalmoplegia and ptosis are commonly seen in:

a) DMD
b) Myotubular myopathy
c) CMD
d) LGMD
e) Congenital fiber-type disproportion
3. A 7-year-old girl is being evaluated for repetitive episodes of vomiting, which have required
eight prior hospitalizations for intravenous rehydration. Her examination in your office is
normal. She had a brother who died at 3 days of life, and the coroner ruled that the death was due
to sudden infant death syndrome. The most likely laboratory abnormalities that would be noted
during the next exacerbation would be:

a. Elevated blood ammonia level with low blood urea nitrogen (BUN) levels
b. Elevated blood and cerebrospinal fluid (CSF) glycine levels
c. Low CSF glucose with normal blood glucose
d. Normal blood glucose level with no urine ketones
e. Elevated blood glucose level with no urine ketones

1. The skills of kicking a ball and jumping in place are gross motor milestones that occur at
which age?

a) 15 months
b) 18 months
c) 24 months
d) 30 months

2. A 4-year-old child should be able to:

a) Ride a bicycle
b) Hop on one foot
c) Skip by alternating the feet
d) Tandem walk backward

3. The ability to follow a point occurs at what age?

a) 8 months
b) 10 months
c) 15 months
d) 18 months

4. The ability to build a tower of three cubes occurs at what age?

a) 15 months
b) 16 months
c) 18 months
d) 24 months
5. A vocabulary of 50 or more words and the ability to speak in two- and three-word sentences
should be acquired by what age?

a) 15 months
b) 18 months
c) 24 months
d) 30 months

1. All of the following statements regarding MR are true, except:

a) The diagnosis requires a performance on standard measures of intelligence two standard

deviations or more below the mean, or poor functioning in two areas of daily living as assessed
by standardized measures.
b) The cause is most commonly unknown.
c) In general, MR is generally more severe in children in whom the signs become apparent at an
earlier age.
d) Most of the affected children have mild MR.
e) Treatment is geared toward maximizing adaptive functioning.

2. Newborn screening identifies Hb F and Hb S in an infant. The diagnosis could be:

a) Homozygous sickle cell disease

b) Homozygous sickle cell disease with persistence of Hb F
c) Sickle cell/β thalassemia
d) Any of the above
e) None of the above

6. Screening of a newborn has detected a hemoglobinopathy with Hb Bart's. All of the following
statements are true, except:

a) The infant may have a α thalassemia trait.

b) The infant may be a silent carrier of α thalassemia.
c) The infant may have microcytosis and anemia.
d) The infant may have β thalassemia.
e) The infant may be hematologically normal.

2. Which of the following are the two most important prognostic indicators in children in whom
ALL is diagnosed?

a) Age and immunophenotype

b) Sex and white blood cell count
c) Platelet count and immunophenotype
d) Immunophenotype and white blood cell count
e) Age and white blood cell count
f) Race and hemoglobin level
3. On a physical examination of a newborn infant, an abdominal mass is discovered. The most
likely tumor diagnosis is:

a) Lymphoma
b) Wilms tumor
c) Hepatoblastoma
d) Neuroblastoma
e) Retinoblastoma
f) None of the above

4. A chest radiograph reveals a posterior mediastinal mass. The most likely tumor diagnosis is:

a) Hodgkin disease
b) Rhabdomyosarcoma
c) Neuroblastoma
d) Ewing sarcoma
e) Lymphocytic lymphoma

1. The two most important prognostic indicators in neuroblastoma are as follows:

a. Age of the patient and stage of disease

b. Stage of disease and histopathology
c. Sex of the patient and catecholamine levels in a 24-hour urine collection
d. Presence of cerebellar ataxia and stage of disease
e. N-myc copies and age of the patient
f. None of the above

3. Generalized lymphadenopathy is a common presenting sign in which of the following groups

of childhood malignancies?

a. Neuroblastoma, acute lymphoblastic leukemia, rhabdomyosarcoma

b. Osteosarcoma, Ewing sarcoma, Wilms tumor
c. Acute lymphoblastic leukemia, neuroblastoma, non-Hodgkin lymphoma
d. Acute nonlymphocytic leukemia, neuroblastoma, hepatoblastoma
e. Acute leukemia, Wilms tumor, retinoblastoma

12. Beckwith-Wiedemann syndrome is associated with which of the following malignancies in

children:

a. Wilms tumor and hepatoblastoma

b. Retinoblastoma and Ewing sarcoma
c. Hodgkin disease and adrenal tumors
d. Acute leukemia and osteosarcoma
e. Both a and c
13. A 23-month-old boy presents with a 2-week history of progressive cerebellar ataxia. The
results of magnetic resonance imaging (MRI) of the brain are normal.
What other type of malignancy should be sought?

a. Hepatoblastoma
b. Burkitt lymphoma
c. Hodgkin disease
d. Primitive neuroectodermal tumor (Ewing sarcoma) of the spinal cord
e. Neuroblastoma

14. Proptosis as a presenting sign is more commonly seen in which of the following pediatric
tumors:

a. Hodgkin disease
b. Retinoblastoma
c. Ewing sarcoma
d. Rhabdomyosarcoma
e. T-cell acute lymphoblastic leukemia
f. Primitive neuroectodermal tumor

16. A 15-year-old boy has difficulty breathing when lying flat in his bed. When he sits up, he has
no trouble breathing.
What would you expect to find on his physical examination?

a. Rales at both lung bases

b. Diffuse inspiratory and expiratory wheezing
c. Large goiter
d. Lower cervical and supraclavicular adenopathy, especially on the right side
e. Lungs clear to auscultation with no adenopathy detectable
f. Croup-like cough with inspiratory stridor

20. Awell-appearing, well-nourished, asymptomatic 2-year-old boy presents to your office with a
large abdominal mass.
Which of the following radiographic studies is not indicated?

a. Computed tomography (CT) scan of the chest, abdomen, and pelvis

b. MRI of the thoracic, lumbar, and sacral spine
c. Ultrasonography of the inferior vena cava and heart
d. Chest radiography