1.

Phototherapy for hyperbilirubinemia should be initiated in a newborn at 35 or more weeks of gestation when total serum bilirubin (TSB) is

29-48 hours (2 days) at >15 mg/dL

49-72 hours (3 days) at >18 mg/dL

72 hours (> 3 days) at >20 mg/dL

Or >5 mg/dL/day

2.

A premature infant develops abdominal distention and is very ill after initiation of feeding. What is the greatest concern?

Necrotizing enterocolitis (NEC): a diffuse necrotic injury to the bowel, which can result in perforation or subserosal collections of gas

3.

Juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis) is associated with what eye finding?

Uveitis

4.

Strep throat modified Centor criteria include what clinical findings?

• 
  

  Age (5-15 years)

  
  
• 
  

  Tonsillar exudates

  
  
• 
  

  Tender, enlarged (1 cm) anterior cervical lymph nodes (posterior chain nodes imply viral illness, most commonly mononucleosis)

  
  
• 
  

  Fever

  
  
• 
  

  Absence of cough and rhinorrhea

5.

What is the most common cause of amblyopia (decreased vision in one or both eyes due to abnormal development of vision in infancy or childhood)?

Strabismus (turn of the eye)

6.

Who develops NEC?

NEC is most commonly seen in premature infants in the first 3 weeks of life, but 10% of those who develop NEC are born at term.

7.

Nasal polyps are associated with what pediatric chronic pulmonary condition?

Cystic fibrosis

8.

A previously continent 6-year-old male has repeated stool soiling of his underwear. What condition needs to be addressed?

Constipation; encopresis is defined as repeated unintentional soiling of underwear and is commonly associated with functional constipation with severe stool retention and subsequent overflow incontinence.

9.

What is the most likely etiology of proteinuria in children?

Transient proteinuria that can be caused by fever, exercise, seizures, and/or hypovolemia

Orthostatic (postural) hypotension is a common cause of proteinuria in children, where protein excretion can be high with standing and return to normal when supine.

10.

What are the clinical features of a cephalohematoma?

Swelling of the scalp, with edema located below the periosteum of the skull that does not cross suture lines; it is caused by rupture of vessels during delivery.

11.

How is pediatric encopresis treated?

Initial fecal disimpaction with oral polyethylene glycol (PEG-3 350 (0.75 mg/kg/24 h) and behavioral modification (child to sit on toilet for defined amount of time (1 min/year of age to a maximum of 10 minutes) 1-2 times per day (ideally after a meal) and perform a Valsalva maneuver (blow into a pinwheel or a balloon to try to make them bear down). Should use a sticker/star chart to reward success. Diet should include high fiber and water, and elimination of all highly processed foods and sweetened foods and drinks.

12.

What is the difference between primary and secondary enuresis?

Primary nocturnal enuresis (NE) is most common; child/adult who has never established urinary continence on consecutive nights for a period of ≥6 months; secondary NE: resumption of enuresis after at least 6 months of urinary continence

13.

What is the natural course of a cephalohematoma?

Most will resolve by themselves in a few weeks

Complications include hyperbilirubinemia, calcification, infection

14.

What is caput succedaneum?

Swelling of the scalp, edema is located above the periosteum of the skull; findings can cross suture lines, and may or may not be bloody.

15.

What is a subgaleal hemorrhage?

Swelling is over the entire scalp, feels boggy and fluctuant. Edema is located between the periosteum of the skull and the aponeurosis.

Edema can cross the suture line; is bloody and caused by shearing of emissary veins during delivery

Risk of massive blood loss and mortality (12%-14%).

16.

What is Erb palsy?

“Waiter’s tip;” Upper brachial plexus injury due to injury during birth leaving the arm extended and hand palmar flexed. Examine for clavicular fracture.

17.

What is the most common cause of secondary enuresis?

Situational stress: family stress, depression, anxiety, social phobias, conduct disorder, hyperkinetic syndrome, internalizing disorders

18.

What is Klumpke palsy?

When a paralysis of the hand and wrist results in a claw hand; often with Horner syndrome (miosis, ptosis, anhidrosis)

19.

What are the physical exam findings of phimosis?

The inability to retract foreskin

20.

What is the common term for and clinical course of genu varum?

Bow-legged; usually resolves between 18-24 months.

21.

What is the common term for and clinical course of genu valgus?

Knock knees; usually resolves before age 10.

Physiologic genu valgus will see improvement over time, but pathologic valgus will typically worsen after age 4.

22.

What are the physical exam findings and clinical course of talipes equinovarus?

Clubfoot. Will not self-correct and patient should be referred to an orthopedic specialist.

Initial management includes manipulation and stretching of the foot.

23.

What are the physical exam findings and clinical course of metatarsus adductus?

The forefoot turns toward midline. Most will self-correct by age 2.

24.

What is transient tachypnea of the newborn?

Pulmonary edema in the newborn caused by delayed clearance and resorption of fetal lung fluid. More often seen in premature babies and babies born with cesarean sections. TTN often resolves in the first 48 hours of life.

25.

What are the common treatments for primary enuresis?

Simple behavioral interventions: (e.g., scheduled wakening, positive reinforcement, bladder training, diet changes). Encourage reduction of liquids intake in the hours prior to sleep; regular bedtime with full night’s sleep, scheduled voiding before bed, nightlights to light the way to the bathroom, reward system for dry nights. If all these fail, consider use of bed alarms or desmopressin (DDAVP).

26.

What are clinical features of transient tachypnea of the newborn?

Tachypnea (> 60 minutes) within the first 2 hours of delivery, which is self-limiting, and care is supportive.

27.

