Peds Clerkship Review
questions
A 1-week-old baby is brought to the ED for worsening vomiting for the last day. Baby has
been vomiting almost every feed and some episodes the vomitus is green in color,
although most have been white. He was born full-term and had an uncomplicated
pregnancy and delivery. Was observed in the Nursery for 24 hrs and discharged. Vitals
show temp of 100.0 F, HR 180/min, RR 30/min, and BP is 65/40. He appears lethargic with
abdominal distension and appears to be tender to palpation. On rectal exam, gross blood is
noted. An upper GI series with barium contrast is done and is shown. Which of the
following events most likely explains the patient’s presentation?
a) Failure of proximal bowel cannulization
b) Abnormal migration of ganglion cells in the colon
c) Abnormal rotation of the bowel during development
d) Occlusion of a segment of small bowel intestinal lumen
e) Abnormal exocrine secretion from the pancreas
A 3yo F is brought to the ED for progressively worsening cough for the last 10
days. She has coughing spells which last for about 2-3 minutes at a time. The
patient occasionally vomits following the episodes of cough. Lungs are clear to
auscultation; you notice the patient has a runny nose and hear a “whoop”
sounding cough. No report of fever at home. Vitals are normal, and the patient
is generally well-appearing otherwise. She has shown ability to drink in the ED
without vomiting. There is a new 2-month-old baby in the home. What is the
best next step in management?
a)
b)
c)
d)
e)
Providing oxygen for comfort to the patient
Vaccination of the patient
Antibiotic administration to the baby
Counseling the family to separate the two siblings in the home
Hospitalize the patient due to risk of dehydration or worsening respiratory
status
A 4-year old boy presents with periorbital swelling and abdominal distension with fluid-wave
5 days after recovering from an upper respiratory infection with sore throat. Vitals are
normal, and on exam breath sounds are diminished on the right side. Labs show:
WBC 5000
Hgb 11.5
Na+ 130, K+ 4.3, Cl- 110, CO2 22, glucose 100
BUN 6, Cr 0.5
Plts 250k
UA shows 4+ protein, no RBCs/WBCs/casts/glucose/ketones/leukocyte esterase/nitrites.
What is the most likely diagnosis?
a) Minimal change disease
b) Focal and segmental glomerulosclerosis
c) IgA nephropathy
d) Post-infectious glomerulonephritis
e) Lupus nephritis
A 7-month-old female is brought to the physician for fever. Urinalysis
shows 30-50 WBCs/hpf, positive leukocyte esterase and nitrites and
Urine Culture grows Klebsiella pneumoniae. Looking back her records,
you see she had a febrile UTI 3 months ago and renal ultrasound was
done which showed normal kidneys. She was treated with antibiotics at
that time. Which of the following of is the most appropriate next step?
a)
b)
c)
d)
e)
Observation for recurrent symptoms
Repeat Urine culture in 3 months
Intravenous pyelography
Cystoscopy
Voiding cystourethrography
Since birth, a 48-hour-old newborn has had poor urine output mostly consisting of dribbling. He was
born full term to a 27-year-old primigravid woman following an uncomplicated pregnancy and delivery.
The newborn has been feeding well on formula and appears well-hydrated and well-appearing. On
exam, there is a midline, firm, mass palpated in the lower abdomen. He is not circumcised. Labs show:
Na+ 135, K+4.5, Cl- 105, HCO3- 22, BUN 5, Cr 0.4, glucose 84.
UA: pH 6, spec grav 1.009, protein trace
Which of the following is the most likely cause of his poor urine output?
a) Glomerulonephritis
b) Posterior urethral valves
c) UTI
d) Vesicoureteral reflux
e) Phimosis
f)
Early onset sepsis
A 3-year-old girl is brought to the ED for acute onset fast breathing and
shortness of breath. Her temperatures is 37o C, pulse is 110/min,
respiratory rate is 30/min, and blood pressure is 120/80. The lungs are
clear to auscultation. Percussion of the right side of the chest shows
hyperresonance. Chest Xray shows slight hyper-expansion of the right lung
compared to the left lung. Oxygen is administered via face-mask. Which of
the following is the best next step in management?
a)
b)
c)
d)
e)
CT scan of the chest
Tube thoracostomy
Needle decompression
Bronchoscopy
Administration of hyperbaric oxygen
A 5-week-old female is brought to the ED by parents due to worsening vomiting
which has become more forceful the last 5 days. She appears hungry and when fed,
drinks 2 ounces within 5 minutes, but then proceeds to vomit almost the entire
amount out 15 minutes after feeding. She was born at 41 weeks gestation without
pregnancy nor delivery complications. She is not in day care and there are no sick
contacts. Her temperature is 37oC, pulse is 190/min, respiratory rate is 34/min, and
blood pressure is 65/55. Her oral mucosa is dry. She had 1 wet diaper in the last 24
hrs. What is the most likely set of electrolyte findings you will see?
