Pediatrics

Question 1

You are assessing a neonate that was born two minutes ago via uncomplicated NSVD. The infant is crying forcefully and has good muscle tone, but you notice that the extremities are somewhat cyanotic. You apply a pulse oximeter and find the spO2 to be 68%. What is the most appropriate next action?

A) Intubate via rapid sequence induction
B) Provide high-flow oxygen by mask or blow-by method
C) Start the patient on nasal CPAP
D) Continue your assessment

Answer 1

D) Continue your assessment

this is a normal finding 2 minutes after delivery

Question 2

You are assessing an neonate 1 minute after birth. The trunk is pink, but the hands and feet are blue. She is crying vigorously and has some extremity movement, but little flexion. The heart rate is 120 and the respiratory rate is 40. The APGAR score is ______. This is a ______ (normal/low) score, and should be rechecked at ______ minutes.

Answer 2

8, normal, 5

Question 3

Which of the following is not associated with gestational diabetes?

A) Macrosomia
B) Microcephaly
C) Perinatal hypoglycemia
D) Shoulder Dystocia

Answer 3

B) Microcephaly

Question 4

You are attending a delivery. Two minutes after birth, the infant’s heart rate is 50. After 30 seconds of warming, drying, and stimulating and 30 seconds of positive pressure ventilation, there is no change. What is the most appropriate next action?

A) Intubate
B) Transcutaneous pacing
C) Administer epinephrine
D) Start chest compressions

Answer 4

D) Start chest compressions

Question 5

Which of the following perinatal complications is least associated with sepsis in the newborn?

A) Premature rupture of membranes
B) Chorioamnionitis
C) Gestational DM
D) Maternal GBS colonization

Answer 5

C) Gestational diabetes

Question 6

An infant develops significant respiratory distress and cyanosis soon after birth. He is given IV prostaglandins which reestablish patency of the ductus arteriosis and cause improvement in the patient’s symptoms. Which of the following congenital disorders is most likely present?

A) Transposition of the great arteries
B) Atrial septal defect
C) Tetralogy of Fallot
D) Persistent pulmonary hypertension of the newborn

Answer 6

A) Transposition of the great arteries

Question 7

The presence of one of the following structural defects can increase survivability for patients with total anomalous pulmonary venous return. Which one is it?

A) Aortic stenosis
B) Tricuspid atresia
C) Atrial septal defect
D) Hypoplastic left heart

Answer 7

C) Atrial septal defect

Question 8

You are assessing a newborn and notice a soft split S2 when listening at the left upper sternal border. Which congenital abnormality do you suspect?

Answer 8

Atrial septal defect

Question 9

While examining an infant, you notice a harsh, holosystolic murmur at the lower left sternal border. The child’s parents are concerned and want more information. What is the best thing to tell them?

A) Emergent surgery is required, but the success rate is quite high
B) This defect often resolves without intervention
C) The preferred management is prostaglandin infusion
D) This murmur is a normal variant in infants

Answer 9

B) This defect often resolves without intervention

Question 10

A 13 year-old female presents with episodic palpitations and chest pain. The EKG shows a short PR interval with prominent delta wave. What is the most likely diagnosis?

Answer 10

Wolff-Parkinson-White syndrome

Question 11

Which of the following is least likely to be detected via pre and post-ductal oxygen saturation screening?

A) Patent foramen ovale
B) Transposition of the great arteries
C) Pulmonary atresia

Answer 11

A) Patent foramen ovale

Question 12

You are called to examine an infant who has fed poorly and had persistent tachypnea in the hours since birth. You find that the patient’s lower extremities are cyanotic, but the upper extremities are pink. Brachial pulses are bounding, but femoral pulses are barely palpable. Which congenital cardiac abnormality do you suspect?

Answer 12

Coarctation of the aorta

Question 13

You are examining an infant who is cyanotic. With which of the following cardiac abnormalities are you least concerned?

A) Truncus arteriosis
B) Tetralogy of Fallot
C) Hypoplastic left heart syndrome
D) Patent ductus arteriosis

Answer 13

D) Patent ductus arteriosis

Question 14

You are examining a newborn and notice a holosystolic “machine-like” murmur at the left upper sternal border. Which congenital abnormality do you suspect?

Answer 14

Patent ductus arteriosis

Question 15

You are examining a newborn and notice a holosystolic “machine-like” murmur at the left upper sternal border. IV indomethacin would likely cause the murmur to ______ (disappear/persist), while IV prostaglandins would likely cause the murmur to ______ (disappear/persist).