What speed is the acceptable newborn heart rate?

120-160 beats/min

28.

What is the normal newborn respiratory rate?

30-60 breaths/min.

29.

What are the common treatments for secondary enuresis?

Address stressors at home and at school. If constipation, use of PEG-3550. Behavioral interventions similar to primary enuresis (limiting late night liquids, bedtime toileting, etc.).

30.

In infants, what is the most common cancer?

Neuroblastoma

31.

What genetic condition is associated with meconium ileus in the newborn?

Cystic fibrosis

32.

A 12-month child who is less than 2 standard deviations from the mean for weight or whose weight for chronologic age is less than the 5th percentile has what condition?

Failure to thrive

33.

What pediatric condition is associated with prolonged fever, a nonexudative conjunctivitis, fissured lips, strawberry tongue, cervical adenopathy, and an erythematous polymorphous rash?

Kawasaki disease

34.

What is the female athlete triad?

Clinical syndrome of low energy availability (eating disorder +/- exercise expenditure greater than calories consumed), menstrual dysfunction (commonly amenorrhea due to low estrogen state), and low bone mineral density

35.

Prolonged jaundice in a newborn is suggestive of

Biliary atresia

36.

How can you differentiate between slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease?

By age. Legg-Calvé-Perthes (necrosis of femoral head): 4-10 years of age; SCFE adolescent boys over the age of 10 years. The two conditions have similar features, and include antalgic gait, resistance to internal rotation, and insidious onset.

37.

Erythema toxicum is commonly known as

Newborn acne

38.

In newborns, what time period should birth weight be regained?

2 weeks

39.

What are likely diagnoses if no passage of meconium occurs within 24 hours of birth?

Imperforate anus, Hirshsprung disease, or cystic fibrosis

40.

In exclusively breastfed infants, what is the only additional supplementation recommended?

Vitamin D supplementation of 400 IU/day

41.

What is a severe complication associated with Kawasaki disease?

Coronary artery aneurysm

42.

What infectious agent is the cause of a child’s low-grade fever, blotchy rash that appears on the cheeks (“slapped-cheek appearance”) that may spread to the extremities (sparing the palms and soles) in children?

Parvovirus B19 is the cause of fifth disease or erythema infectiosum.

43.

What physical exam findings support the diagnosis of female athlete triad?

(BMI) <17.5% kg/m²; bradycardia, orthostatic hypotension, hypothermia, cold extremities, lanugo, parotid gland enlargement or tenderness, epigastric tenderness, eroded tooth enamel, and knuckle or hand calluses (Russell sign)

44.

A 12-year-old male presents with a solitary red papule on his arm that has grown rapidly, formed a stalk, and bleeds with light contact. What is the likely diagnosis?

He likely has a pyogenic granuloma. They are benign, acquired, and solitary vascular proliferations that occur most often on the head and neck, the lips and oral cavity, the trunk, and the extremities. They are friable and bleed easily. They start as smooth, red to purple lesions that can be sessile or pedunculated and grow rapidly over several weeks.

45.

What is the treatment of choice for uncomplicated lice?

Malathion or permethrin

46.

What are the anthropometric findings in growth hormone deficiency (GHD)?

Children with GHD have short stature and drop off in height, then weight, then head circumference on the growth curve with >2.5 SD below mean (corresponds to <0.5 percentile) for height (for chronologic, age, sex, and background) and/or height velocity >2 SD below mean (corresponds to approximately <3rd percentile).

47.

What potentially allergenic compound is used to make the measles, mumps, and rubella (MMR) immunization?

Gelatin

48.

What is the workup when growth hormone deficiency (GHD) is suspected?

TSH for hypothyroidism, electrolytes (low bicarbonate levels may indicate renal tubular acidosis), CBC, ESR, karyotype (in females to rule out Turner syndrome) and radiograph of hand and wrist to determine skeletal age in children (GHD is effectively excluded in children with normal bone age and height velocity.)

49.

What diagnosis should be considered if the child has trismus (jaws clamped shut)?

Peritonsillar abscess

50.

All children between the ages of 2 and 24 months need further evaluation for their first febrile urinary tract infection with an

Ultrasound to evaluate the kidneys alone.

A voiding cystourethrogram (VCUG) to evaluate for vesiculoureteral reflux is NO LONGER recommended for first infection.

51.

A few days after eating deli meat at a picnic, a woman who gave birth a few weeks ago develops fever, watery diarrhea, nausea, headache, myalgias, joint aches with a severe headache, and stiff neck. What infection is most concerning for the infant?

Listeria, which has a high mortality rate in neonates, infants, and the elderly. It is extremely common in food supply: listeria recovered from 15-70% of raw vegetables, fish, meat, ice cream, and unpasteurized milk. Deli meats are the most common source of infection.

52.

What are the most common causes of pneumonia in children between ages 5 and 15 years?

Mycoplasma pneumoniae

Streptococcus pneumoniae

Chlamydia pneumoniae

Viruses are still a major cause.

53.

A 17-day-old male presents with decreased feeding; rectal temperature is 100.8° Fahrenheit. Can this child be managed as an outpatient?

No, admission with a septic workup and empiric antibiotics are necessary.

54.

Forward-facing child car seats are appropriate for children at what age?

Forward-facing child car seats are appropriate for children aged 2 up to at least age 5, or when they reach the upper weight or height limit of that seat.

55.

What is the most common cause of pneumonia in children under age 5?

Viruses. In older infants and up, respiratory syncytial virus is the main viral pathogen.

56.

What antibiotics should be used to empirically treat neonatal fever?