a)
b)
c)
d)
e)
Na+
145
136
135
145
140
K+
6
4.0
4.2
5
4.5
Cl112
85
86
112
105
pH
7.48
7.40
7.51
7.50
7.25
A 6-month-old boy is brought to the ED due to 4-week history of abnormal
movements that seem to occur in clusters when waking up from sleeping. No
real association with feedings but has vomited occasionally after these
episodes. They are becoming more frequent and consists of sudden flexion of
the head/neck with extension of both arms and legs. On exam there is a 1/6
systolic murmur heard at the left sternal border and 3 areas of skin
hypopigmentation that are flat, which parents state are birth marks. His father
has mild mental impairment and suffers from seizures. Which of the following
is the appropriate first-line treatment?
a)
b)
c)
d)
e)
Benzodiazepine
Proton pump inhibitor or H2-receptor antagonist
ACTH injections
Vigabatrin
Counseling on reflux precautions
An 8-year-old girl is brought the physician because of pallor and easy
fatiguability for the past 2 months. Her symptoms began after an upper
respiratory tract infection. She was adopted, and her family history is
unknown. She appears pale. The spleen tip is palpated 2 cm below the
left costal margin. Her hematocrit is 28%, and reticulocyte count is 7%,
with 3+ spherocytes. Splenectomy is most likely to prevent which of the
following complications?
a)
b)
c)
d)
e)
Cholelithiasis
Esophageal varices
Overwhelming sepsis
Painful crises
Pancreatitis
A previously healthy 30-month-old girl is brought to the physician because
of a firm mass in the left flank. She has constipation but no other
symptoms. The child appears healthy but pale, and a discrete mass is
palpated in the left flank. Ultrasound shows a normal right kidney, and a
left kidney with a mass distorting the collecting system. Examination of
the bone marrow is normal. Urinalysis shows no WBC/hpf and 20-30
RBC/hpf. Which is the following is the most likely diagnosis?
a)
b)
c)
d)
e)
Autosomal dominant polycystic kidney
Multicyclic dysplastic kidney
Nephroblastoma (Wilms tumor)
Neuroblastoma
Renal cell carcinoma
A 17-year-old female who emigrated from Indian subcontinent presents
with a painless lesion on the vulva. She is sexually active with 2 male
partners and has had sex without consistent use of condoms. There is an
elevated, round lesion on the right labium without discharge nor bleeding,
measures about 1cm in diameter. Which is the most likely organism?
a)
b)
c)
d)
e)
f)
g)
h)
Chlamydia trachomatis
Gardnerella vaginalis
Haemophilus ducreyi
Herpes simplex virus
Human papillomavirus
Neisseria gonorrhoeae
Treponema pallidum
Trichomonas vaginalis
A 8-year-old girl is brought to the physician because of worsening gait and
rash for the last 3 days. Rash started on the ankles bilaterally and seems to be
spreading upward. It is non-blanching in nature. She has knee and ankle pain
and is unable to bear weight on her feet due to pain. She had a low-grade
fever and fatigue 1 week prior to these symptoms. On exam, the rash is raised
and there are areas where they appear purpuric in nature. Other than
temperature of 100.7oF, rest of vitals are normal. What is the most likely
diagnosis?
a)
b)
c)
d)
e)
f)
Ankylosing spondylitis
Behcet syndrome
Dermatomyositis
IgA vasculitis
Juvenile idiopathic arthritis
Kawasaki disease
g) psoriatic arthritis
h) reactive arthritis
i) sarcoidosis
j) Sjogren syndrome
k) systemic lupus erythematosus
l) systemic sclerosis (scleroderma)
A previously healthy 3-year-old female presents with crying, fast breathing,
and drooling 20 minutes after being found next to a bottle of drain cleaner
by her parents. Her vitals show temperature of 38o C, HR 120/min, RR
42/min and blood pressure 120/80. She has blisters on the tongue and lips
and exhibiting stridor on exam. After stabilization of the airway, what is the
best next step?
a) Insertion of NG or orogastric tube
b) Calling Social work or Child protective services for concerns of
abuse/neglect
c) Esophagography
d) Lateral X-ray of the neck and soft tissues
e) Endoscopy
A full-term baby is born via spontaneous vaginal delivery and has respiratory
distress and perinatal depression immediately after birth. There is terminal
meconium noted on the skin and fingernails. She appears cyanotic and
administration of positive-pressure ventilation does not improve clinical
condition and she is intubated and brought to the NICU. A chest x-ray will
show what findings if the etiology was meconium aspiration syndrome?
a) Coarse irregular infiltrates and hyperexpansion of lung fields
b) Granular appearance of the parenchyma with air bronchograms
c) Prominent perihilar streaking in the interlobular fissures
d) Cardiomegaly with clear lungs
e) Lack of pulmonary marking extending to the periphery with tracheal
deviation
A 7-year-old boy is brought into the ED for neck stiffness and lethargy and is
subsequently admitted to the ICU for fever and hypotension from septic shock.
