[dr.Ira]

49. A 14-year-old boy is brought to the walk-in clinic by his father late on Saturday afternoon because his left ear is swollen and
painful. The boy's ear has been black and blue since he injured it in a wrestling match 3 days ago. Symptoms have increased
significantly following a repeat injury 3 hours ago. On physical examination, his left ear is markedly swollen and tender to
palpation. Which of the following is the most appropriate next step?

(A) Reassure him and start aspirin therapy
(B) Reassure him and start codeine therapy
(C) Recommend that he apply cold packs to the ear for the next 12 hours
(D) Recommend that he apply hot packs to the ear for the next 12 hours
(E) Refer him to a surgeon for immediate drainage of the lesion

Items 50-51
A 6-week-old infant is brought to the health center by his mother because of projectile vomiting. You have not seen this infant before
and the mother says he has not been seen by a physician since birth. Weight at birth was 3550 g (7 lb 13 oz) and physical
examination was normal. Examination today is normal except for weight, now 4000 g (8 lb 13 oz), and slight dehydration.

50. Which of the following is the most appropriate management for this infant?
(A) Elevate the head of his crib to relieve gastroesophageal reflux
(B) Order supine and decubitus x-ray films of the abdomen
(C) Order ultrasonography of the pylorus
(D) Order an upper gastrointestinal barium study
(E) Place him on a clear pediatric electrolyte solution

51. The appropriate diagnostic test is done and is equivocal. Which of the following imaging modalities necessary to help
diagnose this infant's illness is most operator-dependent?
(A) CT scan
(B) Radionuclide gastric emptying time studies
(C) Routine x-ray films
(D) Ultrasonography
(E) Upper and lower gastrointestinal barium studies