Ampicillin and a third generation cephalosporin; the common bacterial causes include Group B Streptococcus, Escherichia coli, Listeria monocytogenes, coagulase-negative Staphylococcus, and Treponema pallidum. The ampicillin is needed to cover the listeria.

57.

What is the treatment for scabies in children over age 5 years?

5% permethrin cream

58.

A newborn has a loud systolic heart murmur heard at the left upper sternal border. What is the likely diagnosis?

This child likely has a patent ductus arteriosus (PDA). If it is persistent PDA after 3 months, it is considered pathologic and should be evaluated for closure.

59.

What infection is related to exposure to reptiles?

Pet-associated salmonellosis

60.

The appearance of a varicocele on the right side or a varicocele that persists in a supine position is suggestive of

Inferior vena cava (IVC) obstruction due to abdominal or retroperitoneal mass, kidney tumors, IVC or renal vein thrombosis.

61.

By what age will flat feet correct spontaneously in children?

One year of age

62.

What is the diagnosis when a 7-year-old female develops breast buds and pubic hair?

Precocious puberty; it is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys; it is more common in females than males.

63.

Fluoride supplementation is recommended for

Preschool children over the age of 6 months. If water not fluorinated, doses include

6 months-3 years: 0.25 mg/day

3 years-6 years: 0.50 mg/day

6 years-18 years 1.0 mg/day

64.

What condition is associated with projectile vomiting after eating and poor weight gain in fullterm male infants? What color do you expect the vomit to be?

Pyloric stenosis.

Vomit should be nonbilious as the stenosis is located at the pylorus, and above the ampulla of Vater (second part of the duodenum) where bile is released.

65.

What is the most common cause of death in ages 1-12 months of life?

Sudden infant death syndrome (SIDS)

66.

How should febrile seizures be treated?

Antipyretics

67.

“Swimming pool” folliculitis is associated with what organism often found in pools?

Pseudomonas aeruginosa

68.

What are the risk factors for SIDS?

Prone and side sleep positions, overheating from heavy clothing and bedding, soft bedding, bed sharing; parental smoking, alcohol, and drug use

69.

What noninvasive test should be done in children with acute respiratory distress?

Pulse oximetry

70.

What conditions are associated with a “strawberry tongue?”

Kawasaki disease and scarlet fever

71.

A 3-year-old African American male has a left flank mass on exam. What is the most concerning etiology?

Wilms tumor (nephroblastoma): most common kidney tumor of childhood; African Americans have a greater risk.

72.

Describe the rash in Kawasaki disease.

Erythematous rash that starts at the trunk and spreads to extremities; hands and feet may be swollen and painful.

73.

Describe the rash in scarlet fever.

Sandpaper rash, with small papules

Rash starts in skin folds, like the neck, axilla, and the groin.

74.

How should a young child be positioned to examine the perineum?

Knee-chest position

75.

Palpable purpura is a common presenting sign of what illness?

Henoch-Schonlein purpura (HSP); nearly all patients of HSP have palpable purpura.

76.

What is the classic tetrad for Henoch Schonlein purpura?

• 
  

  Palpable purpura without thrombocytopenia and coagulopathy

  
  
• 
  

  Arthritis/arthralgia (second most common feature after purpura)

  
  
• 
  

  Abdominal pain, colicky

  
  
• 
  

  Renal disease—nephritic syndrome secondary to IgA vasculitis

77.

A 12-year-old male is found to have an enlarged liver and brownish rings surrounding his iris. What is the likely diagnosis?

Wilson disease; an autosomal recessive defect in copper excretion resulting in liver deposition and Kayser-Fleischer rings in the eyes

78.

Tibial tubercle enlargement and pain with activity in an adolescent is most likely what diagnosis?

Osgood-Schlatter disease

79.

In prepubescent females, what is the first line of treatment for labial adhesions?

Topical estrogen

80.

An infection with parvovirus B19 in a child with sickle cell anemia can lead to

Aplastic crisis

81.

What is the antibiotic of choice for uncomplicated acute otitis media (AOM)?

High dose amoxicillin (80-90 mg/kg/day)

Streptococcus pneumoniae is the most common bacterial cause of AOM and includes variants with antibiotic resistance.

82.

What is the most common infection to cause acute glomerulonephritis in children?

Acute streptococcal throat or skin infection

83.

Flesh-colored domeshaped papules between 2 and 5 mm with central indentation suggest

Molluscum contagiosum, a viral infection in the poxvirus family

84.

Which headache type is most common in children?

Migraine

85.

What organisms are associated with external otitis?

External otitis, also known as “swimmer’s ear, is most often associated with Pseudomonas aeruginosa (most common), Staphylococcus epidermidis, and Staphylococcus aureus.

86.

New onset hip pain with a negative x-ray in a child suggests

Transient synovitis, a self-limiting condition that resolves on its own between 1 and 4 weeks.

If hip pain persists, then evaluate for Legg-Calve-Perthes disease, as its early stages will not show up on radiograph.

87.

What is the antibiotic of choice for complicated AOM?

Augmentin (amoxicillin-clavulanate)

Children presenting with AOM with purulent conjunctivitis, children with a history of recurrent AOM, and recent use of β-lactams (higher risk of antibiotic resistance) should receive this.

88.

A 3-year-old boy who has had a cold and fever for the last day has a generalized seizure lasting 2 minutes; he is now fine and exam is normal. What is the likely diagnosis?

Febrile seizure; if the patient has pointing neurologic signs, has a repeat seizure within 24 hours, or if the seizure lasts more than 15 minutes, more aggressive work up is needed, including a lumbar puncture (LP).

89.

Anaphylaxis including hypotension and respiratory distress due to an insect sting is best treated with what agent?