On exam there is purpuric lesions over the trunk and extremities and are nonblanching in nature. Blood and CSF gram stain both show Gram negative
diplococci. What is the most likely underlying cause of this patient's condition?
a)
b)
c)
d)
e)
f)
AIDS
T lymphocyte dysfunction
X-linked agammaglobulinemia
Complement deficiency
IgA deficiency
Wiskott-Aldrich Syndrome
A 5yo boy is brought to the ED by his parents because of left hip pain for 2 days
and an associated limp for the past 4 days. One week ago, he had watery stools
and temperatures to 100F; these symptoms resolved within 2 days. There is no
history of trauma or recent immunizations. He is otherwise healthy, and his
immunizations are up-to-date. He appears alert. His temperature is 96.8F, pulse
is 90/min, RR 18/min, and BP is 110/75 mmHg. The left hip is not swollen or
erythematous, but there is pain with movement and weight bearing. ESR is 28
mm/h. US of the left hip shows a small effusion. Which of the following is the
most appropriate pharmacotherapy?
a)
b)
c)
d)
e)
Oral acyclovir
Oral clindamycin
Oral ibuprofen
IV ceftriaxone
IV vancomycin
A previously healthy 4-month-old girl is brought to the ED in January because of
cough and poor feeding for 2 days. She is still urinating and making tears. She
initially had a fever of 100.8 F, but has been afebrile for the past day. She
appears mildly ill. Her temp is 99.5F, pulse is 140/min, and RR 56/min. Exam
shows pink tympanic membranes with good mobility. There are mild intercostal
retractions, and diffuse bilateral crackles and wheezes are heard. Pulse ox on
room-air shows an oxygen saturation of 84%. Which of the following is the most
appropriate next step in management?
a)
b)
c)
d)
e)
f)
g)
h)
Arterial blood gas analysis
Culture of the pharynx for bacteria
Viral culture of the respiratory secretions
CXR
Neck XR
Administration of an inhaled bronchodilator
Administration of oxygen
Subcutaneous administration of epinephrine
An 8yo girl is brought to the physician because of a diffuse rash for 24 hrs. She has
had cough, congestion, eye discharge, and fever for 4 days. The rash initially
began on her face and chest but has spread to involve her abdomen, back, and
lower extremities. Her temp is 102.1 F, pulse is 100/min, RR 16/min, and blood
pressure is 115/70 mmHg. Exam shows a diffuse red, macular and popular rash
involving the face, trunk, and extremities; there are no lesions on the palms or
soles. Which of the following is the most likely diagnosis?
a)
b)
c)
d)
e)
Ehrlichiosis
Henoch-Schonlein purpura
Id reaction
Kawasaki Disease
Pityriasis rosea
f) Rocky Mountain spotted fever
g) Rubeola
h) Scabies
i) Scarlet fever
j) Staphylococcal-scaled skin
A 16-year-old girl is brought to the office for a well-child visit. She has no
symptoms and is otherwise healthy with a BMI in normal range. She has
started playing basketball for the school team for the last 4 months and has
practice 5 times/week. She has lost 2 lbs since the start of basketball season
when she came into the office for Sports clearance. What is the best next step
of management for this patient?
a)
b)
c)
d)
e)
Urine gonorrhea/chlamydia testing by PCR
No intervention, follow-up at next visit
Follow-up for weight check in 3 months
Screen for developmental delay
Thyroid studies
A 7-year-old boy is brought to the ED 30 mins after the onset of confusion,
altered mental status, headache, weakness, shortness of breath. When his
mother returned from home, she found him in front of the TV with a space
heater. What is the most appropriate treatment?
a)
b)
c)
d)
e)
f)
g)
h)
i)
Acetylcysteine
Amyl nitrite
Atropine
Deferoxamine
Dimercaprol
Methylene blue
Naloxone
Oxygen
Vitamin K
A 6-year-old girl is brought to the office by her mother for compulsive eating
beginning at the age of 3. She was born following an uncomplicated pregnancy,
delivery was complicated by breech presentation. During infancy, the patient had
hypotonia. She began walking at the age of 2 years and talking at the age of 2.5
years. The patient lives with her mother and older sister. She is at the 52nd
percentile for height and 98th percentile for weight. Her temp is 37o C, HR
92/min, RR 20/min, blood pressure is 86/50. Exam shows almond-shaped eyes
and prominent nasal bridge. She has delayed speech and motor development.
Which of the following is the most likely diagnosis?
a)
b)
c)
d)
e)
f)
Angelman syndrome
Down syndrome
Fetal alcohol syndrome
Prader-Willi syndrome
Rett disorder
Williams syndrome
A 16-year-old girl is brought to the physician by her mother due to not
having a period. She is otherwise healthy and in no distress. She is 5ft 7in
tall and 120lbs, BMI is 19kg/m2. Breast development is Tanner stage 4 and
there is minimal axillary and pubic hair development. Pelvic exam shows
normal external female genitalia. The cervix is not visible, and no pelvic
masses are palpable. What is the most appropriate next step in
management?
a)
b)
c)
d)
e)
Follow-up exam in 6 months
Karyotype analysis
Measurement of serum estrogen concentration
MRI of the pituitary gland
Estrogen therapy
Amenorrhea
workup