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Med Peds Resident Qbanks

Med Peds Question Banks


Aligned with the American Board of Internal Medicine and American Board of Pediatrics content blueprints. Authored & peer-reviewed by faculty, clinicians, and program directors.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
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An 18-year-old man presents to the hematology clinic for a follow-up. He has a history of sickle cell disease and is currently taking hydroxyurea. He is tolerating the hydroxyurea at maximum dose without side effects, but in the past year, he has been hospitalized six times for acute pain episodes involving his left arm and right leg. These pain episodes resolved after treatment with opioids and hydration. Other than sickle cell disease, he has no significant medical conditions. On vital signs, he has a T of 98.3°F, HR of 78 bpm, BP of 120/70 mm Hg, RR of 15/min, and SpO2 of 98%. The physical exam is unremarkable. Which of the following is the most appropriate next step in management?

A Add crizanlizumab
B Add deferasirox
C Continue current treatment
D Refer for hematopoietic stem cell transplantation
Correct Answer Distractor
Sickle cell disease is a hemoglobinopathy often associated with pain episodes involving the back, extremities, chest, and other sites. These pain episodes are caused by vaso-occlusion from the sickle-shaped red blood cells, leading to ischemia and pain. 

Treatment of acute pain episodes typically involves analgesia, often with NSAIDs for mild pain and opioids for more severe pain. The disease-modifying agent hydroxyurea is advised for patients with sickle cell disease. It has multiple beneficial effects, such as improving survival and reducing both vaso-occlusive pain episodes and the need for transfusion. 

For patients with recurrent pain episodes despite maximal doses of hydroxyurea or who cannot tolerate hydroxyurea, crizanlizumab can be considered. Crizanlizumab is an antibody against the adhesion molecule P-selectin. Vaso-occlusive pain episodes develop in part due to the upregulation of P-selectin in platelets and endothelial cells. Crizanlizumab decreases the frequency of pain episodes and, in patients who tolerate hydroxyurea, is typically added as an adjunctive disease-modifying agent to reduce recurrent pain episodes.


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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

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Why do patients with sickle cell disease typically have increased susceptibility to bacterial infections?

Reveal Answer

Sickle Cell Disease

  • Sickling → vaso-occlusive ischemia
  • Hydroxyurea increases fetal hemoglobin (HbF) production, reduces chance of sickling
  • ↓ O2, dehydration, acidosis → sickling
  • Crizanlizumab -> to reduce frequency of vaso-occlusive crises
  • Newborns: initially asymptomatic (due to ↑ HbF)
  • Most common presentation in infants: dactylitis
  • Aplastic crisis: ↓ Hgb + reticulocytopenia, parvovirus B19
  • Acute chest syndrome
    • Most common cause of death in adults
    • Fever, CP
    • CXR: pulmonary infiltrate
  • Splenic sequestration crisis: rapid splenic sequestration of RBCs → splenomegaly + severe anemia
  • Stroke
  • Aseptic necrosis of the femoral head
  • Dysfunctional spleen → ↑ infection risk
    • Salmonella osteomyelitis
    • S. pneumoniae sepsis: most common cause of death in children

Rapid Review

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These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

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Attending Physician

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