Systemic epinephrine

90.

Where should a pulse be obtained in a child under age 1 year?

Brachial pulse

91.

What syndrome is associated with a thin upper lip, a smooth philtrum, flat nasal bridge, growth retardation, clinodactyly (curved digit), and central nervous system (CNS) abnormalities?

Fetal alcohol syndrome

92.

Paroxysms of severe coughing with an inspiratory whoop are associated with what preventable infectious disease?

Pertussis (“whooping cough”)

93.

Regarding the routine screening of asymptomatic adolescents for idiopathic scoliosis, the United States Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians has recommended

Against routine screening

94.

Henoch-Schonlein Purpura (HSP) is the most common vasculitis of childhood which rarely causes what organ system to fail?

Renal system failure

HSP is an immunoglobulin A vasculitis that causes nephritic syndrome and can lead to renal failure.

95.

A 10-year-old female presents with 2 days of sore throat, fever, and now bilateral knee pain. What is the likely diagnosis?

Acute rheumatic fever (large joint arthritis, carditis, heart valve disease, an erythema marginatum rash, subcutaneous nodules, chorea) is related to a recent group A strep infection.

96.

When pertussis is diagnosed, how should close contacts be treated?

Post-exposure prophylaxis (macrolide) and nasopharyngeal specimen regardless of symptoms

97.

What malignancies are associated with Down syndrome?

Acute myeloid or lymphoblastic leukemia; Testicular cancer

98.

In a patient with egg allergy, which vaccine should be used with caution?

Both inactive and live attenuated influenza vaccine (LAIV) contain trace amounts of egg; they may be used with caution as the amount of egg exposure is considered not significant.

99.

A male is born with a hypospadias; is this a contraindication to circumcision?

Yes, contraindications for immediate circumcision include prematurity, genital anomalies, and bleeding disorders.

100.

What is the mechanism of action of benzoyl peroxide?

Benzoyl peroxide is an antibacterial drug that acts by releasing free radical oxygen. It is useful in treating inflammatory acne.

101.

Indication for the human papilloma virus (HPV) recombinant vaccination includes what population?

Females and males aged 9-26 years

102.

Cyclical abdominal cramping in the absence of menstrual blood flow in an adolescent female who is otherwise fully developed suggests what diagnosis?

Imperforate hymen

103.

How is the diagnosis of pertussis confirmed?

Polymerase chain reaction (PCR) obtained from a nasopharyngeal swab

104.

What is the most common cause of visual impairment in children?

Amblyopia (visual loss due to decreased input, often from strabismus [lazy eye])

105.

What class of oral antibiotics should be avoided until after adolescence?

Fluoroquinolones

106.

Severe conjunctivitis, keratitis, and visual loss are associated with what infection?

Herpes infections

107.

What medication, if administered to a patient with infectious mononucleosis, may cause a maculopapular, petechial, or urticarial rash?

Ampicillin (or amoxicillin)

108.

A 4-year-old male presents with a fever (101°F) and sore throat. There is no cough or rhinnorhea. His exam finds tonsillar exudates and painful anterior cervical lymphadenopathy. What is the most likely diagnosis?

Streptococcal pharyngitis

109.

An infant presents with excessive tearing and a swelling of the tear duct; what is the likely diagnosis?

Congenital dacryostenosis or congenital nasolacrimal duct obstruction, which usually self-resolves by 6 months of age. Treatment consists of milking the lacrimal sac.

110.

The development of a “herald patch” on the trunk followed by generalized eruption of salmon-colored lesions in a Christmas tree pattern is associated with what skin condition?

Pityriasis rosea

111.

A teenage female shows you a rash on the external surface of her proximal arms that are small papules of keratin with a sandpaper-like feel; what is the likely diagnosis?

Keratosis pilaris; an abrasive (“sandpaper-like,” “chicken skin-like,” or “goose bump-like”) texture of the skin is caused by excess buildup of keratin. Treatment includes lactic acid 12% creams/lotions or topical 40%-50% urea.

112.

Screening of vision in young children is designed to identify patients with what condition that causes reduced visual acuity without an identifiable organic lesion of the eye.

Amblyopia; a functional reduction in visual acuity due to abnormal visual development. It has three etiologic classes: strabismus, refractive errors, and deprivational loss from congenital defects (i.e., congenital cataracts, ptosis, congenital corneal opacities, vitreous hemorrhage).

113.

What tests can be used to detect strabismus (ocular misalignment) in children under the age of 1 year?

The cover test and the corneal light reflex test

114.

Screening for visual disorders (amblyopia, strabismus, and defects in visual acuity) is recommended in children of what age?

Less than 5 years of age

115.

Severe sore throat, fever, tonsillar exudates, and posterior chain lymphadenopathy is associated with what infection?

Infectious mononucleosis

116.

Petechiae on the palate of a child or teen is associated with what infections?

Streptococcal pharyngitis and mononucleosis

117.

What are the major complications associated with strep throat?

Acute rheumatic fever and post-streptococcocal glomerulonephritis

118.

A child who presents with a toxic appearance, muffled voice, fluctuant tonsils, and uvular deviation has what condition?

Peritonsillar abscess

119.

Why should children under 1 year of age avoid honey?

Honey may contain Clostridium botulinum which, in the immature intestine, can result in neurotoxicity.

120.

Acute conjunctivitis is most commonly caused by which virus?

Adenovirus

121.

What are the most common causes of bacterial conjunctivitis in children?

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Staphylococcus aureus is another cause but is more often seen in adults.

122.

Café-au-lait spots are common macular hyperpigmented lesions in children; if more than 6 are present, what condition should be considered?