Answer 15

disappear, persist

Question 16

A parent brings a 3 year-old to the clinic stating that the child sometimes develops respiratory distress and cyanosis during vigorous exercise. The child often squats during these episode, which seems to alleviate the symptoms. Which of the following findings do you least expect to find?

A) Aortic stenosis
B) Overriding aorta
C) Ventricular septal defect
D) Pulmonic stenosis

Answer 16

A) Aortic stenosis

Question 17

You are examining the gluteal cleft in a newborn. Which of the following findings is most concerning?

A) Lanugo
B) Mongolian spot
C) Sacral dimple
D) Nevus

Answer 17

C) Sacral dimple

Question 18

Which of the following is the strongest indication for serum lead testing in pediatric patients?

A) Medicaid insurance
B) Failure to thrive
C) Obesity
D) Hyperlipidemia

Answer 18

A) Medicaid insurance

Question 19

Which of the following screenings is most likely to be useful in the immigrant population, compared with non-immigrants?

A) Lead screening
B) TB screening
C) Lipid screening
D) Autism screening

Answer 19

B) TB screening

Question 20

Of the following screenings we learned about in pediatrics class, which is most likely to be done for the first time on a non-pediatric patient by a non-pediatric provider?

A) Blood pressure
B) STI
C) HIV
D) Cervical dysplasia

Answer 20

D) cervical dysplasia

Question 21

Sadie is a 2 year-old girl who asks her parents for “abba doos” (apple juice) pretty much constantly throughout the day. Which of the following would be the worst thing to tell the parents?

A) At this age, only about half of what Sadie says should be understandable by strangers so it’s ok that people don’t know what “abba doos” is.
B) At this age, we only expect Sadie to use two-word phases, so her speech seems developmentally appropriate.
C) It is best to avoid giving Sadie apple juice altogether, no matter how cute it is when she asks for it.
D) It’s best to give juice as a replacement for another serving of fruit, rather than in addition to it.

Answer 21

D) It’s best to give juice as a replacement for another serving of fruit, rather than in addition to it.

Question 22

Anticipatory guidance about drawer and cabinet locks would be most appropriate at which well-child visit?

A) 1 month
B) 6 months
C) 12 months
D) 18 months

Answer 22

B) 6 months

Question 23

A lethargic five week-old male presents with projectile vomiting. He is one ounce smaller than he was last week. Which of the following physical exam findings is most specific to this presentation?

A) Machine-like murmur at LUSB
B) Sausage shaped abdominal mass with hematochezia
C) Olive shaped mass in the RUQ
D) Sunken fontanelle

Answer 23

C) Olive shaped mass in the RUQ

Question 24

Which of the following ABG values is most consistent with pyloric stenosis?

A) ph 7.50, pCO2 35, HCO3 31
B) ph 7.30, pCO2 50, HCO3 24
C) ph 7.50, pCO2 28, HCO3 24
D) ph 7.30, pCO2 40, HCO3 18

Answer 24

A) ph 7.50, pCO2 35, HCO3 31

Question 25

An 8 month-old patient presents with diarrhea, abdominal distention, and poor weight gain in the past two months. He is afebrile. Which of the following historical factors might best explain these symptoms?

A) Introduction of gluten-containing cereals at 6 months of age
B) Introduction of peanut products at 6 months of age
C) Administration of DTaP vaccine at 6 months of age
D) Environmental lead exposure starting at 6 months of age

Answer 25

A) Introduction of gluten-containing cereals at 6 months of age

Question 26

An 18 month-old male presents with episodes of abdominal pain for the past day. His parents state that he draws his knees up during these paroxysms, and that they have begun to notice blood and mucus in the stool. Which diagnostic procedure is also likely to be therapeutic for this patient?

Answer 26

Barium or air enema

Question 27

An 8 year-old female presents with a 24 hour history of nausea, anorexia, and umbilical pain that migrated to the RLQ. She is febrile, and the WBC is elevated. Which diagnosis is highest on your differential?

Answer 27

Appendicitis

Question 28

An 18 month-old female presents with red stool that her parents describe as “brick colored”. The child does not seem to be in any pain. What is the most likely diagnosis?

Answer 28

Meckel’s diverticulum

Question 29

Which historical item is most useful in differentiating pyloric stenosis from malrotation?

A) Bilious vomit
B) Age of patient
C) Gender of patient
D) Growth chart trends

Answer 29

A) Bilious vomit

Question 30

A 6 year-old male presents with a sudden onset of dyspnea, sore throat, and fever to 104. You find the patient drooling and sitting in a tripod position. Given the presentation, which vaccine do you suspect the patient never received?

Answer 30

HiB