Neurofibromatosis type 1

123.

What are the cardinal features associated with Marfan syndrome?

Aortic root dilation and ectopic lentis (dislocation of ocular lens)

124.

A tall young male presents for a new visit; he has an arm span that exceeds his height, a high-arched palate, pectus excavatum, and hyperextensibility of joints. What condition needs to be investigated?

Marfan syndrome is an inherited connective tissue disorder with unique physical characteristics including an arm span that exceeds height, arachnodactyly (“spider fingers” long thin fingers), ocular lens disorders, a high-arched palate, pectus excavatum, and hyperextensibility of joints.

125.

Hypextensibility of joints, stretchy skin, multiple joint dislocations, bruises, and poor wound healing should raise suspicion for

Ehlers-Danlos syndrome

126.

What is the treatment of choice for children less than 2 years of age with nasal congestion?

Saline nose drops and rubber suction bulbs; over-the-counter decongestants should not be used.

127.

What is the most common cause of fecal incontinence in children?

Functional constipation

128.

An infant presents with long delays between bowel movements that are often large and hard; what are the organic causes of constipation in children?

Cystic fibrosis (constipation presents in infancy), Hirschsprung disease (presents in infancy), celiac disease, hypothyroidism. Older children may develop constipation from lead poisoning, developmental delay, abuse, medication side effects.

129.

A teen presents with “flashes of light,” decreased night vision, and loss of peripheral vision fields. What common inherited condition can cause blindness by age 30?

Retinitis pigmentosa is an inherited condition that causes night blindness due to degeneration of rods resulting in decline of night vision, followed by progressive loss of peripheral fields. It affects 1 in 4,000 people in the United States.

130.

In early childhood development, at what age should children know the basic colors and be able to articulate most words?

4 years of age

131.

At what age should a male with an undescended testicle be referred for urologic evaluation?

Referral should occur if the testicle remains undescended after 6 months, with the plan to repair if it does not descend before 24 months of age.

132.

A child is found to have an absent testicle; at what age should orchiopexy be performed?

Before 24 months of age

133.

What test is used to diagnose testicular torsion?

Ultrasound

134.

In a child with short stature, delayed bone age is found. What conditions should be considered?

A systemic or metabolic disorder (i.e., hypothyroidism)

135.

What are the signs and symptoms of growth hormone deficiency?

Poor height velocity, slower muscular development, and delayed gross motor milestones (standing, walking, jumping)

136.

A 2-year-old presents a few days after resolution of an upper respiratory tract infection (URI) with sudden onset of severe intermittent (colicky) abdominal pain characterized by drawing the legs up to the abdomen and crying. What condition should be of concern?

Intussusception

137.

At what age do frontal sinuses develop in children?

Frontal sinuses develop around age 10; frontal sinusitis is unusual before age 10.

138.

What diagnostic tools are used in the diagnosis of attention deficit hyperactivity disorder?

Vanderbilt Assessment Scale and the Conners

Comprehensive Behavior Rating Scales

139.

A young child complains of leg pain only during the night; what signs and symptoms are consistent with “growing pains?”

1. 
   

   The leg pain is bilateral and there is no arthritis.

   
   
2. 
   

   The pain occurs only at night.

   
   
3. 
   

   The child has no limp, pain, or symptoms during the day.

140.

What are the common organisms associated with peritonsillar abscess?

Often polymicrobial organisms, including Streptococcus pyogenes (group A β-hemolytic Streptococcus), Streptococcus anginosus, Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus [MRSA]), and anaerobes

141.

In addition to inflamed joints, what are the other features of juvenile idiopathic arthritis?

High “quotidian” fevers (pattern of daily fever spikes and spontaneous return to normal temperature), macular salmon pink rash, uveitis

142.

A child comes in with > 6 weeks of joint swelling, restricted range of motion, warmth, redness, or pain. What is the likely diagnosis?

Juvenile idiopathic arthritis; lab evaluation will likely show leukocytosis, thrombocytosis, and anemia, elevated ESR or CRP, elevated ferritin.

143.

What is the most common cause of diffuse, chronic abdominal pain in a child?

Functional gastrointestinal disorder (FGID); ROME criteria include functional abdominal pain at least 25% of the time and one or more of the following:

• 
  

  Some loss of daily functioning

  
  
• 
  

  Additional somatic symptoms such as headache, limb pain, or difficulty sleeping

144.

Under what conditions can a child start using an adult seat belt?

When the seatbelt fits properly, i.e., when the lap belt fits over proximal thighs (not stomach) and upper belt fits across the chest (not the neck)

145.

What are the criteria for children to use booster seats?

From age 5 years until the lap and chest seatbelts fit properly

146.

A local elementary school has an outbreak of vomiting in the student body. What virus is the likely cause?

Rotavirus, often presenting with vomiting

147.

Early sexual activity and childbirth is associated with what outcomes?

Academic deficiencies, lower socioeconomic outcomes, repeat pregnancy, and tendency to single parenthood

148.

What are the first objective signs of puberty in girls?

Rapid increase in height, then the development of breast buds

149.

What are the first objective signs of puberty in boys?

Testicular enlargement followed by the appearance of pubic hair, enlargement of the penis, and development of sperm

150.

An upper GI series shows a “bird’s beak” sign in a child. What is the most likely diagnosis?

Midgut volvulus secondary to malrotation around the superior mesenteric artery

151.

What are the health risks of bottle feeding at bedtime?

Dental caries

152.

Most otitis media is caused by viral infections. What bacteria commonly cause AOM?

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

153.

What are the risks of elevated serum lead levels in children?

Lead toxicity can cause developmental delay, language delay, intellectual disability, behavior issues, hearing loss, and encephalopathy at high levels.

154.

The parent of a bottle-fed infant asks how much formula the baby needs. How many ounces per day does the baby need?

Generally, a term infant needs 2.5 oz/lb/day.

Formula contains 20 cal/oz.

155.

Significantly elevated bilirubin levels lead to

Kernicterus

156.

What hip condition affects previously healthy overweight adolescent boys and presents with antalgic gait and resistance to internal rotation of the hips?

Slipped capital femoral epiphyses (SCFE): chronic pain with insidious onset in boys between ages 10 and 16 years. Antalgic gait results from hip pain caused by displaced capital femoral epiphysis from the femoral neck. Pain will occasionally refer to the knees.

157.

What oral medication is used for the treatment of tinea capitis?

Oral griseofulvin or oral terbinafine, as topical treatment of tinea capitis is not effective.

158.

What clinical finding is the most common presenting finding associated with Hodgkin lymphoma?

Painless lymphadenopathy in the neck that feels rubbery and firm

159.

What bacteria is the focus of treatment in adolescent acne?

Propionibacterium acnes

160.

What condition is associated with a child who has academic performance below IQ, being forgetful or a “daydreamer,” and a characteristic 3-Hz generalized spike-and-slow wave pattern on EEG?

Absence seizures

161.

Idiopathic avascular necrosis of the femoral head in a young child is also known as what condition?

Legg-Calve-Perthes disease

162.

Where is lymphadenopathy found in infectious mononucleosis?

Posterior cervical chain

163.

To prevent hemorrhagic disease of the newborn, what medication is given at birth?

Vitamin K, 0.5-1 mg administered intramuscularly

164.

For mild to moderate croup, what treatment is effective in lowering the risk of progression and intubation?

Dexamethasone

165.

What is the antidote of choice for iron poisoning?

Deferoxamine

166.

What clinical manifestations are associated with Down syndrome?

Flattened midface with depressed nasal bridge, slanted palpebral fissures, epicanthic folds, low set ears, single palmar crease, hypotonia, poor Moro reflex, dysplasia of mid phalanx of fifth finger, excessive skin at nape of neck, hyperflexibility of joints, dysplasia of pelvis, Brushfield spots (gray to white spots around the periphery of the iris), intellectual disability, short fingers

167.

What macular rash begins on the chest, moves to extremities, and converts to crops of vesicles on erythematous bases (“dewdrops on a rose petal”)?

Varicella (chickenpox)

168.

What illness begins initially with a macular rash that becomes vesicular and occurs on the palms of the hands and plantar aspects of the feet?

Hand-foot-and-mouth disease caused by coxsackievirus. The illness typically has a 1-day prodrome of fever, anorexia, malaise, abdominal pain, and upper respiratory symptoms.

169.

What infection may induce fetal hydrops in a pregnant woman?

Erythema infectiosum

170.

An infant presents with an erythematous diaper rash that involves the skin folds and has “satellite lesions” is most likely caused by what organism?

Candida albicans

171.

A diaper rash that is erythematous and prominent on the convex surfaces but spares the skin folds is most likely what kind of rash?

Irritant dermatitis

172.

What do clinical manifestations of Kawasaki disease include?

High fevers minimally responsive to antipyretics and unexplained source lasting 5 days or more, nonexudative conjunctivitis, lip cracking and fissuring, strawberry tongue, cervical lymphadenopathy, arthralgias, exanthema, redness and swelling of the hands and feet, can include palms and soles

173.

In a child with Kawasaki disease, what organ system complication is most worrisome?

Coronary artery aneurysm is the main complication. However, myocarditis, pericarditis, valvular heart disease, and coronary arteritis, acute MI, arrhythmia, and death can also occur. Coronary artery thrombosis is the leading cause of death in Kawasaki disease (and why aspirin is prescribed).

174.

With premature infants, what modifications need to be made to the immunization schedule?

Standard immunization schedule should continue just like a full-term well baby. The only exception is the Hepatitis B vaccine, which should be delayed by 1 month.

175.

A child is seen in the Emergency Department with a spiral fracture and multiple injuries in different stages of healing. What diagnosis should be considered?

Child abuse

176.

Coarctation of the aorta will be suggested by what finding on chest x-ray?

Rib notching on a chest radiograph is suggestive of coarctation of the aorta.

177.

What are the common complications of cystic fibrosis?

Meconium ileus present at birth, chronic cough and wheezing with copious mucus production, pancreatic insufficiency, insulin-dependent diabetes mellitus, retarded growth, and infertility

178.

In a child with concerning clinical features, what test is used to diagnose cystic fibrosis?

Sweat chloride test

179.

A young adult with a cough who develops pleuritic chest pain, but without rales on exam is suspicious for Mycoplasma infection. What antibiotic should be used first line?

A macrolide antibiotic

180.

Why does the AAFP and the AAP recommend withholding whole milk to infants younger than 1 year of age?

It may induce iron deficiency anemia.

181.

A 5-year-old keeps waking at night complaining of rectal itching; you suspect pinworms (Enterobius vermicularis). What are the treatment options for pinworms?

Albendazole, mebendazole, or pyrantel pamoate (over the counter)

182.

What condition in a child under 4 years of age is associated with farm animal contact or eating undercooked chicken, resulting in bloody diarrhea?

Campylobacter infection

183.

An infant has a “C shaped” foot, with medial deviation (adduction) of the distal foot while the hindfoot remains in a normal position forming a concavity of the medial aspect of the foot. What is the likely diagnosis?

Metatarsus adductus is the most common congential foot abnormality in children.

184.

An unvaccinated child presents with some respiratory distress and an unusual inspiratory “whoop.” What is the likely diagnosis and treatment?

This child likely has whooping cough caused by a Bordetella pertussis infection, which is treated with a macrolide antibiotic.

185.

What is the drug of choice for the treatment of impetigo with a small number of lesions?

Topical mupirocin

186.

The parents of an infant with an umbilical hernia are concerned and want him to have surgery. What should you tell them about the natural course of umbilical hernias in children?

Umbilical hernias found in infancy most often resolve by 1 year of age.

187.

A delay in growth and development that patterns after parental growth and development suggests what condition?

Genetic short stature

188.

In children, what is the most common malignancy?

Acute lymphoblastic leukemia (ALL)

189.

When should ironfortified cereals be the first solid food introduced to young infants?

Between 4 and 6 months of age

190.

In a very premature infant, what is the danger of excessive oxygen administration?

Retinopathy of prematurity (ROP)

191.

For children with cradle cap, what is the treatment of choice?

1% hydrocortisone cream

192.

What congenital feature found in young boys increases the risk of recurrent urinary tract infections?

Posterior urethral valves

193.

A 16-year-old boy presents with a rash on his back that follows a “Christmas tree” pattern that began as a pink macular spot. What is the likely condition?

Pityriasis rosea

194.

What is the next course of treatment for a 9-year-old female with asthma who has 4 days of wheezing despite using her rescue inhaler every 4 to 6 hours with only temporary improvement?

Oral steroids

195.

Lower leg pain in an athlete that resolves with rest with tenderness over the middle to distal third of the tibia is consistent with what?

Medial tibial stress syndrome (shin splints)

196.

Lower leg pain in an athlete that gets worse with exercise who cannot hop 10 times on the affected leg due to pain needs testing for what condition?

Stress fracture; x-ray may not turn positive until >2 weeks of pain.

197.

In January, you see a 5-month-old male with fever, cough, runny nose, and wheezing. What is the likely infection?

Bronchiolitis caused by respiratory syncytial virus (RSV)

198.

A 2-year-old male presents with a barky cough and stridor with slight retractions; his cough was preceded by 2 days of mild cold symptoms. What is the likely diagnosis?

Croup, caused by parainfluenza virus; treatment includes dexamethasone and if concerned, epinephrine.

199.

What organism causes hand-foot-and-mouth disease?

Coxsackievirus A16

200.

By what age should the anterior fontanel close?

12 months of age

201.

A 5-year-old internationally adopted male presents with drooling and difficulty breathing; lateral neck x-ray shows a “positive thumb sign.” What is the likely diagnosis?

Epiglottitis

202.

A 13-year-old male presents with unilateral breast tenderness; the remainder of his exam is normal. What is the likely diagnosis?

Benign gynecomastia of adolescence; treatment involves reassurance, and encouragement to not repeatedly irritate the breast.

203.

A 3-year-old male presents with a unilateral purulent, malodorous, and bloody nasal discharge. What is the likely cause?

A foreign body

204.

On the 12-month visit, you notice a child has femoral anteversion (“toeing-in”). What treatment should be initiated?

Observation; most cases resolve by age 8 years.

205.

Parents report their child wakes at night screaming, with eyes open, but seems unable to see and appears scared and confused. What is the likely diagnosis?

Night terrors are associated with these symptoms and are related to a child not getting enough sleep or having fever. It occurs in Stage 3 and 4 of nonrapid eye movement (NREM) sleep.

206.

An under-immunized child presents with URI symptoms including a cough, bilateral conjunctivitis, and runny nose. His exam is significant for an erythematous rash that begins at the neck, and small white spots on an erythematous base on the buccal mucosa. What is the likely diagnosis?

Measles. The oral findings are Koplik spots, pathognamonic signs of measles (rubeola).

Other symptoms of measles include the three Cs (cough, coryza, conjunctivitis), high fever, and a maculopapular rash.

207.

What is a chronic pruritic superficial inflammation of the skin with a relapsing and remitting pattern, also affecting the antecubital and popliteal fossa called?

Atopic dermatitis

208.

“Currant jelly” stool is suggestive what diagnosis?

Intussusception

209.

A child that “walks” his hands and arms forward to assist in rising from a sitting position is associated with what condition?

Duchenne muscular dystrophy

This pattern of movement is the Gower sign, and occurs due to diminished hip and thigh muscle strength from the disease.

210.

What is the mechanism of injury associated with “nursemaid’s elbow?”

Subluxation of the radial head past the annular ligament when a child’s fully extended arm is pulled in an upward direction. The annular ligament becomes trapped in the radiohumeral joint.

211.

What is the most common malignant pediatric bone tumor?

Osteosarcoma

212.

Chronic unilateral limb pain that awakens a child from sleep suggests what diagnosis?

Osteosarcoma

213.

Patellofemoral syndrome most commonly presents with what clinical signs?

Chronic diffuse anterior knee pain that worsens with squatting, running (especially downhill), stairs, and getting up from a chair after sitting for some time

214.

Patellofemoral syndrome responds to rehabilitation of what muscle group?

Quadricep muscles

215.

Isotretinoin requires monitoring of what blood tests?

Pregnancy (is a teratogen), LFTs, lipids

216.

The most common cause of occult bacteremia in children?

Streptococcus pneumoniae

217.

How does a child with occult bacteremia present?

Relatively well-appearing young child (usually < 3 years) with high fevers (≥ 39°C) and unknown source.

218.

What vaccination should not be given at the same time as varicella as it may decrease the effectiveness of the varicella vaccine?

MMR vaccine

219.

What are the most common organisms associated with periorbital cellulitis in vaccinated children?

Staphylococcus aureus, Streptococcus pneumoniae

220.

What diagnosis presents with a lack of attachment to others, preoccupation with inanimate objects, avoidance of eye contact, resistance to change, outburst of temper, repetitive often self-destructive acts, and delayed speech development?

Autism

221.

On routine newborn exam, a painless cystic structure is found in the scrotum that transilluminates. What is the likely diagnosis?

Hydrocele, a collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis; Most hydroceles seen in newborns resolve during the first year of life.

222.

What is the most common pediatric immunodeficiency?

IgA deficiency

223.

Head lice is passed on by what mode of transmission?

Person-to-person contact

224.

What is the drug of choice for treating dog bites?

Amoxicillin-clavulanate (Augmentin)

225.

What percentage of females are believed to be sexually assaulted or abused by age 18?

12%-25%

226.

A 1-month-old infant presents with cyclic paroxysms of crying, abdominal pain, and irritability that is difficult to console and resolves on its own by age 4 months. What is the likely diagnosis?

Infant colic

227.

Pediatric fluid resuscitation for an emergent situation should be treated with what fluid and bolused at what rate?

20 mL/kg of lactated Ringer solution or 0.9% sodium chloride solution rapidly infused intravenously

228.

Amblyopia is a reduction in visual acuity because of abnormal visual development in the absence of a structural or pathologic abnormality of the eye, not correctable by eyeglasses or contact lenses. How is this treated?

Glasses and patching

A patch is placed over the normal preferred eye, forcing the use of the suppressed eye.

229.

How is pseudostrabismus diagnosed?

Symmetric corneal light reflex

230.

Who should be screened for sexually transmitted infections (STIs)?

Sexually transmitted diseases including gonorrhea and chlamydia should be screened for in sexually active women age 24 years and younger and in older women who are at increased risk for infection; for men, evidence is lacking, but screening is encouraged.

231.

What are the discharge criteria for a premature infant from the neonatal unit?

1. 
   

   Body temperature is maintained.

   
   
2. 
   

   Weight gain of 10-30 g/day is achieved.

   
   
3. 
   

   No medications require hospital management.

   
   
4. 
   

   No major changes in medications or oxygen administration have occurred.

   
   
5. 
   

   No recent episodes of apnea or bradycardia have occurred.

232.

Impetigo is caused by what organisms?

Staphylococcus aureus is the primary pathogen. Group A β-hemolytic Streptococcus is less common but can also cause impetigo, at times, in combination with S. aureus.

233.

In young athletes, what is the most common cause of sudden cardiac death?

Hypertrophic cardiomyopathy

234.

What type of murmur should suggest hypertrophic cardiomyopathy?

A systolic ejection murmur at the left upper sternal border that increases in intensity with a Valsalva maneuver

235.

An erythematous wheal with a central papule that comes and goes in newborns is called

Erythema toxicum

236.

What is the thin yellow fluid that presents in the mother’s breast before and for a few days after birth called?

Colostrum

237.

What components in colostrum are important to a baby’s health?

Colostrum is a high-calorie and high-protein substance containing maternal antibodies.

238.

What are the five criteria used when calculating an Apgar score?

Color, heart rate, respiration, reflex response, and muscle tone

239.

With a pertussis infection, what are the three stages and their implications?

Catarrhal stage: Sneezing, lacrimation, coryza, hacking cough especially at night, fever is rare. Lasts 1 to 2 weeks. Antibiotics may shorten illness and infectious state.

Paroxysmal stage: Cough increases in severity, 5-15 consecutive coughs occur in a single expiration followed by a “whoop”—a hurried deep inspiration—and copious amounts of mucus may be expelled. Can last between 2 and 8 weeks. Antibiotics provide no benefit to the patient.

Convalescent stage: Cough starts to improve, paroxysms not as frequent or severe, patient looks and feels better. Lasts from a few weeks to months.

240.

What condition may occur from aspirin use in children with respiratory infections?

Reye syndrome

241.

What is the most common type of child abuse?

Neglect is most common (˜75% of abuse) and includes physical neglect (not providing basic necessities such as food and clothes), medical neglect (not meeting basic medical needs), emotional neglect (lack of support, security, encouragement), and educational/developmental neglect (not providing experiences to promote education).

242.

What is a common cause of unilateral heel pain in a 13-year-old male that has come on gradually over the last few weeks, and hurts now with activity and with rest?

Sever syndrome: an inflammation of the calcaneal growth plate, typically occurring in teens who are active. Symptoms resolve on their own when the activity is lessened or the growth plate closes.

243.

A 4-year-old presents with 2 months of arthralgias, fever, fatigue, malaise, myalgias, weight loss, morning stiffness, and rash. What condition needs to be ruled out?

Juvenile rheumatoid arthritis

244.

What is the initial treatment for Kawasaki disease?

IVIG and aspirin

245.

What is the most common gastrointestinal (GI) complication associated with Henoch Scholein purpura?

Intussusception

246.

What factor increases the risk for AOM?

Age is the greatest risk factor. AOM peaks between 6 and 18 months and declines in schoolage children and adolescents. Other factors include

• 
  

  Attendance at day care centers

  
  
• 
  

  Lack of or limited breastfeeding

  
  
• 
  

  Exposure to cigarette use

  
  
• 
  

  Race and ethnicity—Native American, Alaskan/Canadian Eskimo descent, indigenous Australian children

247.

What test should you perform in office for a child with proteinuria?

A negative dip stick on first morning voided specimen can rule out pathologic causes of pediatric proteinuria.